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What accounts for a low red blood cell count? – Anemia

Anemia is a disease that affects a third of the world population, albeit a low red blood cell count is of easy diagnosis and treatment. This disease causes many deaths or long term complications, like an unhealthy development of the neurological system in children.

It has many ways of presentation, either acute or chronic. Also, several causes trigger anemia, ones more severe than others. Therefore, obtaining in-depth knowledge about this disease is mandatory nearly for everyone. Its prevention is the responsibility of all of us. By reading this article, you would gain critical insights about anemia directly from a doctor.

What are the red blood cells?

It is a blood cell that comes from the bone marrow. The primary function of the red blood cell is to transport oxygen from the lungs to all the body. This role is possible thanks to a protein, hemoglobin (HGB). The HGB is the one that binds to the oxygen in the lung, and then discharge it in the tissues. A red blood cell is just a carrier of the hemoglobin.

As I said, red blood cell production is in the bone marrow. In there, many other blood cells are produced, as the white blood cell. However, the creation of this select type of blood cell requires many factors. Firstly, a hormone that the kidney produces as erythropoietin. Secondly, what would be the bricks for building that wall, which is the substrate. They are many, including iron, vitamin B12, and folate (commercially sold as folic acid). All of them are necessary for red blood cell production. If one of them is missing, a blood disorder could develop.

Red blood cells can survive in blood for up to 120 days. Then, the body proceeds to eliminate and recycle them efficiently. Thanks to the liver and the spleen. In light of this, for maintaining enough red blood cells, it is necessary to have a daily renewal of them. A reticulocyte is an immature form of the red blood cell. It constitutes the 0,5 to 1,5 % of the total red blood count. Every day the body is releasing it to the blood, so replenishes the red blood cell loss. The reticulocyte becomes mature and fully functional in the bloodstream after one day of circulation.

File:Red Blood Cell.jpg
Source: https://upload.wikimedia.org/wikipedia/commons/3/37/Red_Blood_Cell.jpg

What is anemia?

Anemia is an acute or chronic disease in which hemoglobin concentration and/or red blood cell numbers are lower than average. Therefore, they are insufficient to meet a person’s body function requirements. Not all people need the same amount of hemoglobin or red blood cells. It would depend on many variables, such as age, sex, pregnancy status, genetic, environmental factors, and, potentially, race.

The newborns have the highest concentrations during human life. They can portray hemoglobin concentrations between 17 and 21 g/dl, and it is totally normal. The levels start to decrease for increasing again in childhood. Then, the concentrations would decline in adulthood, and a similar situation would happen to the elderly.

Moving forward, because of the menstruation, a difference in the sex appears in puberty, with women having slightly less hemoglobin. Also, during pregnancy, the levels decrease even more during the first and second trimesters, for then rising gradually in the third.

Several other determinants can modify the normal range of hemoglobin or red blood cell count. For example, someone smoking cigarettes for an extended period or the altitude where people live. All of them can define how much is enough red blood cells in an individual.

According to the World Health Organization (WHO), the classification of anemia is based on three main factors, sex, age, and pregnancy status. It would depend on how much the decrease was. There are three significant categories mild anemia, moderate, and severe anemia. Also, the anemia division is ground on the length. It could be either an acute or chronic anemia; the usual cause for acute anemia is bleeding; it is an abrupt and massive loss of blood. On the contrary, chronic anemia, one of the most common reasons, is iron deficiency, which tends to occur over time.

What are the types of anemia?

The anemia has different types; it would depend on many characteristics to define which one is. Luckily, here we will find distinct features that not only help in categorizing the anemia but also to discover what disease is underneath. Please calm that I would thoroughly explain them to you.

Three primary situations develop anemia. The patient is losing blood. There is direct destruction of the red blood cells or exists a decrease in red blood cell production. Remember that anemia more than a disease; it is the expression of an underlying disorder. It has many causes, and the doctor’s purpose would always be to find it.

The blood loss cases could be either acute or chronic—for example, acute blood loss due to severe internal bleeding. And, the most typical of the chronic form is heavy menstrual bleeding.

