HEMATO DISORDERS & ANABOLIC STEROIDS
Anemia is caused by either a decrease in production of red blood cells or hemoglobin, or an increase in loss or destruction of red blood cells.Some patients with anemia have no symptoms. Others may feel tired, easily fatigued, appear pale, a feeling of heart racing, short of breath, and/or worsening of heart problems.
Androgens clearly influence the rate of erythropoiesis in humans.
In the case of red blood cells, the renal hormone erythropoietin is the signal that tells the bone marrow to form these cells from stem cells. They will develop first into a series of immature precursor cells, and ultimately adult red blood cells. The normal stimulus for the production and release of erythropoietin is hypoxia, or a lower than ideal supply of oxygen to the body tissues. High red blood cell concentrations alternately serve as a feedback mechanism, lowering the release of erythropoietin so that RBC concentrations to not get over elevated. Androgens are known to primarily act at the level of erythropoietin, enhancing the release of this hormone from renal tissue. It is also suggested however that androgens may affect the stem cell directly, perhaps by enhancing cell responsiveness to erythropoietin.
Response to therapy is variable, and the time to clinical improvement is long, frequently ≥3 months.
Hematology is the study of blood, the blood-forming organs, and blood diseases. Hematology includes the study of etiology, diagnosis, treatment, prognosis, and prevention of blood diseases that affect the production of blood and its components, such as blood cells, hemoglobin, blood proteins, and the mechanism of coagulation. The laboratory work that goes into the study of blood is frequently performed by a medical technologist. Hematologists also conduct studies in oncology—the medical treatment of cancer.
Physicians specialized in hematology are known as hematologists.
TREATMENTS OF HEMATOLOGY
Treatments of Hematology include:
- Diet advice
- Oral medication – tablets or liquid medicines
- Anticoagulation therapy
- Intramuscular injections (for example, Vitamin B12 injections)
- Blood transfusion (for anemia)
- Venesection also known as therepeutic phlebotomy (for iron overload or polycythemia)
- Bone marrow transplant (for example, for leukemia)
- All kinds of anti-cancer chemotherapy
- Radiotherapy (for example, for cancer)
Anemia is the most common blood disorder, and according to the National Heart, Lung, and Blood Institute, it affects more than 3 million Americans.
THE ROLE OF RED BLOOD CELLS IN ANEMIA
Red blood cells carry hemoglobin, an iron-rich protein that attaches to oxygen in the lungs and carries it to tissues throughout the body. Anemia occurs when you do not have enough red blood cells or when your red blood cells do not function properly. It is diagnosed when a blood test shows a hemoglobin value of less than 13.5 gm/dl in a man or less than 12.0 gm/dl in a woman. Normal values for children vary with age.
WHEN YOU HAVE ANEMIA, YOUR BODY LACKS OXYGEN, SO YOU MAY EXPERIENCE ONE OR MORE OF THE FOLLOWING SYMPTOMS:
- Shortness of breath
- Fast or irregular heartbeat
- Pounding or “whooshing” in your ears
- Cold hands or feet
- Pale or yellow skin
- Chest pain
AM I AT RISK?
Many people are at risk for anemia because of poor diet, intestinal disorders, chronic diseases, infections, and other conditions. Women who are menstruating or pregnant and people with chronic medical conditions are most at risk for this disease. The risk of anemia increases as people grow older. People who engage in vigorous athletic activities, such as jogging or basketball, may develop anemia as a result of red blood cells breaking down in the bloodstream.
If you have any of the following chronic conditions, you might be at greater risk for developing anemia:
- Rheumatoid arthritis or other autoimmune disease
- Kidney disease
- Liver disease
- Thyroid disease
- Inflammatory bowel disease (Crohn disease or ulcerative colitis)
The signs and symptoms of anemia can easily be overlooked. In fact, many people do not even realize that they have anemia until it is identified in a blood test.
COMMON TYPES OF ANEMIA
Iron-deficiency anemia is the most common type of anemia. It happens when you do not have enough iron in your body. Iron deficiency is usually due to blood loss but may occasionally be due to poor absorption of iron. Pregnancy and childbirth consume a great deal of iron and thus can result in pregnancy-related anemia. People who have had gastric bypass surgery for weight loss or other reasons may also be iron deficient due to poor absorption.
