Iron-deficiency anaemia Health Dictionary

Lack of enough blood in the body causing paleness... anaemia

A metal which is an essential constituent of the red blood corpuscles, where it is present in the form of HAEMOGLOBIN. It is also present in muscle as MYOGLOBIN, and in certain respiratory pigments which are essential to the life of many tissues in the body. Iron is absorbed principally in the upper part of the small intestine. It is then stored: mainly in the liver; to a lesser extent in the spleen and kidneys, where it is available, when required, for use in the bone marrow to form the haemoglobin in red blood corpuscles. The daily iron requirement of an adult is 15–20 milligrams. This requirement is increased during pregnancy.

Uses The main use of iron is in the treatment of iron-de?ciency anaemias (See ANAEMIA.) Iron preparations sometimes cause irritation of the gastrointestinal tract, and should therefore always be taken after meals. They sometimes produce a tendency towards constipation. Whenever possible, iron preparations should be given by mouth; if PARENTERAL administration is clinically necessary because of malabsorption, a suitable preparation is iron sorbitol injection given intramuscularly. Most patients respond successfully to oral iron preparations.... iron

An autoimmune disease in which sensitised lymphocytes (see LYMPHOCYTE) destroy the parietal cells of the STOMACH. These cells normally produce intrinsic factor, which is the carrier protein for vitamin B12 that permits its absorption in the terminal ileum. Without intrinsic factor, vitamin B12 cannot be absorbed and this gives rise to a macrocytic ANAEMIA. The skin and mucosa become pale and the tongue smooth and atrophic. A peripheral NEUROPATHY is often present, causing paraesthesiae (see under TOUCH), numbness and even ATAXIA. The more severe neurological complication of sub-acute combined degeneration of the cord is fortunately more rare. The anaemia gets its name from the fact that before the discovery of vitamin B12 it was uniformly fatal. Now a monthly injection of vitamin B12 is all that is required to keep the patient healthy.... pernicious anaemia

A rare genetic disorder in which a person is missing the enzyme alpha1-antitrypsin, which protects the body from damage by other enzymes.

The disease mainly affects tissues in the lungs, resulting in emphysema, and the liver, causing cirrhosis.

The effects of alpha1-antitrypsin deficiency may not become apparent until after the age of 30.

There is no cure, but symptoms can be relieved by drug treatment.

In severe cases, a liver transplant may be a possibility.... alpha-antitrypsin deficiency

See anaemia, aplastic.... aplastic anaemia

See thalassaemia.... cooley’s anaemia

A rare type of aplastic anaemia characterized by severely reduced production of all types of blood cells by the bone marrow.... fanconi’s anaemia

A large machine formerly used to maintain breathing, especially in people paralysed by poliomyelitis. The iron lung has been replaced by more efficient means of maintaining breathing (see ventilation).... iron lung

A severe manifestation of infection with the Human immunodeficiency virus (HIV).... acquired immune deficiency syndrome (aids)

See THALASSAEMIA.... cooley’s anaemia

Any disease resulting from the absence from the diet of any substance essential to good health: for example, one of the vitamins.... deficiency disease

A deficiency in the enzyme G6PD resulting in a haemolytic anaemia. This haemoglobinopathy contraindicates the use of the 4-aminoquinolines such as primaquine for the radical treatment of benign tertian and ovale tertian malaria.... glucose-6-phosphate-dehydrogenase (g6pd) deficiency

This may occur in diseases of intestinal malabsorption. A severe form of this anaemia in women, known as chlorosis, used to be common but is seldom seen nowadays.... inadequate absorption of iron

Failure of the bone marrow to produce red cells because of infection, also neutropenia and depletion of platelets in the blood through chronic disease (TB etc) elsewhere in the body, or through chemicals in food and medicine. Other causes include food preservatives, X-ray radiation, fluoride in water supply and environmental pollution. The condition is serious.

Possibility of mercurial poisoning. A 59-year-old man employed filling thermometers with mercury developed aplastic anaemia and died. His urine contained 1.01mg mercury per litre. (D.R. Ryrie. Brit. Medical Journal, i/1970, 499. A similar report D.R. Wilson, ibid., ii/1966, 1534)

Symptoms. Headache, dizziness, pallor of skin, loss of weight and appetite, sore or burning tongue, jaundice, bruising, nose-bleeds. A low state of the immune system exposes the subject to infection. Treatment. Hospital supervision. Necessary to identify the causative toxic agent and eliminate it. Condition fails to respond to usual preparations of iron taken by mouth. No specific exists but supportive adaptogen herbs sustain and raise haemoglobin levels, marginally increasing red cells.

