Abstract
The aim of this paper is basically to discuss anemia. There are many aspects related with anemia. Anemia is a blood disease which is characterized by reduced level of red blood cells. Red blood cells are produced in the bone marrow with the help of other components like iron, hemoglobin and erythropoietin. If any of these in not adequate, anemia may result. When red blood cells are produced with less hemoglobin, transportation of oxygen will not be possible. The recommended hemoglobin level is different for men and women. For a man to be described as anemic, their hemoglobin level must be less than 13.5 gram/100ml. For women to be described as anemic they should have hemoglobin level which is less than 12.0 gram/100ml. Anemia has many causes and occurs in different types which are discussed in this paper. Some of the causes include; heavy blood loss, iron deficiency, vitamin deficiency, genetic conditions like sickle cell anemia, alcoholism and increased iron needs during pregnancy. Types of anemia discussed include; sickle cell anemia, Megaloblastic anemia, pernicious anemia, iron deficiency anemia and anemia associated with chronic kidney disease. For an individual to know whether or not they are suffering from anemia, it is important to look out for signs and symptoms associated with it like fatigue, paleness, palpitation, general malaise, chest pain, angina, heart attack, dizziness, fainting and rapid heart rate. For a correct diagnosis of anemia, individuals are advised to visit health care facilities in order to receives tests which can prove anemia and determine its cause since it a symptom of another disease. Medical treatment is recommended and prevention of anemia can be achieved through health living habits.

Introduction
Anemia is the most common blood disease in the United States. It is characterized by reduced level of red blood cells which are responsible for transporting oxygen from the lungs to the other parts of the body by use of hemoglobin. There are many causes of anemia including heavy blood loss, iron deficiency, vitamin deficiency, and genetic conditions like sickle cell anemia, alcoholism and increased iron needs during pregnancy among others. Symptoms associated with anemia include fatigue, paleness, palpitation, general malaise, chest pain, and angina, heart attack, dizziness, fainting and rapid heart rate (MedlinePlus, 2011). Anemia can occur in different types like sickle cell anemia, Megaloblastic anemia, pernicious anemia, iron deficiency anemia and anemia associated with chronic kidney disease only to mention a few. It is important for patients to visit hospitals any time they suspect symptoms of anemia in order to undergo tests which help in the diagnosis of anemia (MedlinePlus, 2011). The tests include laboratory tests, physical examination and medical history. Anemia can also be prevented through frequent examination, intake of healthy and nutritious foods and health living habits.
Anemia
Anemia is usually a condition characterized by abnormal and unexpected decrease in the total amount of total red blood mass in the body. Generally, anemia results when the body does not have sufficient amount of healthy red blood cells. Red blood cells are responsible for supplying the body tissues with oxygen (MedlinePlus, 2011). For a person who has anemia, his/her red blood cells do not supply sufficient oxygen to the rest of the body. Anemia can also occur when red blood cells lack sufficient amount of hemoglobin. The recommended hemoglobin level is different for men and women. For a man to be described as anemic, their hemoglobin level must be less than 13.5 gram/100ml. For women to be described as anemic, their hemoglobin level should be less than 12.0 gram/100ml. However, the hemoglobin levels depend on the laboratory reference being used. Anemia is the most common blood disease especially in the United States (MedlinePlus, 2011). There is increased risk of anemia among women and individuals with chronic diseases.
Blood
Sometimes people may assume that the body is full of blood and it is difficult to have insufficient blood. This is a wrong assumption since blood only occupies approximately 7% of the total body volume (Uthman, 1998). Blood comprises of two parts which are the liquid part known as the plasma and the cellular part. The cellular part contains red blood cells, white blood cells and platelets. Red blood cells are very crucial when it comes to anemia (MedlinePlus, 2011). The main function of red blood cells is to supply oxygen from the lungs to the other parts of the body. The red blood cells are made in the body through specific steps (MedlinePlus, 2011). They are first manufactured in the bone marrow and after all step required for them to manufactured are complete, they are released to the blood stream. Red blood cells do have nucleus but have hemoglobin as their main functional unit. Iron is an important component of hemoglobin and is crucial in formation of red blood cell (Ross, 2000). Erythropoietin is a molecule secreted by kidney and promotes formation of red blood cells (MedlinePlus, 2011). The life span of red blood cells is approximately between 90 and 120 days. After this period, the old red blood cells are removed from the body after which erythropoietin gives a warning to the bone marrow which in turn responds by making more red blood cells. Since hemoglobin is responsible for carrying oxygen inside the red blood cells, it gives blood the red color.
