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Posted July 28, 2009 | Copyright © The Northern Virginia Daily
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Tiredness, shortness of breath can be signs of anemia


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By Elizabeth Wilkerson -- ewilkerson@nvdaily.com

WINCHESTER -- Since surviving typhoid fever when she was 8 years old, Helen Arthur has always been "dog tired."

"I think being tired all your life, you learn to adjust to it and you know your limitations," said Arthur, an 86-year-old Winchester resident.

Most of her life, Arthur has had anemia, a condition in which the blood has a lower-than-normal number of red blood cells, according to the National Heart, Lung and Blood Institute. The most common symptom of anemia is fatigue.

As a child, Arthur earned low grades in physical education because she "simply did not have the energy to get out there and play," she said. As an adult, she spent her workday breaks resting, she said, and others questioned whether her fatigue was genuine or just in her head.

"You really learn not to give a hoot about what people think about you," she said, "because they don't know what you're going through."

Blood, which is made in bone marrow, is made up of oxygen-carrying red blood cells, infection-fighting white blood cells and platelets, which help the blood to clot, said Dr. Bill Houck Jr., an oncologist/hematologist with Shenandoah Oncology Associates in Winchester. Under normal circumstances, red blood cells are released into the bloodstream when they're 10-14 days old and live for about 120 days, he said.

"If, for some reason, the red blood cells are not surviving 120 days, the bone marrow has to increase its production, or else the level of red cells becomes low, which is what we call anemia," Houck said.

Red blood cells could live fewer than 120 days because they're being lost through bleeding or destroyed faster than normal, he said.

"The bone marrow has a remarkable capacity to compensate for shortened red cell survival as long as it has the building blocks that it needs to make new red cells," he said. Those building blocks include vitamins, such as B12, and minerals, such as iron, he said.

"There is a tendency, also, for people to think low iron and anemia are the same thing," he said. "They are not. Low iron is one cause of anemia," as is low B12, he said.

Normally, Houck said, people take in the necessary vitamins and minerals in the foods they eat. But, "if for some reason our body's not absorbing the B12 or the iron, then, over time, the reserve we have gets depleted," he said.

"Your car will run perfectly well on one 16th of a tank, but when it runs out, it stops," he said. "And, you won't have any way of knowing that your tank is getting low until you run out."

A patient also could have a lower-than-normal red blood cell count if production of the cells has decreased, he said, which could be caused by some injury to the bone marrow or "something malignant, like leukemia." And, there are certain familial anemias, where the body destroys the cells early, often because of cell deformities, he said.

Arthur said her doctor explained to her that her kidneys are not producing a certain protein and "therefore the marrow in [her] bones cannot produce red blood cells." To correct the problem, she receives shots of aranesp, a man-made form of the protein she lacks.

"I was getting them once a month, and the last week I would be so dog tired" that they were moved up to once every three weeks, she said. The shots pep her up, though "being 86 and everything I don't imagine I'm going to be skipping rope anytime soon," she said.

Normally, red blood cells are very pliable, Houck said, but, "just like people, as they get older they get stiffer." Eventually, they can no longer pass through the spleen, which is a filter, he said, and the components of the cells are reused.

"Our bodies are the ultimate recycling system," he said. But, if red blood cells are being lost through bleeding, whether it be women's menstrual cycles or someone giving blood, there's nothing to recycle, he said.

Houck said he thought iron deficiency anemia was likely the most common type of anemia in the United States.

The big group at risk for iron deficiency anemia is women, he said, because of their menstrual blood loss and childbirth. This form of anemia is also common in parts of the world where parasites, which can cause internal bleeding, are an issue, he said.

And, "as we get older, the bone marrow tends not to function quite as well, and so older people are a little more prone to mild anemia," he said.

The general symptoms of anemia are fatigue and lack of energy, he said, but shortness of breath can be a symptom in severe cases, since red blood cells carry oxygen. Houck said he often describes red blood cells as "little trucks carrying oxygen."

"If, for some reason, you don't have enough trucks, those trucks have to go faster" and make more trips to deliver oxygen, he said. The heart is the engine for those trucks, he said, so "if you get significant anemia, you might have a faster heartbeat."

"If you've got heart disease, and the heart can't keep up like normal, then the same level of anemia's going to bother you more than it would someone with a healthy heart," Houck said. "If you've got lung disease, the truck gets a smaller load than normal, because the lung's not getting the oxygen into it."

For iron deficiency anemia, iron is usually given by mouth or intravenously, he said, and B12 can be injected if the body can't absorb it otherwise. If the patient's losing blood, the doctor must identify the source of the blood loss and try to correct it, he said.

If a person suspects they may have anemia, when they should see a doctor "depends on how profound the fatigue is" and "if it's really out of proportion to what they expect of their normal lifestyle," he said. The test for anemia is extremely simple and inexpensive, he said.

"There are a whole lot more tired people than there are anemic people," he said.

A complete blood count will reveal whether a person's red blood cell count is low, he said, and there are "some fairly simple things that we can do to tell whether the bone marrow's not producing" or cells are being lost early.

Particularly with patients with iron deficiency anemia, he said, it's important to make sure they're not bleeding from their bowels.

"I think checking the stool for blood should be a routine part of the work up of anybody who's anemic," he said.

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