Ever wondered if there's more to your fatigue than meets the eye? Join Professor Jonathan Sackier and Dr. Nigel Guest as they guide you through the world of anaemia… from the esoteric to the bleeding obvious.
From the basics of red blood cell deficiency to the intricacies of different symptoms, they're here to shed light on this commonly underestimated condition. Repair to anaemia, where Professor Sackier enlightens us as to the various types and their unique characteristics. From bleeding-related anaemia to the complexities of chronic causes and blood disorders, Dr. Guest delves into the diagnostic realm, unveiling the array of methods used to detect anaemia. From comprehensive medical histories to physical examinations and full blood counts, discover the tools that aid in uncovering this silent blood thief.
The conversation takes a turn when The Docs stumble upon a rare and blood-curdling case of auto-vampirism, where an individual was found to be consuming their own blood—talk about a blood thirsty situation! Lucky Nigel carries garlic wherever he goes. Well... he smells like he does!
They will chat about treatment and management strategies and explore the role of iron supplementation and folic acid during pregnancy, vital for maintaining healthy blood levels and preventing complications.
You will hear about some strange cravings caused by anaemia, come might call it rocket science! Or arugula science for our American listeners. Dive deeper into the realm of genetic anomalies with discussions on sickle cell disease, thalassemia, and emerging gene editing techniques.
But how are advancements in modern medication reshaping anaemia treatment? You’ll find all of this out, and more, in this week’s episode.
Professor Jonathan Sackier, March 2024
My hometown, London, England, boasts nearly 1,000 blue historical plaques to mark where the famous resided or worked. On the wall of 15A Grafton Street a plaque notes Sir Henry Irving lived there from 1872 -1899. Irving was a prominent actor and theatre owner, a celebrity of the latter part of the 19th century. About two miles west, at 19 St. Leonard’s Terrace, another plaque commemorates the London residence of Bram Stoker, Irving’s assistant, and the author of the most famous Gothic horror novel of them all, Dracula.
The story was based on the life and exploits of Vlad the III otherwise known as Vlad the Impaler, given his penchant for placing the heads of those who displeased him on spikes for all to see. As far as we know, however, he did not suck blood from necks, did not feel dead on his feet, slept in a coffin nor avoided garlic! But given all the movies, one would have to live in the wildest Transylvania not to know that Dracula’s victims displayed all the symptoms of anaemia, the topic of this article.
Anaemia originates from the Greek, anaimi, meaning “lack of blood.” Circulating blood contains various components and performs several functions; leukocytes or “white blood cells” fight disease, platelets help clotting, serum contains various chemicals and erythrocytes or “red blood cells” (RBC) collect oxygen from the lungs and dump carbon dioxide to be exhaled. These cells contain haemoglobin, the clever substance that manages gas transport. RBC are shaped like a “biconcave disc,” a fancy way of saying they look like a doughnut, but without a hole in the middle. And no jam.
Anaemia occurs if there is either insufficient RBC, insufficient haemoglobin or the haemoglobin present is not working properly. If red cells are scarce that could be due to inadequate production, destruction inside the body or one is losing blood – which is rather careless frankly!
Failure to produce RBC or sufficient haemoglobin:
Destruction of RBC:
Blood Loss
Symptoms and Signs
In addition to the effects of whatever is inducing anaemia, symptoms may be subtle such as fatigue, poor sleep, breathlessness or even chest pain as the heart works hard to oxygenate the body with the little blood available to it. On examination a physician may see pale membranes inside the eyelids or mouth, detect a faster heart rate, hear a murmur, and find signs of the underlying cause.
Investigations
“Why did Dracula break up with his girlfriend after she had a blood test – she wasn’t his type!” Investigations will include blood tests to measure the amount of haemoglobin, number, size and shape of red cells and evaluations of the sort of precipitating circumstances described above, perhaps including a bone marrow biopsy or various scans or endoscopic views of the gut, bladder and so on.
Treatment
This depends on the cause, but might include dietary supplementation, suppression of the immune system, drugs such as erythropoietin that stimulate red cell production or even blood transfusion. And as a side note, please consider helping Dracula and give blood - becoming a blood donor can truly save a life and we need all we can get!
And Back to Dracula
There are rare causes of anaemia, and one described in the medical literature by a dear friend of mine concerned a prison inmate who was escorted to his hospital emergency room with profound anaemia and melaena, blood in his faeces. Sometimes it is challenging to find the source of blood from the gut; if one bleeds a great deal, the pressure drops and whatever was bleeding, stops and hides from our gaze. After repeated episodes my colleague ascertained this fellow would surreptitiously drain blood from his veins....and drink it, a condition called auto vampirism (https://journals.sagepub.com/doi/10.1177/014107688908201027)
Seeing blood in the stool or urine, having frequent or persistent nosebleeds, noticing a tendency to bruise easily, or finding red spots on the skin, as well as feeling generally unwell should all lead to a doctor’s appointment.
So, a Join the Docs subscriber visits the doctor and says, “I keep seeing a vampire with fangs and a black cloak.” The doctor replies, “have you seen a psychiatrist? And our perplexed JTD devotee responds “no, just a vampire!”.
Don’t be faint of heart, if you think you are anaemic see a doctor who can stake out the problem and deliver a silver bullet!
DISCLAIMER: The views and opinions expressed on Join the Docs are those of Dr. Nigel Guest, Jonathan Sackier and other people on our show. Be aware that Join the Docs is not intended to be medical advice, it is for information and entertainment purposes only - please, always take any health concerns to your doctor or other healthcare provider. We respect the privacy of patients and never identify individuals unless they have consented. We may change details, dates, place names and so on to protect privacy. Listening to Join the Docs, interacting on our social media, emailing or writing to us does not establish a doctor patient relationship.