Anemia

What is anemia?

Anemia is a medical condition in which the red blood cell count or hemoglobin is less than normal. The normal level of hemoglobin is generally different in males and females. For men, anemia is typically defined as hemoglobin level of less than 13.5 gram/100ml and in women as hemoglobin of less than 12.0 gram/100ml. These definitions may vary slightly depending on the source and the laboratory reference used.

What causes anemia?

Any process that can disrupt the normal life span of a red blood cell may cause anemia. Normal life span of a red blood cell is typically around 120 days. Red blood cells are made in the bone marrow.
Anemia is caused essentially through two basic pathways. Anemia is either caused:

1. by a decrease in production of red blood cell or hemoglobin, or
   
2. by a loss or destruction of blood.

As more common classifications of anemia (low hemoglobin) is based on the MCV, or the volume of individual red blood cells.

1. If the MCV is low (less than 80), the anemia is categorized as microcytic anemia (low cell volume).
   
2. If the MCV is in the normal range (80-100), it is called a normocytic anemia (normal cell volume).
   
3. If the MCV is high, then it is called a macrocytic anemia (large cell volume).

Looking at each of the components of a complete blood count (CBC), especially the MCV, a physician can gather clues as what may be the most common reason for anemia.

 

Can not enough iron cause anemia?

Absolutely! This is because iron is major component of hemoglobin and essential for its proper function. Chronic blood loss due to any reason is the main cause of low iron level in the body as it depletes the body's iron stores to compensate for the ongoing loss of iron. Anemia that is due to low iron levels is called iron deficiency anemia. Iron deficiency it is a very common cause of anemia.
Women are more likely than men to have iron deficiency anemia because of the loss of blood each month through normal menstruation. This is generally without any major symptoms as the blood loss is relatively small and temporary.
Iron deficiency anemia can also be due to small repeated l bleeding, for instance from colon cancer or from stomach ulcers. Stomach ulcer bleeding that may or may no be induced by medications even very common over-the-counter drugs as aspirin and ibuprofen (Advil, Motrin). In infants and young children, iron deficiency anemia is most often due to a diet lacking iron.
Interpretation of CBC may lead to clues to suggest this type of anemia. For instance, iron deficiency anemia usually presents with low mean corpuscular volume (microcytic anemia) in addition to low hemoglobin.

What about acute (sudden) blood loss as a cause of anemia?

Acute blood loss from internal bleeding (as from a bleeding ulcer) or external bleeding (as from trauma) can produce anemia in an amazingly short span of time. This type of anemia could result in severe symptoms and consequences if not addressed promptly.

What are other causes of anemia?

Some of the most common causes include:

• Vitamin B12 deficiency may cause pernicious anemia. This type of anemia could happen in people who are unable to absorb vitamin B12 from their intestines due to a number of reasons:
  
  
  • strict vegetarians who may not be taking adequate vitamin supplements, or
    
  • long-term alcoholics.

This typically causes macrocytic (large cell volume) anemia. Vitamin B12, along with folate, is a involved in making the heme molecule that is an integral part of hemoglobin. Folate deficiency can be the culprit of anemia. This may also be caused by inadequate absorption, under-consumption of green, leafy vegetables, and also long-term heavy alcohol use.

• There can be rupture of red blood cells (hemolytic anemia) due to antibodies clinging to the surface of the red cells (for example, hemolytic disease of the newborn and in many other conditions).
  
• A wide assortment of bone marrow diseases can cause anemia.
  
  
  • For example, cancers that spread (metastasize) to the bone marrow, or cancers of the bone marrow (such as leukemia or multiple myeloma) can cause the bone marrow to inadequately produce red blood cells, resulting in anemia.
    
  • Certain chemotherapy for cancers can also cause damage to the bone marrow and decrease red blood cell production, resulting in anemia.
    
  • Certain infections may involve the bone marrow and result in bone marrow impairment and anemia.
    
  • Finally, patients with kidney failure may lack the hormone necessary to stimulate normal red blood cell production by the bone marrow.
    
• Another common cause of anemia is called anemia of chronic disease. This could typically occur in individuals with long-standing chronic diseases.
  
• Some medications can cause anemia in a variety of ways.
  
• Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) can cause anemia. 

Can anemia be hereditary?

