Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei
Hayeshua Hospital
An obvious cause of anemia is uncontrolled bleeding such as
seen in trauma. Most dangerous bleeds are pelvic and femur
(thigh) fractures in which one can lose all their blood
internally. Abdominal bleeding is another dangerous cause
due to injury to the spleen and liver or lacerations of
major vessels. All of these can be difficult to pick up,
that is why many countries require all physicians to take an
advanced trauma course.
Non-traumatic causes of bleeding include upper GI bleeding,
that is from vomiting blood from the stomach. Ulcers can
cause this, the most common cause of ulcers is misuse of
NSAID drugs (ibuprofen, naproxen and the like), aspirin use
and infection by an ulcer-causing bacteria. NSAID drugs in
the elderly should be taken with protective agents;
buffering, use of antacids or H1 blocking drugs (such as
Zantac or Tagamet) do not help. Vomiting fresh blood is
especially serious, but blood that is sitting there is often
ingested and vomited up as coffee grounds, or released as
black, tarry stool. These require the care of a
physician.
An aneurysm is a weak wall in a major vessel. Unexplained
anemia can be from a leak, and one must be on the look out,
as if major bleeding occurs it could be lethal. A yearly
physical exam is a good start to preventing this.
Lower GI bleeding such as rectal bleeding is a less common
cause of anemia, but a low bleeding colon cancer can cause
anemia. The small amount of blood lost each day isn't
noticed, but a test by your physician can detect this.
Gynecological bleeding can be a cause of anemia, especially
after birth; people doing home deliveries should be prudent.
Nose bleeds, scalp lacerations and coughing up of blood are
less common causes. Urinating blood doesn't usually cause
anemia either. Clots in all these, and in gynecological
bleeding are not more dangerous, they just mean the blood
has been sitting for a while. Most common cause of urinating
blood and coughing up of blood is an infection, but cancer
should be ruled out.
Athletes, males and pregnant women usually have a greater
reserve of blood, or are able to compensate better for blood
losses; people who are elderly, taking blood thinners or who
have clotting disorders such as hemophilia are at more risk.
Write me in care of the Yated.
A message from Glaxo, sponsor of this column.
Headache can be sign of bleeding as well, so if you
suffer from a new headache, be careful. If you suffer from
migraines, consider Naramig -- I have taken it for mine and
am pleased with the results.