Causes of Anemia
Anemia is normally caused by lack of enough red blood cells or hemoglobin in the body. There are various medical and non medical conditions which result to anemia. The first cause of anemia is heavy bleeding leading to loss of large amounts of blood. Heavy bleeding can result due to injury, accidents, or heavy menstrual bleeding (Ross, 2000). Internal bleeding can occur for a very long period of time but the patient does not notice (National Center for Biotechnology Information, 2011). This unnoticed bleeding may be due to gastrointestinal problems like ulcers, hemorrhoids, gastritis, or cancer. Excessive blood loss leading to anemia can also occur during labor and child birth especially if not in hospital setting. The second cause is decreased or faulty red blood cell production. Production of red blood cells is a continuous process and it should be in a way that the amount produced is sufficient enough to supply oxygen all over the body (MedlinePlus, 2011). However, if the red blood cells produced in the bone marrow are few or are not in good functioning order, anemia can occur (National Center for Biotechnology Information, 2011). Red blood cells are considered as faulty is they do not have all the components required for them to function optimally. There are several conditions which can contribute to faulty or less red blood cells. These conditions include; sickle cell anemia, iron deficiency anemia, vitamin deficiency, bone marrow and stem cell problems, and other health related conditions (MedlinePlus, 2011).
Sickle cell anemia is a genetic condition inherited from one family member to another especially parents (Ross, 2000). In this condition, the red blood cells have a crescent shape and breakdown within a very short time hence they do not stay for the required time to supply oxygen to all parts of the body. This results to anemia. Since the red blood cells are crescent shaped, they are likely to be stuck in small blood cells causing pain in the body (Mayo Clinic Staff, 2011). The crescent shape of the red blood cells is associated with abnormal hemoglobin which is related to quality and functionality. Iron deficiency is also another cause of anemia which results when there is insufficient amount of iron mineral in the body. Iron is very crucial in the production of hemoglobin and if inadequate, red blood cells will not have enough of hemoglobin. Iron may be inadequate as a result of poor dietary intake or due to chronic bleeding. Anemia caused by iron deficiency, is referred to as iron deficiency anemia (Mayo Clinic Staff, 2011). Iron deficiency has also been associated with increased need due to pregnancy and lactation, inhibitors available in foods like tea and caffeine, and endurance training without replacement.
Vitamin deficiency is also a big contributor towards development of anemia. The two main crucial vitamins whose deficiency can lead to anemia are Vitamin B12 and folic acid (Mayo Clinic Staff, 2011). These two vitamins are also very important in production of hemoglobin. When they are deficient, the body cannot produce adequate red blood cell resulting to anemia. The deficiency of these two vitamins is mostly associated with poor dietary in take. Vegetarians are at a greater risk of suffering from vitamin B12 deficiency since it’s normally from animal sources (MedlinePlus, 2011). Bone marrow and stem cell problems hinder the body from producing sufficient red blood cells. Stem cells found in the bone marrows sometimes turn in to red blood cells. However, if they are too few, faulty or are replaced by other cells like the metastatic cancer cells, anemia may result. Diseases to the bone marrow like leukemia hinder the production of red blood cells resulting to anemia (Mayo Clinic Staff, 2011). Kidney disease is also another cause of anemia because when the kidney is sick, the production erythropoietin is hindered hence the production of red blood cells is reduced leading to anemia (Mayo Clinic Staff, 2011). Individuals suffering from chronic kidney disease are at a high risk of becoming anemic.