Yes, anemia may be genetic. Hereditary disorders can shorten the life-span of the red blood cell and lead to anemia (for example, sickle cell anemia). Hereditary disorders can also cause anemia by impairing the production of hemoglobin (for example, alpha thalassemia and beta thalassemia).
Depending on the degree of the genetic abnormality, hereditary anemias may cause mild, moderate, or severe anemia. In fact, some may be too severe to be compatible with life and may result in death of the fetus (unborn infant). On the other hand, some of these anemias are so mild that they are not noticeable and are incidentally revealed during a routine blood work.

What are the symptoms of anemia?

Some patients with anemia have no symptoms. Others with anemia may feel:

• tired,
  
• fatigue easily,
  
• appear pale,
  
• develop palpitations (feeling of heart racing), and
  
• become short of breath.

Additional symptoms may include:

• hair loss,
  
• malaise (general sense of feeling unwell), and
  
• worsening of heart problems.

It is worth noting that if anemia is longstanding (chronic anemia), the body may adjust to low oxygen levels and the individual may not feel different unless the anemia becomes severe. On the other hand, if the anemia occurs rapidly (acute anemia), the patient may experience significant symptoms relatively quickly.

Tonsillitis and Adenoid Infection

What are the tonsils and adenoids?

The tonsils and adenoids are composed of tissues that are similar to the lymph nodes or glands found in the neck or other parts of the body. Together, they are part of a ring of glandular tissue (Waldeyer's ring) encircling the back of the throat.
The tonsils are the two masses of tissue on either side of the back of the throat. Normal tonsils are usually about the same size and have the same pink color as the surrounding area. On their surfaces are little depressions, called crypts, which may appear deep and contain pus pockets or stones.
The adenoids are located high in the throat behind the nose and soft palate (the roof of the mouth) and unlike the tonsils, are not easily visible through the mouth. A tonsillectomy and an adenoidectomy (commonly referred to as a T & A) are surgical procedures performed to remove the tonsils and adenoids.

What is the purpose of the tonsils and adenoids?

The tonsils and adenoids are thought to assist the body in its defense against incoming bacteria and viruses by helping the body form antibodies. However, this function may only be important during the first year of life. There is no evidence to support a significant role of the tonsils and adenoids in immunity. Medical studies have shown that children who have their tonsils and adenoids removed suffer no loss whatsoever in their future immunity to disease or ability to ward off infections.

What are common problems affecting the tonsils and adenoids?

The most common problems occurring with the tonsils and adenoids are recurrent or chronic infections and significant enlargement (hypertrophy).
Acute Tonsillitis
Acute tonsillitis is an infection of the tonsils caused by one of several possible types of bacteria or viruses. Acute tonsillitis is characterized by either the sudden or gradual onset of a sore throat which is usually associated with fever. The patient may stop swallowing saliva, start to drool, complain of ear pain with swallowing, and have bad breath. The surface of the tonsil may be bright red or have a grayish-white coating (exudate). The lymph nodes in the neck may be swollen. Fever can be present.
Strep throat (tonsillitis) is a specific type of infection caused by the streptococcus bacteria. Strep tonsillitis can cause secondary damage to the heart valves (rheumatic fever) and kidneys (glomerulonephritis). It can also lead to a skin rash (scarlet fever), sinusitis, pneumonia, and ear infections.
Acute mononucleosis is caused by the Epstein-Barr virus, and can lead to a very severe throat infection which is characterized by the rapid enlargement of the tonsils, adenoids, and lymph nodes of the neck. It also causes extreme malaise and tiredness. The sore throat and gland swelling can last for one week to a month and does not respond to the usually prescribed antibiotics.
Chronic Tonsillitis
Chronic tonsillitis is a persistent infection of the tonsils. Repeated infections may cause the formation of small pockets (crypts) in the tonsils which harbor bacteria. Frequently, small, foul smelling stones are found within these crypts. These stones (tonsilloliths) may contain high quantities of sulfa. When crushed, they give off the characteristic rotten egg smell which causes bad breath. They may also give a patient the sense of something being caught in the back of the throat.
Peritonsillar Abscess
A peritonsillar abscess is a collection of pus behind the tonsils that pushes one of the tonsils toward the uvula (the prominent soft tissue dangling from the back of the upper throat. It is generally very painful and is associated with decreased ability to open the mouth. If left untreated, the infection can spread deep in the neck causing life-threatening complications and airway obstruction.
Enlargement of (Hypertrophic) Tonsils and Adenoids
Obstruction to breathing by enlarged tonsils and adenoids may cause snoring and disturbed sleep patterns that may lead to sleep pauses or sleep apnea. Other features include frequent awakening from sleep, restless sleep, nightmares, bedwetting, mood changes, excessive sleepiness, and even heart problems. Some orthodontists believe that chronic mouth breathing from large tonsils and adenoids causes improper alignment of the teeth (malocclusion). Chronic enlargement and infection of the adenoids may lead to infection of the air passages around the nose (sinusitis) or nasal drainage/obstruction, and/or may affect the eustachian tube of the ear, leading to chronic ear infections.