To facilitate elimination of toxic chemicals:– Teas: Alfalfa, Red Clover, German Chamomile, Ground Ivy, Milk Thistle, Gotu Kola, Nettles, Fennel.

Tea. Formula. Equal parts: Dandelion, Nettles, Alfalfa. 1 heaped teaspoon in each cup boiling water, infuse 10-15 minutes. One cup freely.

Decoction: Gentian – 1 teaspoon in cup cold water. Steep overnight; drink on rising.

Tinctures. To stimulate bone marrow. Formula: equal parts, Echinacea, Prickly Ash bark, Horsetail. Dose: 1-2 teaspoons thrice daily, taken in water or cup of one of the above teas.

Tincture Cinnamon BP (1949). Dose: 2-4ml (30-60 drops).

Powders. Combine: Gentian 1; Yellow Dock 1; Echinacea 2; Cinnamon quarter; Cayenne quarter. Dose: 500mg (two 00 capsules or one-third teaspoon), before meals.

Liquid Extracts: Combine Echinacea 2; Black Cohosh half; Damiana 1; Ginger quarter. Dose: 1 teaspoon in cup Red Clover tea, before meals.

Diet. Dandelion coffee, high fibre, low fat, low salt, molasses, lamb’s liver. Foods containing Vitamin B12.

Supplements daily. Vitamin B12. Folic acid 400mcg, Vitamin C, Floradix. ... anaemia: aplastic

A side-effect of hard training in endurance sports with low haemoglobin and haematocrit levels due to rapid depletion of iron on excessive exertion. See: IRON DEFICIENCY ANAEMIA. ... anaemia: sports

The daily requirement of iron for an adult is 12 mg, and 15–20 mg for an adult woman during pregnancy. This is well covered by an ordinary diet, so that by itself it is not a common cause. But if there is a steady loss of blood, as a result of heavy menstrual loss or ‘bleeding piles’, the intake of iron in the diet may not be su?cient to maintain adequate formation of haemoglobin.

Symptoms These depend upon whether the anaemia is sudden in onset, as in severe haemorrhage, or gradual. In all cases, however, the striking sign is pallor, the depth of which depends upon the severity of the anaemia. The colour of the skin may be misleading, except in cases due to severe haemorrhage, as the skin of many Caucasian people is normally pale. The best guide is the colour of the internal lining of the eyelid. When the onset of the anaemia is sudden, the patient complains of weakness and giddiness, and loses consciousness if he or she tries to stand or sit up. The breathing is rapid and distressed, the pulse is rapid and the blood pressure is low. In chronic cases the tongue is often sore (GLOSSITIS), and the nails of the ?ngers may be brittle and concave instead of convex (koilonychia). In some cases, particularly in women, the Plummer-Vinson syndrome is present: this consists of di?culty in swallowing and may be accompanied by huskiness; in these cases glossitis is also present. There may be slight enlargement of the SPLEEN, and there is usually some diminution in gastric acidity.

CHANGES IN THE BLOOD The characteristic change is a diminution in both the haemoglobin and the red cell content of the blood. There is a relatively greater fall in the haemoglobin than in the red cell count. If the blood is examined under a microscope, the red cells are seen to be paler and smaller than normal. These small red cells are known as microcytes.

Treatment consists primarily of giving suf?cient iron by mouth to restore, and then maintain, a normal blood picture. The main iron preparation now used is ferrous sulphate, 200 mg, thrice daily after meals. When the blood picture has become normal, the dosage is gradually reduced. A preparation of iron is available which can be given intravenously, but this is only used in cases which do not respond to iron given by mouth, or in cases in which it is essential to obtain a quick response.

If, of course, there is haemorrhage, this must be arrested, and if the loss of blood has been severe it may be necessary to give a blood transfusion (see TRANSFUSION – Transfusion of blood). Care must be taken to ensure that the patient is having an adequate diet. If there is any underlying metabolic, oncological, toxic or infective condition, this, of course, must be adequately treated after appropriate investigations.

Megaloblastic hyperchromic anaemia There are various forms of anaemia of this type, such as those due to nutritional de?ciencies, but the most important is that known as pernicious anaemia.

