As you will recall anemia was defined in Part 1 of this article series as a condition whereby the body does not have an adequate number of healthy red blood cells for someone’s age and gender. In the last issue, we discussed different causes of anemia. This issue relies on the foundation provided by the previous article as it focuses on case scenarios to demonstrate different cases of anemia.

 

Scenario 1: Ms. C is a hardworking executive. She is up and about daily. She noticed recently she gets tired in the morning when she has barely done any work. She dismissed the feeling and attributed it to some weight gain. She loves dancing but in the last month she could barely dance for thirty minutes without breathing hard so she decided to see a doctor. She was diagnosed with iron deficiency anemia.

 

Iron-deficiency anemia (IDA): Heavy menstrual blood loss is the commonest cause of iron-deficiency anemia in women of childbearing age. If iron deficiency occurs in men or after menopause, a diagnosis of cancer of the colon should be considered. Passing black stools may be a sign of ongoing blood loss from the colon. People often tolerate blood loss associated with iron-deficiency anemia over a period of time until their blood level is low.

Caution: Do not just self-medicate with iron without investigating the cause of the deficiency. Iron deficiency may be a pointer to a more serious underlying condition like colon cancer. By age fifty, everyone is supposed to have at least one of the tests used to routinely screen for colon cancer.

 

Scenario 2: Mr. John works in the hotel industry. He has a crazy schedule and has not been to the doctor in about four years. He has backache which has worsened in the past year. A month ago, he developed swelling of his feet which he thought was due to prolonged sitting at work. He decided to join the gym because his weight has been increasing for about three months. His gym session was terminated on the first day because he became so short of breath that he almost passed out. At this point, he was told not to return for gym sessions till he got a clearance from his doctor. He did not want to lose the money he paid for the gym, so he decided to get a clearance from the doctor. Do you think he sought medical attention too late?

 

Ans: Mr. John doctor’s visit should have been at least within a few months of the onset of his symptoms. At the doctor’s office, further history revealed that Mr. John’s capacity to cope with his work had been decreasing for the past two years. He also had decreased urine flow but he thought it was because he did not drink enough water. His blood work returned with severe anemia, abnormal blood cells, and decreased kidney function. His anemia resulted both from decreased production of RBCs from his bone marrow and malfunction of his kidneys. More specifically, a line of cells (plasma cells) had become cancerous taking over his bone marrow and producing too much of a type of protein (Bence Jones protein) that damaged his kidney. His swollen legs were due to decreased kidney function. The decrease in his kidney function also led to water in the lungs that made breathing difficult for him. His weight gain was from water retention in the body. Mr. John had multiple myeloma which was already affecting his bone, hence his backache. Mr. John was started on treatment. His anemia improved but his kidney function did not fully recover. He eventually needed dialysis.

 

Caution: It is best not to explain away or dismiss symptoms you feel. The longer you delay check up, the more extensive the damage may become.

 

Scenario 3: Ms. Dandy is a vegan. Her weight to height ratio is very good. She exercises well. She noticed she has some tingling sensations at times on her feet and hands. Her last physical was three years ago just after having her last baby. She goes to the dentist frequently because of sore tongue and bleeding gums. Lately her husband noticed she is becoming more forgetful. She thinks it is just because she is getting older. Her husband is making a fuss for her to see the doctor; is he justified to be worried?

 

Ans: Ms. Dandy was told by her doctor she has anemia and her cells are big. Further testing revealed she had Vitamin B12 deficiency which was treated. Vitamin B12 is usually found in food that comes from animals. A diet without animal products may lead to B12 deficiency if supplements are not taken. Lack of the protein essential for the absorption of B12 (intrinsic factor) can also lead to this deficiency. Vitamin B12 is needed for proper functioning of the nerves so its deficiency manifests in symptoms relating to the nerves such as tingling and memory loss.

 

Take Home Message

Anemia can be easily diagnosed from simple blood tests. Early detection and intervention is essential to prevent permanent damage. Overlooking symptoms may lead to grave but avoidable consequences. It is worth it to have regular medical examinations.

 

Dr. Oluwatoyosi Dairo can be contacted at Amazing Medical Services located at

110-16 Sutphin Blvd, Jamaica, NY 11435; or by phone at 718 526 7600.

This article is for educational purposes only and is not intended to replace the advice of your doctor.