How is tonsillitis and adenoid infection treated?

Bacterial infections of the tonsils and adenoids are treated with various antibiotics. Tonsillitis caused by the streptococcus bacteria can lead to serious complications, and must be treated. Often the diagnosis of strep throat is confirmed by a throat culture or rapid-strep tests in the doctors office. Once treatment begins, it is important to take the full course of antibiotics as prescribed because premature discontinuance of therapy can lead to adverse consequences and regrowth of the bacteria. Surgical removal is considered in situations resistant to medical therapy or in frequently recurrent infections.
Viral causes of tonsillitis are often treated with only supportive care (hydration and control of fever). Antibiotics are not effective for viral infection of the tonsils.
A peritonsillar abscess should be drained either by removal of fluid with a needle and syringe (needle aspiration), cutting open with a scalpel (incision), or tonsillectomy. Chronic stones in the tonsil can be removed with a clean finger or with a blunt probe. Massive enlargement of the tonsils and adenoids causing airway obstruction may be treated with a long course of antibiotics, or even a brief course of steroids (cortisone-related medications, such as prednisone and prednisolone).

When should the tonsils and/or adenoids be removed?

Tonsillectomy and adenoidectomy are indicated in persons with repeated or persistent infections, particularly if they interfere with everyday activities. In general, repeated infections in children are defined as six to seven episodes in one year, or four to five episodes in each of two years, or three episodes in each of three years.
A significant episode of tonsillitis is defined by one or more of the following criteria: (1) a temperature greater than 101°F; (2) enlarged or tender neck lymph nodes; (3) pus material coating the tonsils; or (4) a positive strep test.
In adults, the severity, frequency, and hardship associated with repeated infections are considered more important than the absolute number. Chronic infections characterized by bad breath and/or tonsillar stones causing significant disability are also indicators for tonsillectomy.
Tonsillectomy and adenoidectomy are strongly considered in those patients who are suffering, or may suffer serious complications of infection. These include peritonsillar abscess, history of streptococcal complications (rheumatic heart disease, glomerulonephritis), or neck abscess. Suspicion of malignancy or tumor is a definite reason for surgery.
Tonsillectomy and adenoidectomy are also warranted in situations where there is enlargement of the tonsils and adenoids to such an extent that it causes severe sleep problems (snoring and breath holding), sleep apnea, dental abnormalities, and difficulty swallowing. Adenoid enlargement alone, or in combination with tonsillar enlargement, can cause nasal obstruction, recurrent ear infections, or sinusitis. If these conditions are resistant to medical therapy, surgery is indicated.
In should be emphasized that all decisions for or against surgery are dependent upon the individual patient's particular situation. Additional factors, such as tolerance of antibiotics, concurrent medical problems, school achievement/progress, and family preferences are also important in the decision process.

Tonsillitis and Adenoid Infection At A Glance

• Tonsils and adenoids are composed of tissues that are similar to the lymph nodes or glands.
  
• Acute tonsillitis is an infection of the tonsils caused by one of several possible types of bacteria or viruses.
  
• Chronic tonsillitis is a persistent infection of the tonsils and can cause tiny stone formation.
  
• Peritonsillar abscess is a collection of pus behind the tonsils.
  
• Obstruction to breathing by enlarged tonsils and adenoids may cause snoring and disturbed sleep patterns.
  
• Bacterial infections of the tonsils and adenoids are treated with appropriate antibiotics. Viral infections are not.
  
• Tonsillectomy and adenoidectomy are indicated as follows: (1) in persons with repeated or persistent infections; (2) when serious complications of infection occur; and (3) when enlargement of the tonsils and adenoids causes breathing, swallowing, or dental problems.

Alcohol and Teens

How much alcohol do teens use?

