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Antibiotics and Anemia

Antibiotics Causing Aplastic Anemia - Antibiotics Anemia

The Red Cell and Anemia

Anemia and Chronic Kidney Disease

Iron Deficiency Anemia

Anemia occurs when red blood cells are reduced in number. Red blood cells are a major component of blood and serve the vital function of delivering oxygen from the lungs to the rest of the tissues in the body. When anemia occurs, the body is deprived of the oxygen it needs to function properly.

There are many types of anemia, all of which have their own treatments. The most common types include:

iron-deficiency anemiafolic acid-deficiency anemiaanemia from vitamin B12 deficiency.

Anemia may be a consequence of a chronic disease, medication, or excessive alcohol consumption. In some cases, inherited conditions that produce blood defects result in anemia.

Most cases of anemia are corrected simply by adding more iron or folic acid to the diet. If you have a deficiency of vitamin B12, you may require intramuscular injections. Some cases are not as easily remedied.

A person who is slightly anemic may feel tired and weak and look pale. Getting winded and having chest pains during exercise are other symptoms of anemia. In more serious cases, heartbeat irregularities or neurological symptoms such as confusion, irritability, and numbness or tingling in the extremities appear.

Causes of Anemia

Iron-deficiency anemia is the most common type of the disease, and is most often caused by excessive blood loss. When the body loses blood, it loses iron—a key part of red blood cells. Iron is needed to make hemoglobin, the protein in red blood cells that carries oxygen. Gradual, prolonged blood loss from heavy menstruation is the primary cause of iron-deficiency anemia in women. Gastrointestinal bleeding from hemorrhoids, a stomach ulcer, or an inflammatory bowel condition may also make a person anemic. Blood loss due to colon cancer and other intestinal cancers accounts for about 2% of cases. Long-term use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can irritate the stomach lining and cause bleeding that produces anemia. Women who are pregnant or breast-feeding sometimes become anemic when their increased iron needs are not met. Growing children, who also need more iron, occasionally become anemic. However, dietary lack is rarely the cause of iron-deficiency anemia.

Folic acid deficiency is a type of anemia that develops when there is too little folic acid consumed in the diet, or when it is not properly absorbed in the body. The body needs folic acid to make red blood cells. Too little of this vitamin (also called folate) results in red blood cells that are abnormally large (macrocytic), and die prematurely. The body does not store folic acid in large amounts, and therefore folic acid levels need to be sustained through diet. Folic acid-deficiency anemia is caused by an inadequate intake or inability to absorb the vitamin. At certain times, such as during pregnancy and breast-feeding, the body needs more folic acid than usual. Most pregnant women are advised to take a supplement (which prevents birth defects), and the government now requires that many foods (cereals, breads, pastas) be fortified with the vitamin. People with gastrointestinal illnesses and cancers may have problems absorbing folic acid, and become anemic. Likewise, people taking certain drugs (anticonvulsants, antibiotics, birth control, pills, anticancer agents) sometimes have difficulty absorbing or metabolizing folic acid.

Pernicious anemia is a less common but serious condition that develops when the body cannot absorb vitamin B12. Pernicious anemia is a disorder in which the immune system attacks cells in the stomach that produce intrinsic factor (IF)—a substance needed to transport vitamin B12. Without IF, a B12 deficiency develops and red blood cells grow too large and die too early. Pernicious anemia sometimes arises after intestinal surgery or from an intestinal problem than impairs metabolism of this vitamin. In older people, deterioration of the stomach lining (atrophic gastritis) and subsequent failure to produce IF is a common cause. Diet is rarely implicated in B12 deficiency, though it can be the culprit in strict vegetarians, or vegans, who do not eat any meat or dairy products, which are rich in the vitamin.