PERNICIOUS ANAEMIA An autoimmune disease in which sensitised lymphocytes (see LYMPHOCYTE) destroy the PARIETAL cells of the stomach. These cells normally produce INTRINSIC FACTOR, the carrier protein for vitamin B12 (see APPENDIX 5: VITAMINS) that permits its absorption in the terminal part of the ILEUM. Lack of the factor prevents vitamin B12 absorption and this causes macrocytic (or megaloblastic) anaemia. The disorder can affect men and women, usually those over the age of 40; onset is insidious so it may be well advanced before medical advice is sought. The skin and MUCOSA become pale, the tongue is smooth and atrophic and is accompanied by CHEILOSIS. Peripheral NEUROPATHY is often present, resulting in PARAESTHESIA and numbness and sometimes ATAXIA. A rare complication is subacute combined degeneration of the SPINAL CORD.

In 1926 two Americans, G R Minot and W P Murphy, discovered that pernicious anaemia, a previously fatal condition, responded to treatment with liver which provides the absent intrinsic factor. Normal development requires a substance known as extrinsic factor, and this depends on the presence of intrinsic factor for its absorption from the gut. The disease is characterised in the blood by abnormally large red cells (macrocytes) which vary in shape and size, while the number of white cells (LEUCOCYTES) diminishes. A key diagnostic ?nd is the presence of cells in the BONE MARROW.

Treatment consists of injections of vitamin B12 in the form of hydroxocobalamin which must be continued for life.

Aplastic anaemia is a disease in which the red blood corpuscles are very greatly reduced, and in which no attempt appears to be made in the bone marrow towards their regeneration. It is more accurately called hypoplastic anaemia as the degree of impairment of bone-marrow function is rarely complete. The cause in many cases is not known, but in rather less than half the cases the condition is due to some toxic substance, such as benzol or certain drugs, or ionising radiations. The patient becomes very pale, with a tendency to haemorrhages under the skin and mucous membranes, and the temperature may at times be raised. The red blood corpuscles diminish steadily in numbers. Treatment consists primarily of regular blood transfusions. Although the disease is often fatal, the outlook has improved in recent years: around 25 per cent of patients recover when adequately treated, and others survive for several years. In severe cases promising results are being reported from the use of bone-marrow transplantation.

Haemolytic anaemia results from the excessive destruction, or HAEMOLYSIS, of the red blood cells. This may be the result of undue fragility of the red blood cells, when the condition is known as congenital haemolytic anaemia, or of acholuric JAUNDICE.

Sickle-cell anaemia A form of anaemia characteristically found in people of African descent, so-called because of the sickle shape of the red blood cells. It is caused by the presence of the abnormal HAEMOGLOBIN, haemoglobin S, due to AMINO ACID substitutions in their polypeptide chains, re?ecting a genetic mutation. Deoxygenation of haemoglobin S leads to sickling, which increases the blood viscosity and tends to obstruct ?ow, thereby increasing the sickling of other cells. THROMBOSIS and areas of tissue INFARCTION may follow, causing severe pain, swelling and tenderness. The resulting sickle cells are more fragile than normal red blood cells, and have a shorter life span, hence the anaemia. Advice is obtainable from the Sickle Cell Society.... inadequate intake of iron

corresponds to a large extent with what used to be known as ‘secondary anaemia’. It takes its name from the characteristic changes in the blood.... microcytic hypochromic anaemia

See anaemia, megaloblastic.... anaemia, pernicious

A blood condition due to abnormal destruction of red blood cells in the spleen.

Causes: hereditary background with deficiency of cell enzymes or cell membrane weakness; wrongly matched blood transfusion, environmental chemicals, food additives, colourings, drugs, infections. Symptoms. Pale face, sore tongue, headache, dizziness, palpitations, breathlessness, angina, weakness, loss of weight and appetite, jaundice (yellow skin), feverishness, vague aches and pains, enlarged spleen and pain under left ribs.

Treatment. Under hospital supervision.

Echinacea has a long reputation for regeneration of red blood cells: experience shows it beneficial for this type of anaemia. To assist control of symptoms: Gentian, Motherwort, Mugwort, Barberry, Hops, Saw Palmetto.

Bitter herbs stimulate the stomach, liver and pancreas. By increasing the appetite they benefit digestion and are given half an hour before meals by tea or decoction: Hops, Quassia chips, Angostura, Feverfew, Bogbean.

