Why you shouldn’t ignore persistent anaemia or low hemoglobin


Anaemia or low haemoglobin (Hb) is a common blood disorder that can affect people across all age groups. Haemoglobin is a protein in our red blood cells (RBC) that acts as a transport vehicle for oxygen to all tissues of our body. These RBC and other blood cells are produced in a spongy structure known as bone marrow that is present in most of the long bones in our body.

“When such protein becomes low, they can lead to various symptoms that differ across age groups and vary according to severity. If one has persistently low Hb, and it develops slowly over a period of time, like nutritional deficiency, patients may exhibit few symptoms, appear pale, and have easy fatigability. On the other hand, if it develops quickly, as in blood loss or when the blood is breaking (Hemolytic anaemia) or blood cancers, it can be life-threatening with extreme breathlessness, swelling etc,” said Dr Anand Kumar K, consultant hematologist, bone marrow transplant physician and pediatric oncologist.

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“Just treating all anemia with nutritional supplements (iron and vitamin B12) is not sufficient, nor just advising recurrent blood transfusion, noted Dr Kumar. “Both are not recommended routinely. In all anaemia conditions, one needs to know the root cause so that it can be tackled effectively,” he said.

Anaemia affects many (Source: Getty Images)

What are the causes?

Causes of persistently low Hb or anaemia varies in different age groups. In children, the most common cause of low Hb is nutritional deficiency (iron and vitamin B12) which can be easily corrected with supplements, but the causes of prolonged anaemia in children are few, most of it are congenital or inherited conditions. These children might have a defect in the formation of haemoglobin (Thalassemia, sickle cell anaemia), a defect on the outer wall of a red blood cell (hereditary spherocytosis) or a defect in the enzymes (G6PD deficiency) which may lead to frequent breaking of the blood (Hemolysis). Some of them may have defects in the production in bone marrow (Diamond blackfan syndrome, Fanconi anaemia).

In adults, the conditions include breaking of red blood cells due to our immune system gone rogue (Auto-immune hemolytic anemia), defect in the quality and quantity of blood cells in the bone marrow (Myelodysplastic syndromes), having bad cells in the bone marrow (Multiple Myeloma, Leukemia or Lymphoma) etc.

Some of the red flag signs of having persistently low Hb are

*When your symptoms are not getting corrected by simple nutritional supplements
*Experiencing extremely severe symptoms in a very short span of time
*Having associated symptoms like jaundice, fever, bone pains, easy fractures, and those requiring repeated blood transfusions.

“If one has the above symptoms, they have to consult a hematologist,” the expert suggested.

Diagnosis

To diagnose the above conditions, a range of blood tests are done. A simple test such as a peripheral smear seen by an expert hematologist can provide vital clues to a patient’s underlying condition. If one is not able to find out the reason from the blood tests, bone marrow examination, various body scans are done to elucidate the cause. For example, any elderly person having recurrent iron deficiency cannot be a simple nutritional problem. It may be because of a serious problem such as a stomach or a colon cancer which can be identified in an early stage with endoscopies.

Women are thought to have persistently low Hb due to blood loss in the menstrual cycles due to iron deficiency. However, if it is increasing beyond the norm, one needs to exclude local causes like fibroids or rare inherited bleeding disorders like Von Willebrand disease. Like the above, umpteen number of situations lead to different diagnosis, which your hematologist will be able to diagnose.

Treatment

The treatment depends on the underlying cause. It may include simple iron and or vitamin B12 supplementation for nutritional anaemia, immunosuppression for auto- immune conditions, chemotherapy for blood cancers to bone marrow transplants for congenital blood problems like thalassemia or high-risk blood cancer.

“One need not be alarmed by these rare and dangerous conditions. Being aware and consulting a hematologist (blood expert) at the right time will help to allay the fears, diagnose it early and treat the underlying condition appropriately,” Dr Kumar said.

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