Chronic diseases such as cancer, rheumatoid arthritis, HIV/AIDS, or alcoholism, and certain medications can also cause anemia. Chronic kidney disease is also an important cause of chronic anemia. People with cancers that affect the bone marrow, which is where the majority of red blood cells are produced, often become anemic; so do people with diseases that trigger the inflammatory process, such as rheumatoid arthritis, lupus, Grave's disease, Crohn's disease, and ulcerative colitis. Cytokines, which are proteins released during inflammation, seem to be responsible. Cytokines are essential for healing, but in excess they can interfere with iron and the hormone responsible for stimulating the production of red blood cells (erythropoietin).

Alcoholics sometimes develop anemia because of a nutritional deficiency. Alcohol hampers vitamin absorption, and alcoholics tend to eat poorly.

Medications can also cause anemia. Long-term use of NSAIDs may induce bleeding that results in anemia. Drugs that suppress the immune system and fight cancer can lead to aplastic anemia—anemia that occurs when the bone marrow doesn't make enough red blood cells. Additionally, certain antibiotics, blood pressure medications, and drugs used to treat heart arrythmias rarely can cause hemolytic anemia—anemia that occurs when red blood cells are destroyed prematurely.

Rare but serious anemias such as sickle cell anemia and thalassemia are inherited. As the name implies, sickle cell anemia is characterized by sickle-shaped red blood cells. These cells are stiff, and cannot pass through the blood vessels very well. Consequently, they die after about 20 days (the average life span for a normal red blood cell is 120 days). The resulting anemia, which affects about 0.6% of the population, is serious, and can be deadly. Thalassemia is an inherited blood disorder that stems from a defect in the rate at which hemoglobin is produced. The two main types are thalassemia major (Cooley's anemia) and thalassemia minor (the more common of the two). Thalassemia can be very serious, but the condition is rare; it is more commonly found in people of Mediterranean descent.

Many diseases, conditions, and factors can cause aplastic anemia, including medicines, such as chloramphenicol (an antibiotic rarely used in the United States

Symptoms of Anemia

Anemia produces a variety of symptoms, including weakness, fatigue, and paleness (pallor). Depending on the cause, other symptoms may be present as well. The oxygen deprivation from anemia can make you feel tired and weak, dizzy, short of breath, and confused. Your skin may turn pale—particularly in places that are normally red such as your gums, nail beds, and inner eyelids.

Some people with an iron deficiency develop cravings for nonfood items, such as clay and detergent, a rare condition known as pica. Severe iron deficiency also may cause tongue irritation, cracks in the corners of the mouth, and a spoonlike deformity in the fingernails.

People with pernicious anemia often develop neurologic symptoms. A lack of B12 can initially produce tingling sensations in the hands and feet. This can progress to serious loss of neurologic function.

Risk Factors
Although anemia can strike anyone at any age, it is more common in women and in older people. Iron loss from menstruation and vitamin deficiencies that develop during pregnancy and breastfeeding are the main reasons why younger women are five times more likely than younger men to develop anemia. However, aging increases anemia risk for everyone. One out of every 100 people over the age of 60 has been diagnosed with pernicious anemia. Gastrointestinal bleeding is a major contributor to anemia in older age groups.

Alcoholics, serious athletes, and people with chronic illnesses are at increased risk for anemia. Alcoholics often eat poorly, and the resulting malnutrition leads to anemia. Alcohol also hinders the absorption of nutrients important for preventing anemia. Additionally, internal bleeding, which is more likely in alcoholics, increases risk as well.

Intense physical training, such as that required for a marathon, sometimes results in gastrointestinal bleeding and damage to red blood cells, resulting in a condition called “sports anemia.”

Anyone who has a chronic illness that produces inflammation or bleeding is at increased risk for anemia.

The kidneys are involved in producing a protein that helps in red cell production. People with chronic kidney disease often have anemia because their kidneys do not make enough of this protein.

Treatment of Anemia

Seek medical help if you experience persistent weakness, fatigue, or paleness, dizziness, or heart palpitations.