Alcohol is the most frequently used drug by teenagers in the United States. About half of junior high and senior high school students drink alcohol on a monthly basis, and 14% of teens have been intoxicated at least once in the past year. Nearly 8% of teens who drink say they drink at least five or more alcoholic drinks in a row (binge drink).

What are the dangerous effects of alcohol use in teens?

Just a few of the many dangerous effects of alcohol use in teens include the following:

• Alcohol decreases teens' ability to pay attention.
• Teens who have experienced alcohol withdrawal tend to have difficulties with memory.
• In contrast to adults, teens tend to abuse alcohol with other substances, usually marijuana.
• Male teens who drink heavily tend to complete fewer years of education compared to male teens who do not.
• The younger a person is when they begin drinking, the more likely they are to develop a problem with alcohol.
• Each year, almost 2,000 people under the age of 21 years die in car crashes in which underage drinking is involved. Alcohol is involved in nearly half of all violent deaths involving teens.
• More than three times the number of eighth-grade girls who drink heavily said they have attempted suicide compared to girls in that grade who do not drink.
• Intoxication is associated with suicide attempts using more lethal methods, and positive blood alcohol levels are often found in people who complete suicide.
• Teens who drink are more likely to engage in sexual activity, have unprotected sex, have sex with a stranger, or be the victim or perpetrator of a sexual assault.
• Excess alcohol use can cause or mask other emotional problems, like anxiety or depression.
• Drinking in excess can lead to the use of other drugs, like marijuana, cocaine, or heroin.

How can parents prevent alcohol use?

Clear communication by parents about the negative effects of alcohol, as well as about their expectations regarding drug use, have been found to significantly decrease alcohol use in teens. Adequate parental supervision has also been found to be a deterrent to alcohol use in youth. Alcohol, and other drug use, has been found to occur most often between the hours of 3 p.m. and 6 p.m., immediately after school and prior to parents' arrival at home from work. Teen participation in extracurricular activities has therefore been revealed to be an important measure in preventing use of alcohol in this age group. Parents can also help educate teens about appropriate coping and stress-management strategies. For example, 15- to 16-year-olds who use religion to cope with stress tend to use drugs significantly less often and have less problems as a result of drinking than their peers who do not use religion to cope.

What are the symptoms and signs of alcohol intoxication?

Signs that indicate a person is intoxicated include the smell of alcohol on their breath or skin, glazed or bloodshot eyes, the person being unusually passive or argumentative, and/or deterioration in the person's appearance or hygiene. Other symptoms of intoxication include flushed skin and memory loss.

What is alcoholism?

As defined by the Diagnostic and Statistical Manual of Mental Disorders, alcoholism (alcohol dependence) is a negative pattern of alcohol use leading to a number of problems, which may include needing more alcohol to get intoxicated (tolerance), difficulties that occur when the effects of alcohol wear off (withdrawal), using more alcohol or for longer time than intended, and other life problems because of the use of alcohol.
Five stages of alcohol and drug use have been identified. The first stage is described as access to alcohol rather than use of alcohol, tobacco, inhalants, or other drugs. In that stage, minimizing the risk factors that make a teenager more vulnerable to using alcohol are an issue. The second stage of alcohol and other drug use ranges from experimentation or occasional use to regular weekly use of alcohol, tobacco, inhalants, or other drugs. The third stage is characterized by youths further increasing the frequency of alcohol use and/or using alcohol and other drugs on a regular basis. This stage may also include the teenager either buying drugs or stealing to get drugs. In the fourth stage of alcohol and drug use, adolescents have established regular usage, have become preoccupied with getting intoxicated ("high") and have developed problems in their social, educational, vocational, or family life as a result of using the substance. The final and most serious fifth stage of alcohol or other drug use is defined by the youth only feeling normal when they are using. During this stage, risk-taking behaviors like stealing, engaging in physical fights, or driving while intoxicated increase, and they become most vulnerable to having suicidal thoughts.

What are the causes and risk factors of teen alcoholism?

Family risk factors for teenagers developing drinking problems include low levels of parent supervision or communication, family conflicts, inconsistent or severe parental discipline, and a family history of alcohol or drug abuse. Individual risk factors include problems managing impulses, emotional instability, thrill-seeking behaviors, and perceiving the risk of using alcohol to be low. Girls who drink, as well as teens who begin drinking prior to 14 years of age and those whose mothers have drinking problems, are more likely to develop alcoholism. Teen risk factors for alcoholism differ a bit between the 14- to 16-year-old and 16- to 18-year-old age groups, in that 16- to 18-year-olds tend to be less likely to drink in excess when they have a close relationship with their mothers.