During pregnancy, there is increase in volume of water in the body which is seen as anemia. This is called physiological anemia and is mostly seen as normal condition during pregnancy. There is another condition called thalassemia which is a cause of anemia related to hemoglobin. Thalassemia is hereditary affecting the quantitative aspect of hemoglobin (MedlinePlus, 2011). This means that if thalassemia is present, the amount of hemoglobin produced is not sufficient enough. Alcoholism has also been found to be a contributor to the development anemia because deficiencies in vitamins and minerals have been closely associated with alcoholism. Viral infections, chemotherapy and other medications have also been found to affect the bone marrow adversely reducing the amount of red blood cells being produced. Hemolytic anemia is the type of anemia which is caused by hemolysis of red blood cells (Uthman, 1998). Once hemolysis take place, the red blood cells become dysfunctional resulting to anemia. There are some medications which have been found to result to anemia including chemotherapy, transplant medications, HIV medications, antibiotics like penicillin and chloramphenicol, antifungal medications and antihistamines (MedlinePlus, 2011). These medications cause processes which destroy the red blood cells causing anemia. There are other causes of anemia which are not common such as lead poisoning, exposure to insecticides, viral hepatitis, paroxysmal nocturnal hemoglobinuria and parasitic infections among others.
Symptoms of Anemia
Symptoms are those warning signs manifested in people indicating anemia or process of developing anemia. Since anemia is characterized by reduced amount of red blood cells, there is reduced supply of oxygen to different organs of the body producing signs and symptoms related to anemia (National Center for Biotechnology Information, 2011). In case of very mild or chronic and occurring progressively anemia, symptoms may not be eminent until it reaches the severe stage. Some of the symptoms include; fatigue, decreased energy, weakness, shortness of breath, paleness, lightheadedness, palpitations (Ross, 2000). All these symptoms are associated with reduced oxygen supply (Ross, 2000). Sometimes anemia may proceed to the severe stage in which the patient may experience chest pain, angina, heart attack, dizziness, fainting and rapid heart rate as the heart tries to supply the little oxygen through out the body.
It is advisable that every individual be aware of the signs indicative of anemia. These signs include change in the color of the stool, low blood pressure, yellow skin color, heart murmur and enlargement of the spleen (National Center for Biotechnology Information, 2011). General malaise is also a common symptom of anemia. One should be on the look out for any of these so that they can seek immediate medical attention.
Types of Anemia
There are many types of anemia mostly depending on the causes. For different causes, anemia is given different names. The first type of anemia is iron deficiency anemia which results due to lack of sufficient iron in the body. Lack of adequate iron in the body may result from blood loss or poor dietary practices. Whenever the body loses large amounts of blood, iron is also lost and if it is not replaced within the shortest time possible, it can lead to anemia. Blood loss may be due to injuries or internal bleeding caused by internal injury (MedlinePlus, 2011). Poor dietary practices include consumption of foods not rich in iron or consumption of foods rich in iron but have inhibitors and bidders which reduce the bioavailability of iron difficult. When iron is lacking in the body, red blood cells cannot be produced since iron is one major requirement for their production. There is increased requirement for iron among pregnant women and therefore they should take foods high in iron, or otherwise end up having iron deficiency anemia (MedlinePlus, 2011).
The second type of anemia is pernicious anemia which normally occurs due to lack of vitamin B12. Deficiency of vitamin B12 is very rare; therefore pernicious anemia normally occurs due to poor absorption of vitamin B12. Poor absorption of vitamin B12 results from diseases like Crohn’s disease, intestinal parasite infection, removal of one part of the intestine or stomach through surgery, and HIV infection. In addition to these conditions, vitamin B12 is normally found from animals sources (MedlinePlus, 2011). Therefore, vegetarians should be very careful to find ways to get vitamin B12 or otherwise they may get pernicious anemia. Vitamin B12 is very crucial in the production of red blood cells and therefore if it is deficient, anemia is likely to occur.