Oral iron supplements are usually advised for patients with anemia. Iron supplements should be used under a doctor's supervision. If your iron stores are low because of a serious health problem such as colon cancer, taking supplements could mask the symptom and delay diagnosis.

If your doctor has prescribed iron supplements, take them as advised. It usually takes a few months to correct iron-deficiency anemia. Some people experience stomach upset from iron supplements. Nausea, diarrhea, and constipation are common, and iron supplements almost always turn the stool black (which is harmless). To minimize stomach irritation, take iron 30 minutes before eating, or ask your doctor if you can switch to a different preparation.

A proper diet is usually all that is needed to correct anemia caused by a folic acid deficiency. Eat plenty of green vegetables, whole grains, and beans. Orange juice is another good source of folic acid. Doctors advise women of childbearing age to take a supplement containing 400 mcg of folic acid to protect against birth defects.

Your doctor is the best source of information on the drug treatment choices available to you.

Severe anemia cases warrant a blood transfusion. When blood loss happens quickly (from an accident or childbirth, for example), anemia can be fatal. In such cases, the bleeding must be stopped and red blood cells replaced via transfusion. Chronic illnesses, particularly in older people, sometimes result in blood loss that requires a transfusion as well.

If you can't tolerate oral iron supplements, iron injections are an option. Intravenous iron administration is only needed in rare cases.

If you have pernicious anemia, lifelong B12 injections are required. For pernicious anemia, monthly B12 injections are usually in order. You can give yourself injections, and your symptoms should clear up pretty quickly (within a week or so). For most people, injections do not produce side effects. Oral B12 is not the best option because the condition stems from the body's inability to absorb the vitamin. However, large doses may be tried if injections are out of the question.

Anemia due to an enlarged spleen may be helped by spleen removal. The spleen is a major site of red blood cell destruction. An enlarged spleen may also reduce the number of white blood cells and platelets in the bloodstream. Treatment is typically targeted at the problem that caused the spleen to enlarge in the first place, but spleen removal may be necessary is some cases.

Drugs that affect stomach acid (antacids, antihistamines, proton pump inhibitors) can interfere with iron absorption, and some medications may not work as well while you are taking iron. Be sure to tell your doctor about existing prescriptions. Drugs that interfere with iron include: Antacids such as Maalox, Tums, and MylantaHistamine H2 receptor blockers for ulcers and heartburn, such as Cimetidine (Tagamet), Famotidine (Pepcid), Nizatide (Axid), and Ranitdine (Zantac) Proton pump inhibitors such as omeprazole (Prilosec) for treatment of ulcers, heartburn, and other conditions where too much acid exists in stomachLevodopa (Atamet, Laradopa, Sinemet) for treatment of Parkinson's diseaseMethyldopa (Aldomet) for treatment of high blood pressurePencillamine (Cuprimine, Depen) for treatment of a variety of problems, including rheumatoid arthritisAntibiotics such as norfloxacin (Chibroxin) and ciprofloxacin (Cipro), used for treatment of a variety of infections, including urinary tract infections and eye infections. Tetracyclines such as micocyclin and tetracycline: antibiotics for treatment of a variety of problems, including acne

Prognosis depends on the cause of anemia and how severe the condition is. The underlying cause of the anemia, such as heavy periods or slow stomach bleed from an ulcer must alwasy be corrected before blood stores can start to recover. Replenishing low iron stores usually takes a few months. A B12 deficiency can be corrected in a few weeks if there are no neurological complications. In such cases, it may take six months or longer for symptoms to clear. Sickle cell anemia is a chronic disease for which there is no cure. Attacks are usually managed with supportive care. Chronic illnesses, such as kidney disease or rheumatoid arthritis that lead to anemia, may have a more complex course, dpending on the severity of the chronic disease.

Some antibiotics can cause blood dyscrasias which is serious adverse effect.

Sources used -

Antibiotics Dictionary

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