Happy Sunday readers! For those who are
viewing our blog for the first time, allow me to give you a brief idea about
anemia. Let’s have an interview with one of the medical field expert, Dr. Allen
Nissenson.
Dr. Allen Nissenson is a
professor of medicine and director of the dialysis program for the David
Geffen School of Medicine at the University of California, Los
Angeles. He has written two medical textbooks on kidney disease treatment and
was president of the National Anemia Action Council, a patient advocacy
group.
Q: Anemia can
result from a wide range of diseases and conditions. What are the most
prominent causes?
A: The biggest categories
are nutritional anemias, which are mainly iron deficiency, but also
deficiencies in folic acid or vitamin B12. Another major
cause is bleeding, usually from the gastrointestinal tract. Chronic diseases
that have an inflammatory component, like rheumatoid arthritis, can also cause anemia.
And then there’s cancer itself, or the side effects from
treating cancer, that can cause anemia. Another prominent cause is deficiencies
in erythropoietin, or Epo, a hormone that stimulates red blood cell production,
which is almost entirely a problem in people with kidney disease.
Q: A lot of
symptoms of anemia share the same characteristics as being overworked or just
tired. How do you tell the difference between normal fatigue and anemia?
A: You really can’t. One of
the dilemmas with anemia is that the symptoms are pretty ubiquitous: tiredness,
weakness, some difficulty in thinking clearly. They’re all kind of vague.
So what we tell people is
if you have these symptoms and they go on for a long time or seem to be
interfering with your ability to function normally, then you should see your
doctor. One of the things you need to get checked is your hemoglobin level — the protein that
carries oxygen in red blood cells — to see if that’s part of the anemia.
Q: Is there a
specific cutoff point of hemoglobin that indicates whether someone is anemic?
A: One of the challenges is
defining what normal is, and there’s no uniform acceptance of normal hemoglobin
levels. The one most doctors use is from the World
Health Organization. A hemoglobin level below 13 for men and below
12 for women is considered anemic.
Q: Nutritional
deficiencies are a common cause of anemia. Do these arise from a poor diet or underlying disease?
A: Bleeding is one of the
most prominent causes of iron deficiency, because when you bleed you lose red
blood cells that contain iron. But there still is a significant prevalence of
nutritional iron deficiencies, which is much more common in pregnant women and
children because of their diets.
Nutritional iron deficiency
is the biggest cause of anemia worldwide, and it’s a problem is some segments
of the United States. For folate or vitamin B12, it’s much less common to be
deficient.
Q: How
difficult is to live with anemia?
A: It’s very tough. One of
the things we learned, however, is that the ability of the body to adapt is
tremendous. Over time, even people with moderately severe anemia say, “You
know, I really don’t feel that bad.”
Although people are fatigued
or can’t do as much as they could before, they slowly adapt their lifestyle.
Instead of walking to the grocery store once a week, they may go once a month
and buy everything they need because they’re too tired to keep going back.
There’s a lot of adaptation that takes place, but anemia can be very
debilitating.
Q: Is anemia
life-threatening?
A: The only
life-threatening anemia is if you have massive hemorrhaging. But chronic anemia
can be life-threatening indirectly in the sense that prolonged, severe anemia
can cause the heart to enlarge and overwork, leading to heart failure. So through that mechanism,
anemia can lead to serious morbidity or mortality.
Q: The Food and Drug Administration has issued
warnings on three similar anemia drugs: Procrit, Aranasep and Epogen. How safe
are these to use?
A: The studies that raised
the red flags were either in cancer patients or in people with kidney disease,
and they all showed something similar: if you attempt to correct the anemia
completely back up to normal hemoglobin levels, that’s not a good idea. You
start getting strokes or heart attacks, blood-clotting problems or increased
mortality.
The recent studies that the
F.D.A. flagged were just studies. Kidney specialists weren’t practicing this
way — they were waiting for the studies. So we’re going to continue practicing
the way we were, which is to give modest doses of the drugs, with modest
improvements in hemoglobin.
Q: Are the
drugs potentially dangerous for the elderly or other groups?
A: There are no studies to
help us figure that out. There’s no question that since cancer patients and
kidney patients are so different, but the same problem has arisen, I think
people need to be extremely cautious with the use of these drugs.
One dilemma now is that if
someone wanted to do a study on normalizing hemoglobin levels in the elderly
with these drugs, I think an institutional review board that has to approve the
ethics of studies like this would have a very difficult time because of the
concerns of the risks.
Q: The F.D.A.
says the drugs are safe to use in small doses that keep oxygen-carrying
hemoglobin just below a level that is considered normal. Is this enough to help
anemia patients feel better?
A: The quality of life
benefit is seen with pretty modest increases of hemoglobin. It looks like you
get the biggest bang for the buck early on. If you push the doses, then you
start to see the toxicity.
Q: Are red
blood cell transfusions a potentially safer option given the new concerns about
the drugs?
A: As long as you’re aiming
for a moderate increase in hemoglobin, the drugs are so much simpler and have
few or any side effects unless you start pushing them hard. Whereas with
transfusions, you still have the risk of infectious diseases and other issues.
Q: Are there
lifestyle measures, like diet or exercise, that can treat anemia?
A: In the chronic
conditions, there is probably very little that can be done. Obviously for
nutritional anemia, improving nutrition will help. Probably the only thing you
can do is to go to a higher altitude, because there’s less oxygen available.
As a result, the cells that
make Epo detect that and then stimulate Epo to make more red blood cells. Even
people with chronic illnesses have slightly higher hemoglobin when they go to
altitude for a period of time.
Retrieved from The New York Times