Then, there is the red blood cell destruction or hemolysis. This cause stands for hemolytic anemia. The red blood cell is dying way faster than the body can replenish it. The roots of it could be acquired as an infection. Or be inherited from our parents, as sickle cell anemia.

Furthermore, the ones concerning the bone marrow and how is the red blood cell production have their classification in agreement to the cell form. Normocytic implies that the cell has a normal size. When the cell has a size within normal ranges, normocytic anemia, the common causes for it are a chronic disease or aplastic anemia.

When the size is decreased, microcytic anemia, because of iron deficiency is the most common cause. Finally, when the size of the red blood cell is increased, macrocytic anemia, it is very probable that we are talking about megaloblastic anemia. This anemia is due to a folate or vitamin B12 deficiency.

What causes a person to become anemic?

The reduction of the hemoglobin or red blood cells in the blood has several causes. It could be either a loss or elimination of the red blood cells or due to a lack of production of it in the bone marrow. Also, the causes between mild and moderate anemia, tend to differ tom the ones of severe anemia.

What are the causes?

Nutritional anemias exist because of a lack of vital precursors for hemoglobin production. It could be an iron deficiency anemia, megaloblastic anemia, among others. The causes for it include inadequate dietary intake, increased nutrient losses (parasites, or heavy menstrual bleeding), lack of absorption (of vitamin B), or an alteration in the metabolism. Anemia because of iron deficiency is one of the most common, although several others can cause it also as folate deficiency or vitamin B12 deficiency, or numerous other mineral and vitamins.

The elderly could have a specific type of anemia if they have atrophic gastritis, which is pernicious anemia. In this disease, a special agent called the intrinsic factor necessary for the absorbance of vitamin B12 is lacking. Therefore, it is another source of B12 deficiency, hence megaloblastic anemia.

Furthermore, there are anemias in association with inflammation, infections, and illnesses. Chronic conditions that portray long-term inflammation reduce iron metabolism, hence decreasing red blood cell production.

Aplastic anemia is because of a halt in the production process within the bone marrow. The reasons for this include infection, cancer, drugs, radiation, pregnancy, and autoimmune disorders. Also, any kidney disease, like chronic kidney disease, could develop normocytic anemia. Remember that, in the kidney, is where an essential hormone for red blood cells is generated.

Then, the direct elimination of the red blood cells (hemolytic anemia) can be due to autoimmune hemolytic anemia. In this disease, the body’s protein (antibodies) start attacking our beloved cell, causing its depletion. Now, from the anemias that are inherited from our parents. Sickle cell anemia plays a significant role because it generates nearly 80% of this type of anemias. And the remainder is because of thalassemia. Both of these diseases are hereditary chronic hemolytic anemia.

What are signs and symptoms of anemia?

Anemia has its characteristics signs and symptoms, as we will see. However, it is essential to note that many others could appear because many diseases cause anemia. Therefore, slight differences among them would help with identification. Let us take a closer look.

The general anemia symptoms and signs are an expression of tissues without enough blood cells, hence oxygen. Most of the time, the patients are going to refer only as tired or with fatigue.

Furthermore, some symptoms could vary depending on the source of the anemia. Patients with iron deficiency anemia could have difficulty swallowing, chew or suck ice, brittle fingernails, erectile impotence, excessive fatigue, and out of proportion cramps in the calves because of climbing stairs.

Patients that have a deficiency in B12 could experience a painful sensation within the tongue, early graying of the hair, a tingling in the extremities, and a relative loss in the sense of body orientation. This last symptom is evident in patients that tumble in the dark.

Patients with folate deficiency could develop sore tongue, inflammation of the corners of the mouth, and floating stools, which do not sink when in the toilet.

Anemia has a wide array of signs. The list includes pallor in the skin and mucous membranes. Typically, these membranes are the eyelids and inside the mouth, which should have a vivid red color. There could be nail defects or yellow coloration of the mucous membranes too.