The third type is folic acid deficiency anemia also be known as Megaloblastic anemia. Folic acid/folate is a very important vitamin in the production of red blood cells. Consumption of a diet poor in folic acid or if the body is unable to utilize folic acid Megaloblastic anemia is likely to occur (MedlinePlus, 2011). This is due to the fact the folic acid available is not sufficient enough to promote sufficient production of red blood cells. Therefore lack of enough folic acid in the body results to the type of anemia known as the Megaloblastic anemia. There some illnesses which result to poor absorption of folic acid in the body even if one is taking adequate amounts of folic acid.
The fourth type of anemia is hemolytic anemia which normally results from deformation of red blood cells (Ross, 2000). It is normally an inherited disease which results from inherited blood disorder, harmful substances or from other drugs taken with the aim of curing a particular illness. In most cases, this kind of anemia is passed from one generation to another in the family. For individuals who suffer from hemolytic anemia, their red blood cells are broken down in the body so fast that they cannot carry sufficient oxygen required to all parts in the body (Mayo Clinic Staff, 2011). The red blood cells are deformed and lose the capacity to adequately carry oxygen from the lungs to the other parts of the body.
The fifth type is sickle cell anemia also an inherited disease. For this type of anemia, red blood cells have a sickle or a crescent shape (Ross, 2000). The red blood cells produced in the bone marrow are abnormal and do not stay in the body long enough as normal cells stay. Due to their crescent shape, they get stuck between other smaller blood cells and hence block the flow of the blood which can lead to pain and damage to some body organs. It results from a genetic problem in which one has two sickle cell genes mostly likely inherited from each parent. For individuals with sickle cell anemia, their hemoglobin has both qualitative and functional problems (Mayo Clinic Staff, 2011). Due to the crescent/sickle shape of the red blood cells, hemoglobin clog blood vessels and they break down very easily resulting to anemia.
The sixth type of anemia is aplastic anemia which occurs due to problems of the bone marrow and stem cell (Ross, 2000). Problems with bone marrow and stem cells hinder the body from producing sufficient red blood cells to supply oxygen all over the body. Aplastic anemia occurs when the stem cells are few or are not available all together (Garrison, 2009). It is sometimes associated with genetic factors while at some other times its cause is not clearly known. It has been associated with injury to the bone marrow by medications, radiations, chemotherapy or infection.

Diagnosis of Anemia
For doctors, it is not difficult to detect anemia. Sometimes it can even be diagnosed through observation but it is always advisable to confirm that using a lab test. It can be diagnosed using a blood sample then further tests are done to come up with the possible cause of the disease (Uthman, 1998). Medical history of the patient is also very crucial as it helps the doctor know if there could be a chance of inherited anemia like sickle cell anemia (National Heart Lung and Blood Institute, 2010). Physical examination like paleness of the nails, jaundice, fatigue and enlarged spleen helps in diagnosis. In most times, anemia has been termed as a symptom of another disease. This makes it necessary to contact more tests to come up with the real cause of anemia in order to treat it. There are several lab tests done to confirm anemia. The first one is complete blood count (CBC) which is used to determine the severity and the type of anemia. In most cases, it is the first test done on anemic patients. The second is stool hemoglobin test which tests if there are any traces of blood in the stool. Blood in the stool is an indication that there is bleeding either in the stomach or in the intestines. Third is peripheral blood smear meant to evaluate blood cells (National Heart Lung and Blood Institute, 2010). It assesses size, shape, number and color of the red blood cells. Fourth is iron level which assists in determining if the patient is suffering from iron deficiency anemia or not. This test is not done alone but together with tests to determine the capacity of the body to store iron. Some of these accompanying tests include transferring and ferritin level. The fifth test is transferring level which is meant to assess the condition of the protein which carries iron around the body (National Heart Lung and Blood Institute, 2010). Sixth is ferritin level aiming at determining the total amount of iron available in the body. Seventh is folate level since it is needed in making of red blood cells and is usually low in individual with poor dietary practices (National Heart Lung and Blood Institute, 2010). Eighth is vitamin B12 level which is also required in production of red blood cells and is usually low in individuals with poor dietary practices or in case of pernicious anemia. Ninth is bilirubin a test which helps in finding out whether or not red blood cells are being destroyed in the body or not. If red blood cells are being destroyed in the body, it is a sign of hemolytic anemia (Ross, 2000). Tenth is lead level especially because lead toxicity has been found to be a great contributor towards anemia in children (Mayo Clinic Staff, 2011). The Eleventh one is hemoglobin electrophoresis a test used for people with family history of anemia. It is usually a proof of sickle cell anemia or thalassemia. The Twelfth is reticulocyte count which measures the total amount of new red blood cells being produced in the bone marrow. Thirteenth is liver function tests which helps to determine the working conditions of the liver. This test may help in identifying the underlying causes of anemia (Mayo Clinic Staff, 2011). Fourteenth is kidney function test which helps to identify if there is a kidney dysfunction or not. The fifteenth is bone marrow biopsy a test carried out when there is suspicion of a bone marrow problem. It determines the capability of the bone marrow to produce the red blood cells.
