Anemia is defined as a condition in which the body does not have enough healthy red blood cells in order for oxygen to be carried to tissues (Mayo Clinic, 2010). Red blood cells are shaped like discs and resemble doughnuts without holes in the middle (National Heart Lung and Blood Institute, 2010). Red blood cells are manufactured in bone marrow, and their function is to carry oxygen throughout the body and to remove waste from the body in the form of carbon dioxide (National Heart Lung and Blood Institute, 2010). Anemia can also manifest if red blood cells do not contain enough hemoglobin, an iron-rich protein that lends to the red color of blood (National Heart Lung and Blood Institute, 2010). Hemoglobin is the actual protein that aids red blood cells in the transport of oxygen from the lungs to various bodily tissues (National Heart Lung and Blood Institute, 2010). Although most commonly anemia exhibits decreased healthy red blood cells, with some types of anemia patients display low numbers of white blood cells and platelets as well (National Heart Lung and Blood Institute, 2010). There are several different types of anemia. Some of these types include: aplastic anemia, blood loss anemia, Cooley's anemia, Diamond-Blackfan anemia, Fanconi anemia, Folate or folic acid deficiency anemia, hemolytic anemia, iron-deficiency anemia, pernicious anemia, sickle cell anemia, and thalassemias (National Heart Lung and Blood Institute, 2010). There are three primary causes that result in the manifestation of anemia. These causes include blood loss, lack of red blood cell production, and high rates of red blood cell destruction (National Heart Lung and Blood Institute, 2010).

Causes of anemia may be classified as a result of nutritional deficiencies including a lack of iron, vitamin B-12, and folate, anemia with chronic inflammation, anemia with renal disease, and anemia of unexplained origin (Semba et al., 2007). The different types of anemia vary from mild, acute forms to severe, chronic forms that may result in death if not properly diagnosed and effectively treated (National Heart Lung and Blood Institute, 2010). Forms of anemia that have been more life-threatening and associated with higher mortality are anemia with renal disease and anemia of unexplained origin (Semba et al., 2007).

One of the most common forms of anemia that affects approximately one to two percent of the American adult population is iron deficiency anemia, which is caused by a shortage of iron in the body (Mayo Clinic, 2010). This may present itself as a mild, acute form or it may be more chronic. Iron is necessary for the production of hemoglobin by bone marrow, so it is required in order for red blood cells to effectively transport oxygen (Mayo Clinic, 2010). Vitamin deficiency anemia is caused by a diet lacking in key nutrients such as folate and vitamin B-12, which are necessary as well for the production of red blood cells (Mayo Clinic, 2010). An inability to properly absorb vitamin B-12 can also contribute to the development of vitamin deficiency anemia.

Particular chronic diseases may cause chronic anemia due to disruptions to the production of healthy red blood cells resulting from the diseases (Mayo Clinic, 2010). Some of these conditions include cancer, rheumatoid arthritis, HIV / AIDS, Crohn's disease, and kidney failure (Mayo Clinic, 2010). Anemia may also result due to bone marrow disease, such as leukemia or myelodysplasia, which adversely affect blood production in bone marrow. The manifestation of this type of anemia varies from an acute form due to a mild change in blood production in the marrow, to a severe, life threatening form of anemia in which the process of blood production completely shuts down (Mayo Clinic, 2010). Another variation, hemolytic anemia occurs when auto-immune diseases or certain medications cause the body to produce antibodies that result in the destruction of red blood cells at an accelerated rate (Mayo Clinic, 2010).

Some forms of anemia are rarer and can be very severe, even life-threatening. Sickle-cell anemia is a genetic condition that is caused by defective hemoglobin, which results in red blood cells...

This chronic form of anemia can be severe, and requires proper observation and treatment (Mayo Clinic, 2010). Aplastic anemia is another rare and potentially life-threatening form of anemia. This anemia is caused by an inability on behalf of the bone marrow to effectively produce all three types of blood cells, including red blood cells, white blood cells, and platelets (Mayo Clinic, 2010). Aplastic anemia is often caused by an autoimmune disease (Mayo Clinic, 2010).
There are several risk factors that contribute to an increased chance of the development of anemia. These factors include poor diet, intestinal disorder, pregnancy, menstruation, various chronic conditions such as cancer or liver failure, and a family history of anemia (Mayo Clinic, 2010). There are other factors that may affect red blood cell production and result in anemia such as blood diseases, infections, autoimmune disorders, exposure to toxic chemicals, and some medications such as antibiotics (Mayo Clinic, 2010).

The most common presenting symptom of anemia is fatigue. Other symptoms and signs of anemia are shortness of breath, dizziness, chest pain, pale skin, headache, and coldness experienced in the feet and hands (National Heart Lung and Blood Institute, 2010). The symptoms associated with anemia are a result of the heart's necessity to work harder in order to pump oxygen-rich blood through the body (National Heart Lung and Blood Institute, 2010). However, patients with mild to moderate forms of anemia may demonstrate only mild symptoms or no symptoms at all (National Heart Lung and Blood Institute, 2010). Various complications that may arise due to anemia, such as arrhythmias, organ damage, decreased effectiveness of treatments for diseases like cancer or HIV, as well as heart problems (National Heart Lung and Blood Institute, 2010).

Diagnosis of anemia is conducted through an investigation into family medical history, physical exams, as well as other tests and procedures (National Heart Lung and Blood Institute, 2010). These other procedures include a complete blood count (CBC), which checks hemoglobin and hematocrit levels, and counts of red blood cells, white blood cells, and platelets (National Heart Lung and Blood Institute, 2010). Low levels of hemoglobin and hematocrit are indicative of anemia (National Heart Lung and Blood Institute, 2010). The CBC also evaluates mean corpuscular volume, which measures the average size of red blood cells and may indicate possible causes of the anemia (National Heart Lung and Blood Institute, 2010). Other tests used in diagnosis are hemoglobin electrophoresis, reticulocyte counts, and blood iron tests such as serum iron and serum ferritin tests (National Heart Lung and Blood Institute, 2010).

When treated effectively, many forms of anemia prove to be acute and mild. However, other forms are chronic and severe, and require consistent medical attention and treatment (National Heart Lung and Blood Institute, 2010). Effective treatment of anemia varies based on the type of anemia and population. The rapid growth in children necessitates higher iron levels, and supplements including iron, B-12, and folate are often prescribed (National Heart Lung and Blood Institute, 2010). However, most iron needed by children is provided through a nutritious diet including sources of vitamins B-12 and C, iron, and folic acid.

Pregnant women, lactating women, and young children are populations most affected by anemia throughout the world (Gautam et al., 2008). Iron deficiency has been shown to be the main cause of anemia in children in the second year of life (Bortolini & Vitolo, 2010). Gautam et al. (2008) suggest three main strategies for decreasing iron deficiency in populations. The first strategy is education with modification and diversification of diet for the improvement of iron intake and bioavailability. The second strategy is the provision of iron supplementation without food, and the third strategy is the fortification of foods with iron (Gautam et al., 2008).

Certain medicines…