Sickle cell anemia has a different way to present itself. Besides the typical anemia symptoms, it has pain crises, which are horrendous for the patient to suffer. It can affect any part of the body and can last several hours. Also, frequently, patients with hemolytic anemia could have dark urination, abdominal pain, and leg ulcers.

What are the possible complications of anemia?

Severe anemia could prompt critical symptoms of intense pallor, chest pain, and shortness of breath. All these symptoms should elicit to think that this patient has fewer red blood cells than common anemia. Also, iron-deficiency anemia has a link to a weakened immune system, hence more probabilities of having infections.

Anemia concurrently with other diseases can worsen the patient’s scenario. Anemia in people with heart failure is a frequent situation, and between both of them potentiates the risk of dying. People with colon cancer and an anemia diagnosis also show the poorest outcomes.

Pregnant women with iron deficiency anemias or just the iron deficit have higher chances of getting complications. They are in danger of delivering a newborn with reduced birth weight. This condition is in relation to poor cognitive development later in life. Some other studies suggest that children with anemia may have harmful effects on their cognition, intelligence, and movement abilities.

What is considered severe anemia?

In two situations, there could be severe anemia. According to the WHO guidelines, children below the five years are severely anemic if their hemoglobin is below 7 g/dl. Similarly, for most of the other groups of ages and sex, less than 8 g/dl of hemoglobin would account for severe anemia.

Despite this exact definition that is based just on laboratory tests. If a patient has anemia, and it is moderate because of the hemoglobin level but is having severe anemia symptoms. Mostly due to the lack of oxygen in the tissues, such as high heart and respiratory rate. Then, your doctor would also consider treating it as it was severe.

Not all people require the same amount of hemoglobin. Even though the hemoglobin level, according to age and sex are pretty good for classification and studies, the person, its particularities, and the medical case must always be individualized.

Can anemia kill you?

Of course. Plus, it is not only anemia, the age of the patients, and the underlying disease of it would play an active role in that. Severe anemia can halt all body systems. The estimation is that moderate and severe anemia affects 1,5% of the US population.

The body needs oxygen to fulfill its tasks. So a complete lack of it would end in death. Yet, this is not the case for a vast majority of the anemias. Only exceptionally severe anemia added to challenging diseases could reach that level. For example, sickle cell disease, active bleeding, malaria, visceral leishmaniasis, severe acute malnutrition, among others, would be common causes of severe anemia and death worldwide.

Is anemia a sign of cancer?

In specific populations, as in adult males and postmenopausal women, that have a healthy diet can raise some alarms. Colon cancer is one of the most common cancers worldwide. Approximately, more than 140,000 new colon cancers are diagnosed each year in the United States.

Furthermore, one of every five patients with this cancer bleeds because of it. And, it likely causes an iron deficiency anemia. There already exist exams for diagnosing early these high-risk patients, as fecal occult blood tests and flexible sigmoidoscopy. The former is easy and non-invasive, while the latter requires a straightforward, albeit invasive procedure. Therefore, with all these options to not get tested is not the smartest idea.

How doctors diagnose anemia?

The first step is to identify the anemia by a complete blood count. The WHO uses arbitrary thresholds depending on age and sex. Anemia in adults is a hemoglobin level below 12.5 g/dl, children aging between six months and six years have anemia with levels below 11 g/dl. Similarly, children between six and fourteen years have anemia with a hemoglobin level of less than 12 g/dl. In the United States, this situation varies slightly, with males and females having a threshold of 13.5 and 12.5 g/dl, respectively.

Furthermore, there would now be a specific quest for finding out which disease is underneath. Usually, the second exam performed when a doctor is studying anemia is a blood smear. In here, it is possible to see the shape of the red blood cell, and the white cell also. Any abnormality within this exam, plus the classification into microcytic, normocytic, or macrocytic most of the time, is helpful in diagnosis.

Typically an iron deficiency would yield microcytic hypochromic anemia. However, many others also can develop it, such as chronic inflammation, thalassemia major, thalassemia minor, and lead poisoning.

