MENTION ANEMIA, and most people think iron-poor blood. Take your iron pills or eat more iron-rich foods, the thinking goes, and you're sure to vanquish the persistent pallor and fatigue that the condition so often causes.
But you should never diagnose yourself with anemia just because you're feeling tired. A lack of energy doesn't always mean you have the condition. Even if you do have anemia, it may not be an iron-poor diet that's making you feel under par.
There are many different types of anemia, and the iron-deficiency type is only one of them.
What brings all types of anemia together under the same umbrella is that there's something wrong with the red blood cells--they aren't able to carry out their job of delivering oxygen to all the tissues of the body. In the case of iron-deficiency anemia, for example, there's not enough iron available to manufacture sufficient amounts of hemoglobin, the substance in red blood cells that holds onto oxygen during transport. The iron shortage could be due to anything from loss of iron-rich blood through menstruation to an iron-poor diet to growth spurts in children.
But there are many other things besides a lack of iron that can impair red blood cells' function. A deficit of folate or vitamin B12, for example, can interfere with normal cell growth and division, thus impairing the body's ability to produce enough red blood cells. Pernicious anemia, a B12 problem, arises when a person consumes enough of the vitamin but can't adequately absorb it from the digestive tract.
Some forms of anemia don't have anything to do with nutrition. Sickle-cell anemia, for instance, is a genetic disorder in which the normally flexible, disc-shaped red blood cells take on a rigid crescent shape. That makes them more fragile. When they break down too soon, the body is unable to replace them quickly enough.
In anemia of chronic disease, which is the most common form of anemia in older people and is often caused by an underlying infection or inflammation, the body is low on hemoglobin. It's not because there isn't enough iron stored in the body. It's because there isn't enough released from storage to make hemoglobin molecules. One theory holds that the body can "freeze" its iron stores in an attempt to keep them from nourishing invading bacteria or cancer cells.
Simply losing blood--whether in a single episode or during slow, hidden bleeding from, say, ulcers or colon polyps--can cause anemia, too, because blood loss means that there's a shortage of red blood cells in the system.
That's why it's so important to seek a doctor's advice if you're feeling unduly fatigued. For example, if you assume that your tiredness stems from an iron or B12 deficiency, but it's really because you're experiencing slow blood loss from polyps in your colon, you could be allowing a potential cancer to progress unchecked. In other words, like a rash or a fever, anemia is both a medical problem in itself and a possible sign of underlying disease. It takes medical detective work to get to the root of the problem.
Working backwards from anemia to the underlying problem
Even if you never bring up fatigue to your primary care physician, most doctors check for anemia with blood tests during routine physical exams. One common test, called a hematocrit, measures the percent of blood cells that are the red, oxygen-carrying type. Another checks for hemoglobin levels. If either test result is low, it's a sign that some type of anemia may be present. Then, more tests, such as those that assess how much iron, folate, or vitamin B12 are in your body stores, can help to determine whether a nutrient deficiency might be at work.
A doctor might also have a few of your red blood cells examined in a laboratory to see whether they're larger or smaller than normal. In the case of a folate or vitamin B12 deficiency, red blood cells are abnormally large. Because a lack of either of the two B vitamins can interfere with normal cell growth and division, newly formed red blood cells fail to divide properly, which leads to the increased size.
Your doctor might also question you about your symptoms, delve into your family medical history, and have you tested for internal bleeding to see if that's what might be causing the anemia. Often, when the problem leading to anemia is located and treated, the anemia resolves on its own.
Anemia Can Be Deadly Serious
IT USED TO BE THAT doctors assumed anemia in older men and women was a normal aspect of aging. But recent research has overturned this belief by showing that anemia in elderly people is linked with a higher risk of death. Doctors made the finding after testing the hemoglobin levels of some 750 people ages 85 and up in Leiden, a city in the Netherlands. Ten years later, those who had been deemed anemic because their hemoglobin concentrations were below normal (less than 12 grams per tenth of a liter of blood for women and less than 13 grams for men) tended to have more instances of ulcers, infections, and cancer--and roughly a twofold higher risk of dying than those whose hemoglobin levels were in the normal range.
Anemia is a red flag for those illnesses. Thus, while it may take some time and testing, doctors should launch a concerted effort to find what might be causing an older person's anemia rather than assume it's part and parcel of old age.