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 Medical Self-Care: Women's Health: Anemia 
 
Are you tired and weak? Does the lining of your lower eyelids look pale?

If so, you could be anemic. But what does that mean?

It means that either your red blood cells or the amount of hemoglobin (oxygen-carrying protein) in your red blood cells is low.

There are several types of anemia:

  • Iron-deficiency anemia is the most common one. In the United States, 20 percent of all women of childbearing age have iron-deficiency anemia, compared to only 2 percent of adult men. The primary cause is blood lost during menstruation. But eating too few iron-rich foods or not absorbing enough iron can make the problem worse. The recommended daily allowance for iron ranges from 6 milligrams for infants, to 30 milligrams for pregnant women. Yet one government source found that females between 12 and 50 years old (those at highest risk for iron-deficiency anemia), get about half of what they need. Pregnancy, breast-feeding and blood loss from the gastrointestinal tract, either due to ulcers or cancer, can also deplete iron stores. Older women who have poor diets, especially when they live alone, often have iron-deficiency anemia.
  • Folic-acid deficiency anemia (megaloblastic anemia), occurs when folic-acid levels are low, usually due to inadequate dietary intake or faulty absorption. The need for this vitamin more than doubles during pregnancy. This is often not met by diets of pregnant women, so a supplement of 400 micrograms (mcg) to 1 milligram (mg) per day of folic acid is recommended throughout pregnancy. You should even take this supplement when you plan to become pregnant. Adquate folic acid should be in your system when you conceive and during the first month you are pregnant. Low folic acid intakes have been associated with low birth weight and neural tube defects, such as spina bifida in babies. Folic-acid deficiency can lead to infertility and an increased risk of infection. Also, a deficiency of this vitamin is seen frequently among elderly women, especially those who have poor diets.

Other, less common forms of anemia include:

  • Pernicious anemia - the inability of the body to properly absorb vitamin B12..
  • Hemolytic anemia - when red blood cells are destroyed prematurely.
  • Sickle cell anemia - an inherited disorder that occurs primarily in blacks, which affects the red blood cells’ ability to carry oxygen to the body’s tissues.
  • Thalassemia anemia - an inherited disorder in the synthesis of hemoglobins (substances that carry oxygen). It is also known as Mediterranean Disease.
  • Aplastic anemia - a serious disease of decreased bone marrow production. Alcohol, certain drugs, large amounts of aspirin and some chronic diseases can also cause anemia.
[Note: Keep in mind that fatigue is often the first symptom of pregnancy.]


Treatment

The first step in treating anemia is to pinpoint the cause. When it results from disease, such as a peptic ulcer, you will need to follow your doctor’s advice to get the condition under control. If it’s due to a poor diet, you’re in luck: Iron deficiency anemia is not only the most common form of anemia, it’s the easiest to correct if it’s due to heavy periods or taking in inadequate amounts of certain foods. Folic acid vitamin supplements may also be necessary. See self-care procedures below.

Self Care Procedures

Are you weak and do you have any of these signs and symptoms?
  • Palpitations, fast or irregular heart beat.
  • Faintness and breathlessness.
  • Bleeding from the nose, mouth, gums, vagina or rectum that is spontaneous.
  • Red dots of bleeding under the skin.
  • Ulcers in the mouth, throat or rectum.
  • Bruising that occurs without reason.
  • Yes:See Doctor
    No
    Do you have blood in your stools or urine or have black, tar-like stools?Yes:See Doctor
    No
    Are you dizzy when you stand up or when you exert yourself?Yes:See Doctor
    No
      Do You:
    • Have menstrual bleeding between periods?
    • Have heavy menstrual bleeding for several months?
    • Normally bleed seven days or more every month?
    • Suspect that you are pregnant?
    Yes:Call Doctor
    No
    Do you have ringing in your ears?Yes:Call Doctor
    No
    Do symptoms of anemia, i.e., tiredness and weakness, go on for at least two weeks despite using self-care procedures (listed below) ?Yes:Call Doctor
    No
    No: Self Care

    Self-Care Procedures for Iron-Deficiency Anemia

    You may need to:

    • Eat more foods that are good sources of iron.
    • Concentrate on green, leafy vegetables, lean, red meat, beef liver, poultry, fish, wheat germ, oysters, dried fruit and iron-fortified cereals.
    • Boost your iron absorption.
    • Foods high in vitamin C - like citrus fruits, tomatoes and strawberries - help your body absorb iron from food.
    • Red meat not only supplies a good amount of iron, it also increases absorption of iron from other food sources.
    • Limit the use of tea. It contains tannins, substances that can inhibit iron absorption. Herbal tea is okay though.
    • Take an iron supplement.
      • Consult your physician for proper dosage.
      • While iron is best absorbed when taken on an empty stomach, it can upset your stomach. Taking iron with meals is less upsetting to the stomach.

        [Note: Recent research is suggesting that high levels of iron in the blood may increase the risk for heart attacks. Do check with your doctor before taking iron supplements, especially if you have already gone through menopause.]

    • Avoid antacids, phosphates (which are found in soft drinks, beer, ice cream, candy bars, etc.) and the food additive EDTA. These block iron absorption.
    • Increase dietary fiber to prevent constipation.
    • Avoid aspirin and products with aspirin.

    To get and/or make the best use of folic acid:

    • Eat good food sources of folic acid daily.
      • These include vegetables like asparagus, brussels sprouts, spinach, romaine lettuce, collard greens and broccoli.
      • Black-eyed peas, cantaloupe, orange juice, oatmeal, whole grain cereals, wheat germ, liver and other organ meats are excellent sources also.
      • Eat fresh, uncooked fruits and vegetables often. Don't overcook food. Heat destroys folic acid.
    • Take a multi-vitamin supplement daily that has 100% of the RDA for folic acid.
    • Don't smoke. Smoking increases vitamin needs.
    • Don't drink alcoholic beverages
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