Anemia is a common problem. In order to define it, I will start with hemoglobin.
Our body burns a lot of energy. We require a lot of oxygen to burn that energy. The problem is that oxygen does not dissolve into water easily, and our blood is mostly water. To work around this, our red blood cells contain hemoglobin, which binds oxygen within the blood to a concentration 70 times higher than plain water. Each hemoglobin contains four arms, with an iron atom in each arm. Oxygen binds to iron, and therefore every hemoglobin molecule binds 4 molecules.
Anemia refers to low hemoglobin. Since red blood cells give our blood its color, people with severe anemia often look pale. There are many causes of anemia. I will focus on iron deficiency anemia.
Iron deficiency anemia is caused by bleeding, often due to gastrointestinal bleeding or menstruation. Failure to ingest enough iron, or to absorb it, can be caused by weight loss surgery, celiac disease (gluten allergy), or vegetarian diet. For many people, iron is lost through bleeding, and this often goes unnoticed by the eye.
Blood testing for anemia include:
Serum iron
The concentration of iron within the blood.
Transferrin
Free iron is toxic, and so iron is transported within the blood attached to transferrin.
Ferritin
Ferritin is a molecule that can store 4500 iron atoms within the cells of the liver, spleen, bone marrow, and elsewhere.
CBC, or complete blood count
This test will demonstrate your hemoglobin level. Your current level should be compared to previous levels to look for a drop over time
People with anemia may feel chronically fatigued. However, you may feel fatigued by just being iron deficient, long before your hemoglobin drops. Your hemoglobin level will drop only after your iron is nearly depleted. Therefore, during an investigation for fatigue, it’s important to check not only a CBC, but your iron level as well.
When you are iron deficient, you may see:
Low serum iron
High transferrin and TIBC (this is your body’s way of ramping up iron transport to tissues)
Low iron saturation, which is serum iron/TIBC (as the TIBC rises, the ratio drops
Low ferritin
Think of ferritin as cash in the bank, and serum iron as the cash in your wallet. If ferritin is low, you are definitely deficient in iron. However, even with a lowered ferritin, you may have normal serum iron. Low serum iron is a late finding, and occurs when the ferritin drops below a certain threshold (when the iron in the bank is nearly depleted, the cash in the wallet will be low).
However, ferritin can be tricky. This is because ferritin is not just a measurement of iron stores, it is also a measurement of inflammation. Iron is necessary for pathogens and cancer cells to grow, and so if you have infection, cancer, or any inflammatory process, the body will hide away the iron from disease causing entities (like hiding your valuables from robbers), in the form of ferritin, causing the ferritin to rise. So, you can have iron deficiency with high ferritin.
If you have iron deficiency, you should take iron once-twice daily. There are many formulations. I usually use carbonyl iron-vitamin C tablet 65-125 mg, once daily. The vitamin C enhances absorption, as does plain soda water. Patients with severe anemia may need an iron infusion, which restores the iron level faster.
You should also have an evaluation for the cause of the anemia to identify and treat the underlying cause. People 45 and up are at increased risk for colon cancer, a common cause of iron deficiency anemia. Resupplying the iron is not enough.