Anemia: A Global Concern

Written by Ren on Friday December 6, 2019

Anemia may just be the most common chronic condition people contend with worldwide. With nearly 2 billion people estimated to be living with iron deficiency anemia globally, that’s a whopping 25 percent of the world population living with symptoms that can often can impair quality of life significantly. Fortunately, anemia is extremely treatable. It’s all a matter of resource allocation and public awareness. 

Anemia is a slowly progressing condition, taking months, and sometimes even years to fully manifest symptoms. The body has a decent storage system for iron, so it takes a chronic lack of iron intake to disrupt blood cell activity. Blood cells require iron because the hemoglobin--an oxygen-carrying protein--in them utilizes iron in its oxygen caching and delivery processes. When low iron causes blood cell efficiency to drop it can lead to fatigue, shortness of breath, lack of focus, restless leg syndrome, pica, and unusually rapid heartbeat, especially during exercise.  

But what causes iron deficiency anemia in the first place? There are myriad causes, but the most common include blood loss via routine donation, menstruation, or injury, the maternal-fetal bridge during pregnancy, malaria and hookworm infection, and dietary lack of iron. Children and women of reproductive age are typically the most heavily-affected demographics.

Thankfully, anemia is very rarely fatal. While it can be unpleasant to live with, it can also be managed, treated, and reversed effectively and relatively cheaply. 

In the United States and many other countries, fortifying staple foods like grains and infant formula with extra iron has helped to encourage public consumption and reduce anemia incidence. Unfortunately, food fortification efforts miss the subsistence farming demographic who are often living in poverty in rural areas and cannot afford many store-bought goods. 

Iron supplementation has also been an effective means of providing necessary daily values to communities in need. The problem with iron supplements, even when freely offered, is ensuring that patients comply with the recommendation to take them every day. When taken without a supporting meal, iron pills can sometimes be difficult on the stomach and cause internal upset and discomfort, which might deter people from taking them. Another method employed in impoverished areas is the coordinated effort to donate an iron block or ‘lucky iron fish’ to families in need. These ingots of iron are placed in a cooking pot or pan and slowly release 7mg of daily iron into the food as it cooks. This can be a very affordable method of introducing supplementary iron into people’s lives, right at the flashpoint of mealtime. 

The last method of ensuring that a population has ample access to dietary iron is in making sure that food sources are diverse. Foods highest in iron include meat, especially liver and organ meat, lentils, dark leafy greens, cooked oysters, and dark chocolate. By having an infrastructure that is able to provide a wide array of food available at reasonable, universally accessible prices, iron deficiency anemia will become a concern of the past. 

While iron deficiency is overwhelmingly the most common cause of anemia, it's important to note that not all anemia is caused by low iron reserves. Pernicious anemia, or Addison anemia is a blood disorder caused by a vitamin B12 deficiency and results in a flood of large, immature blood cells called megaloblasts that are unable to properly carry oxygen. Sickle cell anemia--an inherited disorder that results in the malformation of blood cells into ineffective ‘sickle’ shapes--is another example of anemia originating from something other than iron deficiency.  Anemia can also occur in tandem with other chronic conditions. Cancer, acute infection, chronic organ rejection, and kidney disease can contribute to a breakdown in iron homeostasis and lead to anemia in a patient. Treating the anemia tagging along with other underlying diseases greatly improves quality of life and overall prognosis, and is generally recommended. 

With thoughtful reallocation of resources, prioritizing public awareness of the signs and symptoms of iron deficiency anemia, and ensuring that food supplies are adequately biodiverse and fortified, we can make big changes worldwide in reducing the incidence of anemia. 

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Sources:

Pernicious Anemia: https://pdfs.semanticscholar.org/5f59/531c4bca0e6ea151792eb851bce70aa0c029.pdf

Iron Deficiency Anemia: http://163.178.103.176/Fisiologia/cardiovascular/Objetivo1/Anemia_por_deficienciadehierro.pdf

Anemia of Chronic Disease: http://www.grg-bs.it/usr_files/eventi/journal_club/programma/nejm2005.pdf

Cardiovascular Effects of Anemia: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.626.3591&rep=rep1&type=pdf

Sickle Cell Anemia: https://pubs.rsna.org/doi/full/10.1148/radiographics.21.4.g01jl23971

Why nutritional iron deficiency persists as a worldwide problem: https://academic.oup.com/jn/article/141/4/763S/4630688?papetoc

Nutritional Anemia: https://bit.ly/2OUyG75

Iron Deficiency Anemia: A Common and Curable Disease: http://perspectivesinmedicine.cshlp.org/content/3/7/a011866.full.pdf

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