Formula. Tea. Milk Thistle 2; Betony 1; Hops 1. Mix. 1-2 teaspoon to each cup boiling water. Infuse 5-15 minutes. 1 cup, thrice daily.

Decoction. Echinacea 1; Sarsaparilla 1; Peruvian bark half; Saw Palmetto half. Mix. 2 teaspoons to 2 cups water, simmer gently 20 minutes. Half a cup, cold, thrice daily before meals.

For weak heart add one part Hawthorn; neurasthenia (Ginkgo); swelling of ankles (Lily of the Valley); loss of hormonal balance (Ginseng).

Prognosis. Surgical removal of spleen may be necessary.

Diet. Dandelion coffee, molasses, desiccated or fresh calves’ liver. Green leafy vegetables, dried beans, apricots. Shellfish, milk, eggs, Soya, meats. Supplements. Daily. Vitamin B12 1mg; Vitamin C, 1g; Folic acid 400mcg; Floradix. ... anaemia: haemolytic

An estimated 15 per cent of the female population suffers from this form of anaemia. A deficiency of nutritional iron is responsible for oxygen starvation of the blood due to insufficient haemoglobin. Number of red cells is reduced.

Aetiology: heavy menstrual loss, feeble constitution from hereditary weakness, poor diet, hidden or known blood loss from gastric ulcer, pregnancy, bleeding piles or insufficient food minerals: iron, copper, calcium, etc, chronic liver or kidney disease, worms, anorexia nervosa, rheumatoid arthritis, tuberculosis. Symptoms. Tiredness, dizziness, breathlessness, palpitations, pale face and mucous membranes. White of eyes may be blue. Enlarged flabby tongue often bears impression of teeth marks. Hair lifeless, fingernails brittle and ridged. There may be angina, tinnitus and general reduced efficiency.

Treatment. The object is to achieve absorption of iron to raise normal haemoglobin levels and increase red cells. Echinacea has a reputation for regeneration of red cells. Herbs used with success: Echinacea, Gentian, Motherwort, Mugwort, Barberry, Hops, Nettles, Saw Palmetto, Chaparral, Red Clover, Dandelion.

Bitter herbs stimulate absorption of vital nutrients from the stomach, toning liver and pancreas, increasing the appetite; usually given half hour before meals. See: BITTERS.

Gentian. 1 teaspoon fine-cut chips to 2 cups cold water steeped 8 hours (overnight). Dose: Half-1 cup thrice daily before meals.

Tea. Formula. Combine: Agrimony 1; Barberry bark 1; Nettles 2; White Poplar bark half. Place 1oz (30g) in 1 pint (500ml) cold water and bring to boil. Simmer 10 minutes. Drink cold: Half-1 cup thrice daily, before meals.

Powders. Formula. Echinacea 2; Gentian 1; Kelp 1; pinch Red Pepper. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily, before meals.

Liquid extracts. Formula: Echinacea 1; Queen’s Delight 1; Ginseng 1; Ginger quarter. Dose: 30-60 drops in water, thrice daily, before meals.

Infusion Gentian Co Conc BP (1949). Dose: 30-60 drops.

Diet. Dandelion coffee, as desired. Molasses. Desiccated liver.

Floradix. A pre-digested iron preparation. Readily assimilable by the body. Compounded by Dr Otto Greither (Salus Haus). Iron is fed onto yeast which breaks down the metal and absorbs its cells. Other tonic ingredients include extracts of nettles, carrots, spinach, fennel, Vitamin C plus supplements;

Angelica root, Mallow, Horsetail, Yarrow, Juniper and Rosehips. Not chemically preserved.

Avoid chocolate, egg yolk, tea, coffee, wheat bran.

Supplements. Daily. Vitamin C (1g morning and evening). Vitamin B12, Folic acid 400mcg. Vitamin C is the most potent enhancer of iron absorption. Multivitamin containing iron.

Note: Iron absorption is decreased by antacids, tetracyclines, phosphates, phytates (phytic acid from excessive intake of wholewheat bread), and excessive calcium supplements. Lack of stomach hydrochloric acid impairs iron absorption, especially in the elderly. ... anaemia: iron deficiency

See anaemia, haemolytic.... haemolytic anaemia

A condition in which there is an absence of lactase, an enzyme that breaks down lactose (milk sugar), in the cells of the small intestine.

Lactase deficiency results in a reduced ability to digest lactose, also known as lactose intolerance.