Treatment of anemia
It is very easy to teat anemia especially if the cause is known. The patients are advised to take care of themselves by taking medications as prescribed, avoiding harmful medications and alcohol and adequate dietary intake. Medical treatment is also very important and it depends on the cause and the severity o anemia. Anemic patients may be treated as outpatients or in patients depending on severity of the condition (MedlinePlus, 2011). Blood transfusion, intake of iron medications and intake of foods high in iron may be some of the medical treatments prescribed.
Anemia Prevention
Anemia can be easily preventable especially if it is not associated with genetic factors (Garrison, 2009). Consumption of healthy nutritious foods and avoiding alcohol can be some preventive measure (MedlinePlus, 2011). It is also advisable to make frequent visits to the doctor for assessment even if there are no signs of anemia.
Terminologies
Anemia- a blood condition resulting from few red blood cells and less quantity of hemoglobin (Ross, 2000)
Red blood cells-blood cells produced in the bone marrow and responsible for carrying oxygen from the lungs to other parts of the body (Ross, 2000)
Hemoglobin- a protein which helps red blood cells to carry oxygen (MedlinePlus, 2011)
Erythropoietin – a molecule produced by the kidney and promotes production of red blood cells (MedlinePlus, 2011)
Sickle cell anemia- a genetic type of anemia resulting from crescent shaped red blood cells (Ross, 2000)
Megaloblastic anemia- a type of anemia resulting from lack of folic acid (Ross, 2000)
Aplastic anemia- a type of anemia resulting from problems with stem cells and bone marrow (Ross, 2000)
Hemolytic anemia- a type of anemia resulting from deformation of red blood cells (Uthman, 1998)
Thalassemia- it is a genetic defect which affects production of hemoglobin (Ross, 2000)
Bone marrow- a soft blood issue where red blood cells are produced (MedlinePlus, 2011)
Cancer- an abnormal and uncontrolled growth of cells (Garrison, 2009)
Pernicious anemia- a type of anemia resulting from lack of vitamin B12 (Ross, 2000)
Blood count- the total amount of red blood cells in the blood (Ross, 2000)

Reference
Garrison, C. (2009). The Iron Disorders Institute Guide to Anemia. Naperville, Sourcebooks, Inc
National Heart Lung and Blood Institute. (2010). Anemia. Retrieved June 14, 2011, from http://www.nhlbi.nih.gov/health/dci/Diseases/anemia/anemia_whatis.html
Uthman, E. (1998). Understanding Anemia. Mississipi: University Press of Mississippi
Ross, A. (2000). Everything You Need to Know About Anemia. New York, Rosen Publishing Group, Inc
National Center for Biotechnology Information. (2011). Anemia. Retrieved June 14, 2011, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001586/
MedlinePlus. (2011). Anemia. Retrieved June 14, 2011, from http://www.nlm.nih.gov/medlineplus/anemia.html
Mayo Clinic Staff. (2011). Anemia. Retrieved June 14, 2011, from http://www.mayoclinic.com/health/anemia/DS00321