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If you have been feeling breathless, weak or tired lately, you may have anaemia. Women are particularly prone to this condition, in which the blood is lacking in the red protein molecules that carry oxygen around the body.

There can be many obvious causes for feeling tired and low in energy, such as a bad night's sleep. However, if you feel like this for no apparent reason, you could be suffering from anaemia.

The symptoms of anaemia result from the body tissues being deprived of sufficient oxygen for their needs.

Oxygen is carried around the body by our red blood cells. These absorb oxygen from the lungs into their red protein molecules called haemoglobin. Red blood cells are then transported around the body by the circulation and eventually release their oxygen into the body tissue cells. Then they return to the lungs where the process begins all over again.

Concentrations of haemoglobin in the blood are regulated by the dual action of the bone marrow (where red blood cells are made), and the spleen (where they are eventually destroyed). If this balance is upset, however, you may become anaemic. There are a number of reasons why this can happen but the most common is a lack of the mineral iron in the body.

Normal blood concentrations of haemoglobin are in the range of 13.5-18g of haemoglobin per 100ml of blood for men, and 11.5-16g per 100ml for women. If your blood concentration falls below l0g per 100ml, you are likely to feel washed out and tired and you may get headaches.

If your blood concentration falls to below 8g per 100ml, you may experience far more distressing symptoms such as breathing difficulties and palpitations. The degree to which you are affected also depends on how quickly the anaemia has developed. When it develops slowly, you may notice very few, if any, symptoms until it becomes quite advanced.

If you experience some of the above symptoms, your doctor may decide to give you a blood test to see if you are anaemic. The test will confirm if anaemia is the cause and give clues to why the condition has developed. Under the microscope, the blood cells in the sample will be counted and closely examined to see if they appear normal.

Further tests may be needed, such as measuring blood levels of some of the B vitamins and, rarely, screening of the bone marrow cells by taking a biopsy.

If your body becomes short of iron, your haemoglobin concentration will suffer because iron forms an essential part of haemoglobin. The bone marrow which produces haemoglobin and packs it into red blood cells won't be able to do this part of its job properly.

Besides being needed by red blood cells, iron is also vital to growth. Slimmers, old people, children and teenagers all have an increased demand for iron and should take extra care when it comes to their diet. Up until the menopause, women lose small amounts of haemoglobin every month in their periods. Haemoglobin is also lost from bleeding, from the skin cells our bodies are constantly replacing and from the lining of the bowel in the faeces. A tiny amount is also lost when the red blood cells come to the end of their lifespan, although much of their iron is extracted and repackaged into new red cells.

Menstruating women tend to have low or no iron stores, so they quickly become iron-deficient if they are not getting enough from their diet to replace the loss.

Some digestive tract disorders cause bleeding which can lead to iron deficiency anaemia. Other disorders such as coeliac disease will interfere with iron absorption.

Besides the symptoms already outlined, iron deficiency anaemia can cause brittleness of the nails and soreness in the mouth and tongue. If the lack of haemoglobin results from bleeding in the digestive tract, there may be abdominal pain and black faeces.

Iron-deficiency anaemia shows up in a blood test as a low level of haemoglobin and red cells which are smaller and paler than usual. If internal bleeding is suspected, further tests may be carried out.

When there is an obvious underlying cause, treating it should cure the anaemia. Surgery, for instance, should stem internal bleeding. Otherwise, the treatment is simple enough - a course of iron supplements or injections to build up iron stores and a diet high in iron-rich foods.

Another form of anaemia, known as megaloblastic anaemia, is also caused by a deficiency of vital nutrients - in this case vitamin B12 or folic acid. If a shortage of either occurs, too many cells called megoblasts are manufactured by the bone marrow. This gives rise to enlarged and deformed red blood cells called macrocytes.

The most common cause of B12 deficiency is the stomach failing to produce intrinsic factor, a chemical vital to B12 absorption.

Often an auto-immune disorder is to blame for this, where the body mistakenly attacks and destroys its intrinsic factor. This is known as pernicious anaemia and often runs in families, affecting more women than men and beginning in middle age. Another intestinal disorder called Crohn's disease can also upset the absorption of B12.

Heavy drinkers are vulnerable to vitamin deficiency, especially of folic acid, as alcohol robs the body of B vitamins. Crohn's and coeliac disease can also interfere with folic acid uptake.

Megaloblastic anaemia shows up in blood tests as low levels of haemoglobin, an excess of large red blood cells and low levels of B12 and folic acid. The diagnosis can be confirmed with a bone marrow biopsy if a preponderance of megoblasts (abnormal immature red cells) are observed.

In cases where the doctor or specialist suspects that you have pernicious anaemia, a test known as the Schilling test will reveal if this is the root of the problem.

Folic acid tablets and vitamin B12 injections will help correct any deficiency caused by inadequate diet. These may be continued for life in those where the underlying cause cannot be treated.

Haemolytic anaemia develops when red blood cells are killed off prematurely. Normally, red blood cells are only killed off when they are worn out or damaged and the bone marrow compensates by producing new cells. If it can't keep pace with the destruction, however, anaemia will inevitably develop.

Haemolytic anaemia is often caused by an inherited disorder such as sickle cell anaemia - a condition affecting mainly black people or those of Mediterranean origin - which is characterized by deformed red blood cells and a resistance to malaria.

In some cases, the red blood cells are quickly damaged by unusual buffeting, for example against a blood clot or a replacement heart valve. There are also a number of auto-immune disorders which cause the body to attack and destroy red blood cells.

People with haemolytic anaemia can also experience jaundice caused by too much bilirubin - a yellow pigment produced when red blood cells are broken down - in addition to the more common symptoms of anaemia.

In some inherited disorders, the red cell destruction can be reduced by removing the spleen - their main site of destruction. In others, avoiding certain drugs and foods that trigger red cell death will help the condition.. Damage caused by buffeting can be prevented by reducing the disruptive forces.

If an auto-immune disorder is causing the problem, red cell destruction can be controlled with immunosuppressant drugs, which prevent the immune system from attacking the body's own cells.

Acquired diseases like malaria, which cause haemolytic anaemia, need specific treatment for the disease itself. In severe cases of all anaemia, whatever its cause, emergency blood transfusions may prove vital if the condition has become life-threatening.


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