The condition may be permanent, or may occur temporarily after gastroenteritis, particularly in young children.

Symptoms include abdominal cramps, bloating, flatulence, and diarrhoea, all of which are caused by the laxative effect of the undigested sugar in the intestines.

Treatment is with a lactose-free diet.... lactase deficiency

See anaemia, megaloblastic.... megaloblastic anaemia

see AIDS.... acquired immune deficiency syndrome

see adenosine deaminase deficiency.... ada deficiency

A form of anaemia following a deficiency of Vitamin B12. Usually occurs middle life, 45-60.

Symptoms. Skin of yellow tinge, failing eyesight, swollen ankles, feeble heart action, numbness of feet and legs, dyspepsia, tingling in limbs, diarrhoea, red beefy sore tongue, patches of bleeding under skin, unsteadiness and depression.

Treatment. Hospitalisation. Intramuscular injections of Vitamin B12. Herbs known to contain the vitamin – Comfrey, Iceland Moss. Segments of fresh Comfrey root and Garlic passed through a blender produce a puree – good results reported.

Alternatives:– Teas: Milk Thistle, Hops, Wormwood, Betony, White Horehound, Motherwort, Parsley, Nettles, Centuary.

Formula. Combine Centuary 2; Hyssop 1; White Horehound 1; Red Clover flower 1; Liquorice quarter. 1-2 teaspoons to each cup boiling water, infuse 15 minutes. 1 cup thrice daily.

Decoction. Combine Yellow Dock 1; Peruvian bark quarter; Blue Flag root quarter; Sarsaparilla 1; Bogbean half. 1 teaspoon to each cup of water, or 4oz (30 grams) to 1 pint (half litre) water. Simmer gently 10-15 minutes in covered vessel. Dose: Half-1 cup, thrice daily.

Decoction. Combine Yellow Dock 1; Peruvian bark quarter; Blue Flag root quarter; Sarsaparilla 1; Bogbean half. 1 teaspoon to each cup of water, or 4oz (30 grams) to 1 pint (one-half litre) water. Simmer gently 10-15 minutes in covered vessel. Dose: Half-1 cup, thrice daily.

Tablets/capsules. Echinacea, Dandelion, Kelp.

Powders. Formula. Equal parts: Gentian, Balm of Gilead, Yellow Dock. Dose: 500mg (two 00 capsules or one-third teaspoon), thrice daily before meals.

Liquid Extracts. Combine, Echinacea 2; Gentian 1; Dandelion 1; Ginger quarter. Dose: 15-30 drops in water thrice daily.

Gentian decoction. 1 teaspoon dried root to each cup cold water.

Diet. Dandelion coffee. Calves’ liver. Absorption of nutritious food may be poor through stomach’s inability to produce sufficient acid to break down food into its elements. Indicated: 2-3 teaspoons Cider vinegar in water between meals. Contraindicated – vegetarian diet.

Supplements. Vitamin B12, (in absence of injections). Iron – Floradix. Desiccated liver. Vitamin C 1g thrice daily at meals. Folic acid. 400mcg thrice daily. ... anaemia: pernicious

A form of anaemia growing into an acute social problem, affecting people of African, Asian, and Mediterranean origin. Thalassaemias are caused by defects of a gene that produces the globin part of haemoglobin. Such defects in the DNA can now be detected in the womb before birth. The name derives from sickle-shaped cells instead of circular red blood cells. Few sufferers survive beyond their 40th year.

Symptoms. Unhealthy pallor, listlessness, sore tongue, dizziness, vague aches and pains, rapid pulse and breathing, tinnitus, palpitation. The skull may be disproportionately large, resistance to infection feeble, chances of survival poor. This form of anaemia is linked with defective colour vision. Impaired liver function. Stunted growth, great pain. Sufferers have a higher risk of infection.

Malaria. Sufferers are less likely to die of malaria because their red cells do not support the growth of malaria parasites very well.

Carriers: Carriers of the sickle-cell gene can now be identified by a simple blood test.

Treatment. No specifics exist but supportive herbal treatment has been known to increase output of red cells and raise haemoglobin levels:– Red Clover flowers, Yellow Dock, Echinacea, Burdock, Wild Indigo, Gentian, Nettles, Birch leaves, Sage, Walnut leaves, Centaury, Gota Kola (Indian Pennywort). Alternatives:– Tea. Mix equal parts: Iceland Moss, Nettles, Red Clover flowers. 2 teaspoons to each cup boiling water; infuse 15 minutes; 1 cup morning and evening.

