A person does not have to race or run a mile to have easy fatigability, or she does not have to see a ghost or be surprised by her mother-in-law for her face to turn paper-white, if the person is anemic.
As strongly emphasized in the previous article, a person with low blood pressure, lower than 90/60 mmHg-is NOT anemic. From a clinical perspective, the symptoms or complaints of the anemic patient—he or she gets tired easily, dizziness, palpitations, chest pains; and the signs or the findings of the examining physician—pallor or paleness of the conjunctiva of the eyes, lips, nail beds, little or no creases on the palms, tachycardia/fast heart rate, tachypnea/fast shallow breathing—are due to LOW HEMOGLOBIN which is the pigment that imparts the red color to erythrocytes or red blood cells.
Hemoglobin is the carrier of oxygen to the different cells of the body; a variant, myoglobin, transports O2 to the muscles, particularly skeletal muscles-muscles attached to bones. Hemoglobin is composed of a protein globin and a heme, which is mostly iron and with some copper elements.
IRON-DEFICIENCY ANEMIA is the most common type of anemia; primary, if there is a nutritional deficiency of its rich sources. Examples are the leaves and fruits of the bitter gourd or ampalaya and livers, especially from chickens. Secondary iron deficiency occurs in persons with bleeding issues like peptic ulcer, hemorrhoids, profuse and excessive frequent menstrual flow, i.e., metrorrhagia/menorrhagia; cancers, especially of the colon.
In children and adolescents, helminthiasis or parasitic infestation is a common cause of iron deficiency, particularly from hookworms. Necator americanus and Ancylostoma duodenale are two species of worms which suck blood in the small intestines of patients.
The recommended daily allowance for elemental iron for adults is 55-65 mg per day, with a higher dose for pregnant women and lactating mothers.
Popular iron supplements are ferrous sulfate and ferrous fumarate, which could be potentially irritating to the stomach, thus the tablets or capsules should be taken after meals.
MEGALOBLASTIC ANEMIA is due to a structural abnormality of the red blood cells which, in its normal adult configuration, should look like a dumbbell or biconcave disc 7.2 microns in size. Like all cellular components of the blood—platelets or thrombocytes, white blood cells or leukocytes, red blood cells or erythrocytes—start their growth process within the bone marrow of flat bones, namely the pelvis, ribs, breastbone or sternum.
The fundamental defect in megaloblastic anemia is “an arrest in the growth, maturation of red blood cells” so that big round red blood cells called NORMOBLASTS are released into the bloodstream which can already carry oxygen because it has hemoglobin in their cell membrane.
However, because of their huge, humongous size, as the blood passes through the sinuses of the spleen—the so-called the graveyard of red blood cells—the frictional forces exerted on the outer membranes lead to easy hemolysis or breakage earlier than the usual 120-day normal lifespan of healthy adult red blood cells.
Folic acid or vitamin B9 deficiency is a cause of megaloblastic anemia. Folic acid, together with iodine and iron, is one of the important nutrients, strictly and highly recommended in the diet of pregnant women in their first trimester to prevent neurologic structural abnormalities in the brain and spinal cord of the baby. Also called pteroyl glutamic acid, folic acid or folinic acid richest sources are related to its name-foliage- yes indeed, green leafy veggies, which we have in abundance in the Cordilleras.
PERNICIOUS ANEMIA is similar to megaloblastic anemia in terms of the release of large round red cells called NORMOBLASTS info the peripheral circulation or bloodstream. In other words, there is an arrest in the maturation of the red blood cell into its adult form, which is also due to deficiency of vitamin B12. Cobalamin, which comes in hydroxy, nitrito, cyano forms is the biggest vitamin derived only from animal sources, an important fact emphasized among strict vegans—those whose source of proteins are just vegetables or plant-based nutrients.
Pernicious anemia is more serious than megaloblastic anemia because of the neurologic signs and symptoms traced to abnormalities of spinal cord functions, especially in the transmission of sensory impulses to the brain.
Other forms of anemia are sickle-cell anemia common among folks of sub-Saharan African origin and hemolytic anemia seen among patients belonging to the yellow race, a form of hypersensitivity to some medicines like anti-malarials and sulfonamides.
It is the modest and sincere hope of the columnist that when our readers have their blood pressure taken, they now know how different anemia is from low blood pressure.