What are the symptoms of alcohol abuse in teens?

Some of the most common symptoms of alcohol abuse in teenagers include lying, making excuses, breaking curfew, staying in their room, becoming verbally or physically abusive toward others, having items in their possession that are connected to alcohol use (paraphernalia), the smell of alcohol on their breath or body, mood swings, stealing, and changes in friends.

What is the treatment for alcohol intoxication?

Replacing fluids that are lost as a result of the increased urination associated with drinking is often used to treat alcohol intoxication. Doctors frequently use fluids that contain sugars for that purpose.

What is alcohol poisoning?

Alcohol poisoning is the potentially fatal result of drinking excessive amounts of alcohol in a short period of time. It is caused by alcohol slowing down the body's functions (for example, breathing, heart rate, and gag reflex), thereby potentially leading to choking, coma, stopped breathing, stopped heart, and death. Treatment involves getting the person to the hospital immediately so he or she can be closely watched by medical professionals, given oxygen and fluids, and so that other measures can be taken in order to prevent choking, as well as stopped breathing or heartbeat.

What is the treatment for alcoholism?

There are few medications that are considered effective in treating alcoholism. Zofran (ondansetron) has been found to be effective in treating alcoholism in people whose problem drinking began before they were 25 years old. Naltrexone (Trexan, ReVia, or Vivitrol) has also been found effective in managing alcoholism. Naltrexone is the most frequently used medication in treating alcoholism. It decreases the alcoholic's cravings for alcohol by blocking the body's euphoric ("high") response to it. Naltrexone is either taken by mouth on a daily basis or through monthly injections. Disulfiram (Antabuse) is prescribed for about 9% of alcoholics. It decreases the alcoholic's craving for the substance by producing a negative reaction to drinking. Acamprosate (Campral) works by decreasing cravings for alcohol in those who have stopped drinking. However, none of these medications have been specifically approved to treat alcoholism in people less than 18 years of age. Some research indicates that psychiatric medications like lithium and sertraline (Zoloft) may be useful in decreasing alcohol use in teens who have another mental-health disorder in addition to alcohol abuse.
There are numerous individual treatments for alcoholism in teens. Relapse prevention uses methods for recognizing and amending problem behaviors. Individualized drug counseling specifically emphasizes short-term behavioral goals in an attempt to help the individual reduce or stop the use of alcohol altogether. Cognitive therapy techniques, like helping the teen recognize what tends to precede and follow their episodes of alcohol use, are often used to address alcohol abuse in teens. Some treatment programs include drug testing. Twelve-step programs like Alcoholics Anonymous are individualized drug-counseling methods. Motivational enhancement therapy encourages the teen to increase their desire to participate in therapy. Stimulus control refers to a treatment method that teaches the person to stay away from situations that are associated with alcohol use and to replace those situations with activities that are contrary to using drugs. Urge control is an approach to changing patterns that lead to drug use. Social control involves family members and other significant others of the alcoholic in treatment.
While group therapy can be helpful in decreasing alcohol use in teens, groups that include a number of teens who also engage in disordered behaviors can actually tend to increase alcohol use in this age group. Family interventions for alcoholism that tend to be effective for teens include multidimensional family therapy (MDFT), group therapy, and multifamily educational intervention (MFE). MDFT has been found to be quite effective. Longer-term residential treatment of three to five months that addresses peer relationships, educational problems, and family issues is often used in treating alcoholism in teens.
For youth in the first stage of alcohol use (having access, but not having yet used alcohol), preventive measures are used. Therefore, limiting access to alcohol or other drugs, addressing any risk factors of the youth or family, as well as optimal parental supervision and expression regarding expectations are often recommended. The approach to those who have experimented with alcohol should not be minimized by mental-health professionals, since infrequent use can progress to the more serious stages of alcohol use if not addressed. Therefore, professionals recommend that the youth be thoroughly educated about the effects and risks of alcohol, that fair but firm limits be set on the use of alcohol, and that the user be referred for brief counseling, a self-help group, and/or family support group. Teens who have progressed to the more advanced stages of alcoholism are typically treated intensively, using a combination of the medical, individual, and familial interventions already described.