Decoction. Mix equal parts; Echinacea, Walnut leaves, Balm of Gilead buds; 1 teaspoon to each cup water gently simmered for 20 minutes. Half-1 cup, cold, 3 times daily, before meals.

Tablets/capsules. Sarsaparilla. Ginseng. Iceland Moss. Red Clover. Echinacea. Gentian.

Powders. Formula: Echinacea 1; Fringe Tree half; Ginseng half; White Poplar bark 1. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily before meals.

Liquid extracts. Formula. Echinacea 2; Dandelion 1; Oat Husk (avena sativa) 1. Mix. Dose, 1-2 teaspoons before meals, in water or one of the above teas or decoctions.

Tinctures. Same combination. Dose: 2-3 teaspoons.

Dong quai. See entry.

Pollen. Claimed to be of value.

Diet. Dandelion coffee. Molasses. Desiccated liver. Calf liver, fresh. Green leafy vegetables contain chlorophyll, iron and folic acid. Cider vinegar. Dried beans, apricots and shellfish. Dandelion leaves in salads. Milk, eggs, meats, Soya. Carrot juice to increase red cells.

Supplements. Daily. Vitamin B12. Vitamin C, 1g; Folic acid 400mcg, Floradix. Of particular value: Vitamin E 400iu. Zinc.

Note: Those at risk should submit themselves for screening. The disease cannot be cured but can be controlled largely by orthodox measures and sometimes by natural medicine. ... anaemia: sickle cell

(ADA deficiency) a genetic disorder affecting about one baby in 25,000 and characterized by a defect in adenosine deaminase (ADA), an enzyme that is involved in purine metabolism. Deficiency of this enzyme results in selective damage to the antibody-producing lymphocytes; this in turn leads to a condition known as *severe combined immune deficiency (SCID), in which the affected baby has no resistance to infection and must be entirely isolated from birth. Such children have only about a 50% chance of surviving for six months. See also gene therapy.... adenosine deaminase deficiency

n. (in genetics) see deletion.... deficiency

any disease caused by the lack of an essential nutrient in the diet. Such nutrients include *vitamins, minerals, *essential amino acids, and *essential fatty acids.... deficiency disease

a drug containing *iron and *dextran, administered to treat iron-deficiency anaemia. Side-effects can include pain at the site of injection, rapid beating of the heart, and allergic reactions.... iron dextran

see haemochromatosis.... iron-storage disease

Bile is a greenish-yellow alkaline substance secreted by the liver which emulsifies fat and prevents putrefaction in the intestines. An aid to pancreatic juices.

Alternatives. To stimulate flow, Boldo, Horsetail, Dandelion, Blue Flag root, Milk Thistle, Bogbean, Burdock. Teas, capsules, tablets, Liquid extracts, or Tinctures.

A. Vogel recommends: Barberry, Centuary, St John’s Wort, Sarsaparilla.

Combination tea. Equal parts: Peppermint leaves, Milk Thistle, Dandelion root. 1 teaspoon to each cup boiling water; infuse 15 minutes, 1 cup thrice daily for limited period (1 month).

Bile in the urine. (Bilviria)

Arthur Barker: Liquid Extract Black root 1oz (30ml). Liquid Extract Cornsilk 1oz (30ml). Essential Peppermint 30 drops (2ml). Water to 8oz (240ml). 2 teaspoons in water 3 times daily before meals.

Diet. Dandelion coffee. Artichokes.

See: CHOLAGOGUES. CHOLERETICS. ... bile secretion deficiency

A rare but serious type of anaemia in which the red cells, white cells, and platelets in the blood are all reduced in number. Aplastic anaemia is caused by a failure of the bone marrow to produce stem cells, the initial form of all blood cells.

Treatment of cancer with radiotherapy or anticancer drugs can temporarily interfere with the cell-producing ability of bone marrow, as can certain viral infections and other drugs. Long-term exposure to insecticides or benzene fumes may cause more persistent aplastic anaemia, and a moderate to high dose of nuclear radiation is another recognized cause. An autoimmune disorder is responsible in about half of all cases. Aplastic anaemia sometimes develops for no known reason.