Now, macrocytic anemia is further divided into two, megaloblastic and non-megaloblastic bone marrow. Megaloblastic anemia is due to folic acid or vitamin B12 deficiency, and drugs that directly affect DNA. Non-megaloblastic includes several diseases that directly attack or are within the bone marrow like liver disease, hypothyroidism, hypoplastic and aplastic anemia, and bone marrow inflammation.

Besides the many shapes, the red blood cell can have. Another practical exam the doctors use for determining anemia is a reticulocyte count. This exam assesses bone marrow production of immature blood cells. Therefore, it helps to differentiate between the quite distinct anemias where there is nonproduction, versus destruction or loss of the red blood cells.

Does it have a treatment?

Yes, but the treatment relies on the specific cause. That is why I insisted so much throughout the article on defining the source of the anemia. So, let us talk about the most common causes of anemia and their treatments.

A lack of iron produces an iron deficiency anemia, which is easily treatable in a vast majority of the cases with iron supplementation. The cornerstone of this anemia is iron pills. It is effective, cheap, and suitable to deliver to the patient. Its side effects include abdominal pain, nausea, and metallic taste. Some of them could go away by taking the pill with food or milk, among other techniques. Still, in some scenarios, iron supplementation through the vein has to be the first option, mostly in severe conditions as inflammatory bowel disease.

The treatment for megaloblastic anemia depends on which of the factors is lacking. For vitamin B12 deficiency, in pernicious anemia, typically, therapy with vitamin B injections daily for one week, and then once a week for four weeks. And later an injection monthly for life. Also, vitamin B12 orally is another option available beneficial in many situations lacking this vitamin. Folate deficiency is treated with 1mg of folic acid daily for 1 to 4 months, or when the patient recovers.

In patients with sickle cell disease, a bone marrow transplant is the only option known to cure the illness. All the other treatments just reduce the symptoms and severe episodes, albeit not always effective. This treatment continues to evolve, becoming with time a suitable option for patients.

Severe anemia could require a blood transfusion to quicky raise the hemoglobin levels. This resource is not a magical solution. Each blood transfusion only increases hemoglobin by one gram. It is a lifesaver measure.

Do you need to take iron supplements during pregnancy?

Studies suggest that iron deficiency anemias in early pregnancy could cause unhealthy neurological and behavioral changes in those newborns in the long run. For example, it harms the intellectual capabilities of children. On the contrary, late pregnancy does not have that class of repercussions.

Not all pregnant women would need to take iron supplementation. The ones having a flawless iron reserve for enduring the entire pregnancy do not need it, which is equal to or greater than 500mg. This quantity corresponds to serum ferritin concentrations of 70–80 μg/L. They specifically are not in the necessity to take the supplementation.

Approximately, a normal pregnancy would need on average 1000 to 1200 mg of iron. Most of the iron we catch it from the diet, in a specific food. Hence, by securing a good reserve of it prior to pregnancy and with a healthy diet rich in iron. In some cases, it is more than enough.

Nevertheless, this is not the case for a considerable proportion of women. The estimation is that nearly a third of women do not have the necessary iron reserves for enduring a pregnancy without iron supplementation. Therefore, they need it.

Many studies support that iron supplementation prevents iron deficiency and iron-deficiency anemia. Consequently, it would be preventing most of the complications they carry to children.

How long does it take to recover from anemia?

As I told you, the average life of a red blood cell is 120 days. Therefore, the process of recovering could take more or less that time. For example, according to most of the experts, people taking iron supplementation treatment should last from three to six months. Also, we saw that macrocytic anemia required at least four months of treatment when there was a lack of folic acid.

Hence, most of the time would take many months for a total recovery from anemia. However, that depends on the severity of the anemia and the underlying cause too. For that, I discussed here the most probable cause, which accounts for nutritional anemias. The ones because of infections and diseases would require the elimination of them first. Then, if they exist, treating iron or vitamin deficiencies.

I am having symptoms of it, and I am worried; what should I do?

This tool is an anemia symptoms checker, and it will help you to find out if you are having symptoms of this disease. It is free, and it would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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