health talk:with Dr Johannes Marisa
In medical practice, I have noted that so many patients have visited clinicians already with severe anaemia that would require blood transfusion. Some of these patients would be having shortness of breath while others would be having swollen legs, tiredness or dizziness. However, it is a pity that very few people can now afford blood transfusion as the cost of blood and blood products is unbearably high by merely looking at the average salaries in the market. I appreciate the costs involved in processing blood including for screening of diseases like syphilis, hepatitis and HIV. However, a nurse or doctor cannot afford to pay for only one pint of blood in case he needs it as the cost is around $10 000. Something is amiss and government subsidies should be put as a matter of urgency.
Where is the donor community to rescue the Blood Transfusion Service? Where are the churches to help us?
Anaemia
This is a condition in which you lack enough red blood cells to carry adequate oxygen to your body tissues. This can happen if:
lYour body does not make enough red cells.
lBleeding causes you to lose red blood cells more quickly than they can be replaced.
lYour body destroys red blood cells.
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Signs and symptoms of anaemia
Anaemia signs and symptoms vary depending on the cause. If the anaemia is caused by a chronic disease, the disease may mask them, so the anaemia might be detected by tests for another condition. However, some signs and symptoms which have been commonly found include the following:
lFatigue
lWeakness
lShortness of breath
lTiredness
lDizziness
lChest pain
lCold hands and feet
lPallor of the conjunctiva or hands
Common types of anaemia
Iron deficiency anaemia
This is the most common type of anaemia caused by shortage of iron in your body. Without adequate iron, your body cannot produce enough haemoglobin for red blood cells. Blood loss causes this type of anaemia such as from heavy menstrual bleeding, bleeding varices, peptic ulcer disease, cancers like gastric cancer, hookworms like necator americanus and ancylostoma duodenale, and bilharzia. Remember to regularly deworm yourself with simple tablets like Albendazole or Mebendazole.
Vitamin deficiency anaemia
Besides iron, your body requires folate and vitamin B12 to produce enough healthy blood cells. Shortage of these can result in decreased red blood cell production. Lack of a vitamin B12 carrier protein, Intrinsic factor, can result in severe anaemia.
Aplastic anaemia
This anaemia occurs when your body does not produce enough red blood cells. Causes of aplastic anaemia include infections, certain medicines, autoimmune diseases and exposure to toxins.
Anaemia of chronic diseases
Certain diseases such as cancers, renal failure, HIV and Aids, rheumatoid arthritis and Crohn’s disease can interfere with red cell production. Kidneys are a source of erythropoietin needed to make erythrocytes. Anaemia therefore comes.
Sickle cell anaemia
This is an inherited and sometimes serious haemolytic anaemia caused by a defective form of haemoglobin that forces red blood cells to assume an abnormal crescent shape. These irregular blood cells die prematurely, resulting in chronic shortage of red blood cells.
Complications of anaemia
If left untreated, anaemia can cause many health problems which include the following:
Severe fatigue: One can be so tired that completing tasks may be very difficult.
Pregnancy: Pregnant women with folate deficiency may be more likely to have complications like premature birth or malformations.
Heart problems: Anaemia can lead to a rapid and irregular heart. When there is anaemia, your heart must pump fast to compensate for the lack of oxygen in the blood. This can lead to enlarged heart or heart failure.
Death: Some inherited anaemias such as sickle cell anaemia can lead to life-threatening complications. Losing a lot of blood quickly can result in acute, severe anaemia that can kill.
Diagnosis
Common tests which can be done even in resource-limited settings include:
Full blood count: Check if there is microcytosis or macrocytosis on mean corpuscular volume (MCV). Low MCV may point to iron deficiency while high levels are common in vitamin B12 deficiency anaemia, alcoholism and some anti-retroviral drugs like Zidovudine.
Vitamin B12 levels: Vitamin B12 levels can be investigated and if there is shortage, then prompt treatment is given.
Bilharzia fluorescent antigen test (BFAT): Bilharzia can be investigated through an antigen blood check.
Urine microscopy: Bilharzia ova can be detected in the urine.
Stool microscopy: Worms should be investigated and the ova can be detected in the stool.
Other disease screening like HIV and Aids, renal failure, malaria and Crohn’s disease.
Treatment
For iron deficiency anaemia, take iron supplements in the form of tablets or syrups. Iron-rich foodstuffs include beans and lentils, baked potatoes, cashews, spinach, whole grain and enriched breads.
Vitamin B12 deficiency anaemia requires vitamin B12 supplementation usually through periodic injections of vitamin b12.
Anaemia of chronic disease needs to correct the underlying condition like HIV treatment or renal correction.
Blood transfusion if haemoglobin is less than 6g/100ml and now with one pint costing that much, how many will afford?
lDr Johannes Marisa is a medical practitioner who can be accessed on: [email protected]