A low level of red blood cells may cause symptoms common to all types of anaemia, such as fatigue and breathlessness. White-cell deficiency increases susceptibility to infections; platelet deficiency may lead to a tendency to bruise easily, bleeding gums, and nosebleeds.

The disorder is usually suspected from blood-test results, particularly a blood count, and is confirmed by a bone marrow biopsy.

Blood and platelet transfusions can control symptoms.

Immunosuppression is used to treat anaemia due to an autoimmune process.

Severe persistent aplastic anaemia may be fatal unless a bone marrow transplant is carried out.... anaemia, aplastic

A form of anaemia caused by premature destruction of red cells in the bloodstream (haemolysis). Haemolytic anaemias can be classified according to whether the cause of haemolysis is inside or outside the red cells.

When haemolysis is due to a defect inside the red cells, the underlying problem is abnormal rigidity of the cell membrane. This causes the cells to become trapped, at an early stage of their life-span, in the small blood vessels of the spleen, where they are destroyed by macrophages (cells that ingest foreign particles). Abnormal rigidity may result from an inherited defect of the cell membrane (as in hereditary spherocytosis), a defect of the haemoglobin in the cell (as in sickle-cell anaemia), or a defect of one of the cell’s enzymes. An inherited deficiency of the glucose-6phosphate dehydrogenase enzyme (see G6PD deficiency) may result in episodes of haemolytic anaemia since the red cells are prone to damage by infectious illness or certain drugs or foods.

Haemolytic anaemias due to defects outside the red cells fall into 3 main groups. First are disorders in which red cells are destroyed by buffeting (by artificial surfaces such as replacement heart valves, abnormal blood-vessel linings, or a blood clot in a vessel, for example). In the 2nd group, the red cells are destroyed by the immune system. Immune haemolytic anaemias may occur if foreign blood cells enter the bloodstream, as occurs in an incompatible blood transfusion, or they may be due to an autoimmune disorder. In haemolytic disease of the newborn, the baby’s red cells are destroyed by the mother’s antibodies crossing the placenta. Thirdly, the red cells may be destroyed by microorganisms; the most common cause is malaria. People with haemolytic anaemia may have symptoms common to all types of anaemia, such as fatigue and breathlessness, or symptoms specifically due to haemolysis, such as jaundice.

Diagnosis is made by examination of the blood (see blood film). Some inherited anaemias can be controlled by removing the spleen (see splenectomy). Others, such as G6PD deficiency, can be prevented by avoiding the drugs or foods that precipitate haemolysis. Anaemias due to immune processes can often be controlled by immunosuppressant drugs. Transfusions of red cells are sometimes needed for emergency treatment of life-threatening anaemia.... anaemia, haemolytic

(SCID) a rare disorder that usually manifests itself within the first three months of life by severe bacterial, fungal, and viral infection and *failure to thrive. It is due to reduced numbers of T and B *lymphocytes – white blood cells necessary for fighting infection. Some cases are caused by *adenosine deaminase deficiency. The only treatment currently available is a bone-marrow transplant, but *gene therapy offers hope for the future.... severe combined immune deficiency

The most common form of anaemia caused by a deficiency of iron, an essential constituent of haemoglobin. The main cause of iron-deficiency anaemia is iron loss due to heavy or persistent bleeding; the most common cause in women of childbearing age is menstruation. Other causes include blood loss from the digestive tract due to disorders such as erosive gastritis, peptic ulcer, stomach cancer, inflammatory bowel disease, haemorrhoids, and bowel tumours (see colon, cancer of). Prolonged use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) can cause gastrointestinal bleeding. In some countries, hookworm infestation of the digestive tract is an important cause of anaemia. Rarely, bleeding may also occur as a result of disorders of the urinary tract (such as kidney tumours or bladder tumours).

Iron deficiency may also be caused or worsened by lack of iron in, or its poor absorption from, the diet.

The symptoms are those of the underlying cause, along with a sore mouth or tongue, and those common to all forms of anaemia, such as fatigue and breathlessness. The diagnosis is made from blood tests and tests to look for an underlying cause. Treatment is given for the cause, along with a course of iron tablets or, very rarely, injections.... anaemia, iron-deficiency

An important type of anaemia caused by a deficiency of vitamin B12 or another vitamin, folic acid. Either of these deficiencies seriously interferes with production of red blood cells in the bone marrow. An excess of cells called megaloblasts appears in the marrow. Megaloblasts give rise to enlarged and deformed red blood cells known as macrocytes.

