The red blood cells that give our blood its color are the cells that carry oxygen to the farthest corners of the body through capillaries. It does this through the substance called hemoglobin in it.
When anemia is mentioned, the decrease in the amount of this substance called hemoglobin should be understood. Anemia is not a single disease. It is a common finding that occurs due to many different diseases. When this situation occurs, problems arise in meeting the body’s oxygen needs. Weakness and exhaustion occur, pallor is seen. The body tries to send more blood to the tissues to compensate for the deficiency. Therefore, the heart has to pump more blood, tachycardia (increased heart rate) and palpitations occur.
The most common type of anemia in humans is iron deficiency anemia. It is usually seen in women. The most important reason for this is the loss of blood and iron loss as a result of excessive menstruation. Iron deficiency can also be seen during pregnancy and growing children due to the increased need. Iron deficiency in men is mostly caused by hidden bleeding in the gastrointestinal tract. These bleedings that occur unconsciously; may be due to diseases such as gastritis, ulcers, polyps and hemorrhoids. However, the most serious disease is colon cancer. Therefore, if there is iron deficiency in an adult man, he should be examined for colon cancer.
In iron deficiency, serum iron decreases, iron binding capacity increases and serum ferritin level, which is an indicator of bone marrow stores, decreases.
Oral iron pills are given for treatment. Iron pills should be taken on an empty stomach or with meat. Vitamin C improves absorption. For this reason, drinking orange juice with iron and taking vitamin C tablets allow anemia to be healed more quickly. Since beverages such as milk and tea impair the absorption of iron, iron pills should be swallowed at least two hours after taking such foods, and no other food other than meat and orange juice should be consumed for at least one hour after taking the pill in order to allow the absorption of iron. Sometimes anemia may not improve despite iron therapy. There may be two main reasons for this: First, the iron given is not enough because blood loss continues. The second reason is the malabsorption of the given iron in the digestive system. If malabsorption is detected, iron therapy should be administered intravenously.
If there is no iron deficiency, it should not be occupied by giving iron unnecessarily. In this case, other diseases causing anemia should be investigated.
Another common cause of anemia is Mediterranean anemia, namely thalassemia. Beta thalassemia carrier is not uncommon in our country and Cyprus. A detailed examination makes it easy to distinguish between iron deficiency and Mediterranean anemia carrier. Since Mediterranean anemia carrier is a congenital disease, if there are blood levels from previous years, these should be reviewed. Low hemoglobin levels of years ago cause suspicion of being a carrier of Mediterranean anemia. Of course, patients with recurrent iron deficiency anemia and who have not been fully treated for years should not be ignored. Another important point is that since it is a hereditary disease, the mother, father or relatives of Mediterranean anemia carriers have the same situation. These people should also be investigated. There are some tests that we apply to distinguish between iron deficiency and Mediterranean anemia carrier: Since the iron stored in the bone marrow is very low in iron deficiency, the level of “ferritin” in the blood, which is the indicator of this, is below the normal limits. However, in Mediterranean anemia, bone marrow iron stores are not decreased and ferritin levels are within normal limits. For this reason, give these patients as much iron as you want, you cannot cure anemia. For the definitive diagnosis of Mediterranean anemia, a method called “hemoglobin electrophoresis” should be applied. Both of these tests can be done by simply taking a blood sample from the patient. Mediterranean anemia carriers usually have mild anemia and this can be tolerated. In cases where anemia cannot be tolerated, blood transfusion should be performed. In these people, the bone marrow has to work harder because the red blood cells are destroyed quickly. This increases the need for folic acid, a B vitamin. Although Mediterranean anemia carriers can live their lives without any risk for themselves, their spouses should also be investigated in this respect when they want to have a child. If the spouse also has a carrier of Mediterranean anemia, there is a risk of the unborn child being normal or carrier as well as having real thalassemia
Anemia, which can sometimes be confused with iron deficiency, can be seen in some chronic diseases with inflammation such as rheumatic diseases, connective tissue disorders, brucellosis and tuberculosis. . These people have low serum iron but very high ferritin. Anemia is not cured by giving iron. Treatment of anemia is possible with the treatment of the underlying disease.
