The Iron Disorders Institute Guide to Anemia

498 Pages·2009·10.48 MB·English

by  Cheryl Garrison

ANEMIA: A SYMPTOM, NOT A DIAGNOSIS

“A very wholesome book; families will benefit from its contents.”

—SUKIRTI BAGAL, MD, MPH Medical Director,
National Organization of Rare Diseases (NORD)

THE IRON DISORDERS INSTITUTE

GUIDE TO
A N E M I A
The Most
Comprehensive
Guide from the

Leading Resource
on Anemia

S E C O N D E D I T I O N

If you have anemia, you must find out why!

“Iron deficiency is one of the most prevalent nutrient deficiencies
in the world, affecting an estimated two billion people.”

—MOLLY COGSWELL, RN, DrPH,
U.S. Centers for Disease Control and Prevention
KNOW THE SIGNS

• Chronic fatigue • Poor sleep • Inability to think clearly
• Weakness • Confusion • Lightheadedness
• Shortness of breath • Memory loss • Restless legs syndrome
• Dizziness • Numbness • Malaise (general feeling of illness)
• Rapid or irregular • Irritability • Pallor (pale coloring of skin,
heartbeat • Sore tongue • e Pyeilicdas ,( aenadti nligp sic)e, clay, dirt, or cravings
• Ringing in the ears • Loss of sex drive
for crunchy foods)

SCIENTIFIC ADVISOR: E. D. Weinberg, PhD

MEDICAL ADVISORS:

Barry Skikne, MD • Herbert Bonkovsky, MD • P. D. Phatak, MD • Robert T. Means Jr., MD

Foreword by Charles M. Peterson, MD, MBA

Director, Division of Blood Diseases and Resources

National Heart, Lung, and Blood Institutes
CHERYL GARRISON, Editor • Cofounder, Iron Disorders Institute
The Iron DIsorDers InsTITuTe
GUIDE TO
A N E M I A

S E C O N D E D I T I O N
Edited by Cheryl D. Garrison
Iron Disorders Institute Cofounder
Scientific Advisor: E. D. WEinbErg, phD
Medical Advisors: barry SkiknE, mD; hErbErt bonkovSky, mD;
p. D. phatak, mD; anD robErt t. mEanS Jr., mD
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Copyright © 2009 by the Iron Disorders Institute
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Library of Congress Cataloging-in-Publication Data
The Iron Disorders Institute guide to anemia / edited by Cheryl D.
Garrison. — 2nd ed.
p. cm.
Includes bibliographical references and index.
1. Anemia—Popular works. I. Garrison, Cheryl D. II. Iron Disorders
Institute. III. Title.
RC641.I76 2009
616.1’52—dc22
2008040760
Printed and bound in the United States of America.
VP 10 9 8 7 6 5 4 3 2 1
For Jan Roth and her brother Dave Urquhart,
and for Ed and Fay Wojtowicz