Vitamin B12 is found only in foods of animal origin, such as meat and dairy products. It is absorbed from the small intestine after first combining with intrinsic factor, a chemical produced by the stomach lining. The most common cause of vitamin B12 deficiency is failure of the stomach lining to produce intrinsic factor, usually due to an autoimmune disorder; this is called pernicious anaemia. Total gastrectomy (removal of the stomach) prevents production of intrinsic factor, and removal of part of the small intestine prevents B12 absorption, as does the intestinal disorder Crohn’s disease. In a minority of cases, vitamin B12 deficiency is due to a vegan diet.

Folic acid is found mainly in green vegetables and liver. The usual cause of deficiency is a poor diet. Deficiency can also be caused by anything that interferes with the absorption of folic acid from the small intestine (for example Crohn’s disease or coeliac disease). Folic acid requirements are greater than normal in pregnancy.

Many people with mild megaloblastic anaemia have no symptoms. Others may experience tiredness, headaches, a sore mouth and tongue, and mild jaundice. If B12 deficiency continues for a long time, additional symptoms due to nerve damage, including numbness and tingling in the feet, may develop.

Megaloblastic anaemia is diagnosed by blood tests and a bone marrow biopsy. Megaloblastic anaemia due to poor diet can be remedied with a short course of vitamin B12 injections or folic acid tablets and the introduction of a normal diet. A lifelong course of vitamin B12 injections or folic acid tablets is required if the underlying cause of malabsorption is untreatable.... anaemia, megaloblastic

Any abnormality in colour vision that causes difficulty distinguishing between certain colours. Total absence of colour vision (monochromatism) is rare. The most common types of colour vision deficiency are reduced discrimination of red and green. Most cases of red and green colour vision deficiency are caused by defects in the light-sensitive cells in the retina. These defects are usually inherited, although occasionally defects are caused by retinal or optic nerve diseases or injury. The inherited defects tend to be sex-linked (see genetic disorders), which means that the majority of sufferers are male. A person with a severe green deficiency has difficulty distinguishing oranges, greens, browns, and pale reds. In severe red deficiency, all reds appear dull. A much rarer deficiency in which blue cannot be distinguished may be inherited or may be due to degeneration of the retina or optic nerve.... colour vision deficiency

An inherited blood disease in which the red blood cells contain haemoglobin S, an abnormal type of haemoglobin. This crystallizes in the capillaries, making red cells sickle-shaped and fragile, and leading to haemolytic anaemia. The abnormal cells are unable to pass easily through tiny blood vessels. The blood supply to organs is blocked intermittently, causing sickle cell crises. The disease affects mainly black people.Symptoms usually appear after age 6 months, often beginning with painful swelling of the hands and feet. Chronic haemolytic anaemia causes fatigue, headaches, shortness of breath on exertion, pallor, and jaundice. Sickle cell crises start suddenly; they are sometimes brought on by an infection, cold weather, or dehydration, but may also occur for no apparent reason. The sufferer may experience pains (especially in the bones), blood in the urine (from kidney damage) or damage to the lungs or intestines. If the brain is affected, seizures, a stroke, or unconsciousness may result.

In some affected children, the spleen enlarges and traps red cells at a particularly high rate, causing a life-threatening form of anaemia. After adolescence, the spleen usually stops functioning, increasing the risk of infection in those affected.

Diagnosis is made from examination of a blood smear and electrophoresis.

Supportive treatment may include folic acid supplements, and penicillin and immunization to protect against infection.

Life-threatening crises are treated with intravenous infusions of fluids, antibiotics, oxygen therapy, and analgesic drugs.

If the crisis still does not respond, an exchange blood transfusion may be performed.

This may be done regularly for people who suffer frequent severe crises.... sickle cell anaemia

a hereditary disorder – an X-linked condition (see sex-linked) – in which the absence of the enzyme glucose-6-phosphate dehydrogenase (G6PD), which functions in carbohydrate metabolism, results in the breakdown of the red blood cells (*haemolysis), usually after exposure to *oxidants, such as drugs, or infections. The breakdown causes acute attacks that are characterized by pallor, loin pain, and rigors. There are several varieties of G6PD deficiency, which is most common in people of African, Middle Eastern, and Mediterranean descent. Treatment involves identifying and avoiding agents that trigger the haemolysis and treating acute attacks symptomatically. See also favism.... glucose-6-phosphate dehydrogenase deficiency