Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei
Hayeshua Hospital
Anemia can sometimes occur even without blood loss. It is
definitely true that there are individuals out there who
live quite well with a low blood count. That is fine if it
is known that that has been the situation all their lives.
Therefore if you are one of these individuals, please make
your doctor's life easier by remembering your blood
count.
Pregnant ladies have more fluid in their blood stream so
they may have a lower blood count during pregnancy. The
kidneys are in charge of creating the enzyme that stimulates
blood cell production, so people with renal -- that is
kidney -- failure have low blood counts. Often they need
transfusions of blood.
The bone marrow is the area where new blood cells are
formed, so bone marrow failure can cause anemia. This can be
from unknown causes or from cancers or from medications.
There is a great antibiotic called chloramphenicol which is
not used very often because it can, rarely, cause bone
marrow failure that can't be reversed. Another example of
this failure is anemia of chronic disease, where elderly
people with chronic diseases suffer anemia.
Nutritional factors can definitely cause anemia. Iron
deficiency is well known. Pills can be taken for this, but
eating liver and spinach (yes, I love spinach -- but be
careful about bugs - Ed.) can help. Not taking enough
vitamin B-12 -- a problem seen in vegetarians who don't eat
any animal products, or not taking enough folic acid -- seen
chiefly in cancer patients and the elderly can also cause
anemias.
Anemias without a cause can be investigated through
examining a blood smear under the microscope or by doing a
bone marrow aspirate, where bone marrow is removed and
examined. It is a painful test.
We have not discussed the inborn anemia, such as sickle cell
anemia -- seen mostly in black people -- and thalasemia seen
in people from the Mediterranean region. G-6-PD is a
hemolytic anemia where absence of an enzyme can cause blood
cells to burst when exposed to certain chemicals. It is seen
in Sephardic Jews.
Next week we'll close this series with a discussion on
donating blood and getting transfusions. Write me in care of
the Yated.
A message from Glaxo, sponsor of this column.
Augmentin is probably the strongest oral antibiotic we have.
There are many times when strong is best especially in the
elderly and in diseases that are caused by many different
bacteria at once such as diabetic ulcers and cat bites. It
is now available in a convenient twice a day dosing.