Contents
Preface: Comments from the Centers for Disease Control
and Prevention . . . vii
Acknowledgments . . . x
Foreword . . . xii
Introduction from the National Anemia Action Council . . . xv
Part One: Anemia—The Basics
1. Iron Out-of-Balance . . . 3
2. Looking Back at Anemia . . . 15
3. Definition of Anemia, Risk Factors, and Symptoms . . . 23
4. The Normal Blood Cell Cycle . . . 35
Part Two: Iron-Deficiency Anemia—Most Common Cause
5. Anemia in Newborns, Infants, and Toddlers . . . 40
6. Anemia in Juveniles, Adolescents, and Early Teens . . . 60
7. Anemia in Adult Females . . . 73
8. Anemia in Adult Males . . . 86
9. Anemia in the Elderly . . . 96
Part Three: Common Causes—Sometimes
Complicated Diagnosis
10. Anemia of Chronic Disease (ACD) . . . 106
11. Endocrine System Disorders . . . 114
12. Autoimmune Diseases . . . 125
13. Infection . . . 134
14. Nutrient Imbalances . . . 145
15. Alcohol Abuse . . . 157
16. Cancer . . . 177
17. Celiac Sprue . . . 190
18. Crohn’s and Ulcerative Colitis . . . 200
19. Renal Disease . . . 211
20. Hemolytic Anemia . . . 221
21. Sickle Cell Disease . . . 236
22. Thalassemia . . . 254
Part Four: Uncommon and Rare Causes of Anemia
23. Aplastic Anemia . . . 266
24. Myelodysplastic Syndromes (MDS) . . . 280
25. Sideroblastic Anemia . . . 301
26. Hypoplastic Anemias . . . 311
27. Paroxysmal Nocturnal Hemoglobinuria (PNH) . . . 321
28. Hemophilia and von Willebrand’s . . . 337
29. Hereditary Hemorrhagic Telangiectasia (HHT) . . . 347
Part Five: Achieving Iron Balance
30. Oral, Injected, or Infused Iron . . . 356
31. Blood Transfusion . . . 362
32. Bone Marrow Transplantation and Gene Therapy . . . 370
33. Chelation Therapy . . . 380
34. Erythropoietin Therapy . . . 387
35. Diet Plan . . . 394
Glossary . . . 419
Bibliography . . . 451
Index . . . 471
Preface: Comments from
the Centers for Disease
Control and Prevention
Anemia is often preventable, and its severe complications are
typically avoidable or fairly easy to treat. Yet anemia remains
a major public health problem throughout the world. Why?
Many of us who obtain information mostly from our popular
media may overlook the significance of age-old problems that
continue to harm hundreds of millions of people throughout
the world. Still others of us in medicine and public health tend
to specialize by organ systems and assume that anemia is the
job of the hematologists, while failing to remember that the
oxygen-carrying capacity of hemoglobin and normal oxygen
delivery to tissues is a mission we should all embrace. Regardless
of the reasons, the science explaining the importance of normal
iron balance has far outpaced our clinical and public health
activities. This book, like the literature it references, is a call to
action for all of us.
Today as I sit in a rural region of a developing country, I
see the many faces of iron deficiency—mostly unrecognized
and unaddressed. Barefoot children, whose diets are iron defi-
cient, unknowingly donate some of their precious iron stores
to the parasites growing within their intestines as they experi-
ence growth failure and intellectual difficulties that will follow
them throughout their lives. Their mothers, anemic after mul-
tiple bouts of malaria in childhood, entered their reproductive
years already anemic—preconception care opportunities lost,
and themselves at increased risk of death from postpartum
Preface: comments from the centers for
Disease control anD Prevention
hemorrhage since they are severely anemic before the bleeding
begins. Their anemia, progressing in severity from one preg-
nancy to the next, helps place their youngest children at the
highest risk of preventable disease, with even higher rates of
growth failure and preventable intellectual disabilities. Indeed,
anemia and iron deficiency contribute to the cycle of poverty
and disease throughout the developing world.
Back home in the United States, the association between
poverty and iron deficiency plays a role in our own cycle of
poverty and poor health. While none of us should minimize
the impact of social determinants of disease, we should also not
minimize the importance of treating iron deficiency in order to
give our citizens the opportunities to take advantage of eco-
nomic opportunities. The faces of anemia must be recognized
in developed countries too, and their problems addressed in
order to improve the health of those in richer countries.
As the readers of this book will learn, almost all of us at some
time in our lives will be at risk for anemia. As our population
ages, as we do a better job treating chronic diseases, and as
we hopefully enhance access to health care for all Americans,
anemia will be more commonly recognized as a co-morbidity.
We in the United States have long underestimated the burden
of sickle cell anemia in our society; now with improved new-
born screening and better treatment and prevention options,
improving the lives of people with sickle cell anemia is a moral
imperative. Hemophilia and other bleeding disorders, although
rare, are important both because of the very high cost of
inadequate treatment, and because we have now proven that
we can enhance the longevity and improve the quality of life
among people with hemophilia. While we address the bigger
public health problems worldwide associated with iron defi-
ciency, we must maintain and enhance our efforts in these less
common, but critically important, blood disorders.
Just as we are all at risk for anemia, the job of prevent-
ing and treating anemia is a job for all of us. Preventing and
treating anemia worldwide is too big a job for just one medi-
cal specialty. Certainly blood disorders experts, such as the
contributors to this book, and specialty organizations in the
field of anemia and hematology, should help lead prevention
viii
Preface: comments from the centers for
Disease control anD Prevention
and treatment efforts. But only when preventing and treat-
ing anemia and its complications becomes a mandate for all
of us in medicine and public health will we likely achieve the
improvements in health that we all desire. Congratulations to
the authors and to the Iron Disorders Institute for producing
this important book. Now it is time for all of us to use these
pages to improve health.
Edwin Trevathan, MD, MPH
Director, National Center on Birth Defects and
Developmental Disabilities
Centers for Disease Control and Prevention (CDC)
Atlanta, Georgia
USA
ix