Vitamin-deficiency anemia may result from low levels of vitamin B12 or folate (folic acid), usually due to poor dietary intake. Pernicious anemia is a condition in which vitamin B12 cannot be absorbed in the gastrointestinal tract.
Aplastic anemia is a rare form of anemia that occurs when the body stops making enough red blood cells. Common causes include viral infections, exposure to toxic chemicals, drugs, and autoimmune diseases. Idiopathic aplastic anemia is the term used when the reason for low red blood cell production is not known.
Hemolytic anemia occurs when red blood cells are broken up in the bloodstream or in the spleen. Hemolytic anemia may be due to mechanical causes (leaky heart valves or aneurysms), infections, autoimmune disorders, or congenital abnormalities in the red blood cell. Inherited abnormalities may affect the hemoglobin or the red blood cell structure or function. Examples of inherited hemolytic anemias include some types of thalassemia and low levels of enzymes such as glucose-6 phosphate dehydrogenase deficiency. The treatment will depend on the cause.
Sickle cell anemia is an inherited hemolytic anemia in which the hemoglobin protein is abnormal, causing the red blood cells to be rigid and clog the circulation because they are unable to flow through small blood vessels.
Anemia caused by other diseases – Some diseases can affect the body’s ability to make red blood cells. For example, some patients with kidney disease develop anemia because the kidneys are not making enough of the hormone erythropoietin to signal the bone marrow to make new or more red blood cells. Chemotherapy used to treat various cancers often impairs the body’s ability to make new red blood cells, and anemia often results from this treatment.
HOW IS ANEMIA TREATED?
The treatment for anemia depends on what causes it.
Iron-deficiency anemia is almost always due to blood loss. If you have iron-deficiency anemia, your doctor may order tests to determine if you are losing blood from your stomach or bowels. Other nutritional anemias, such as folate or B-12 deficiency, may result from poor diet or from an inability to absorb vitamins in the gastrointestinal tract. Treatment varies from changing your diet to taking dietary supplements.
If your anemia is due to a chronic disease, treatment of the underlying disease will often improve the anemia. Under some circumstances, such as chronic kidney disease, your doctor may prescribe medication such as erythropoietin injections to stimulate your bone marrow to produce more red blood cells.
Aplastic anemia occurs if your bone marrow stops producing red blood cells. Aplastic anemia may be due to primary bone marrow failure, myelodysplasia (a condition in which the bone marrow produces abnormal red blood cells that do not mature properly), or occasionally as a side effect of some medications. If you appear to have a form of aplastic anemia, your doctor may refer you to a hematologist for a bone marrow biopsy to determien the cause of the anemia. Meedications and blood transfusions may be used to treat aplastic anemia.
Hemolytic anemia occurs when red blood cells are destroyed in the blood stream. This may be due to mechanical factors (a leaky heart valve or aneurysm), infection, or an autoimmune disease. The cause can often be identified by special blood tests and by looking at the red blood cells under a microscope. The treatment will depend upon the cause and may include referral to a heart or vascular specialist, antibiotics, or drugs that suppress the immune system.
Talk with your doctor if you believe you may be at risk for anemia. Your doctor will determine your best course of treatment and, depending on your condition, may refer you to a hematologist, a doctor who specializes in blood disorders.
IS ANEMIA PREVENTABLE?
While many types of anemia cannot be prevented, eating healthy foods can help you avoid both iron-and vitamin-deficiency anemia. Foods to include in your diet include those with high levels of iron (beef, dark green leafy vegetables, dried fruits, and nuts), vitamin B-12 (meat and dairy), and folic acid (citrus juices, dark green leafy vegetables, legumes, and fortified cereals). A daily multivitamin will also help prevent nutritional anemias; however, older adults should not take iron supplements for iron-deficiency anemia unless instructed by their physicians.
Between 1999 and 2005, 285 patients received new diagnoses of myelofibrosis with myeloid metaplasia (MMM) in Japan. Anemic symptoms were present in 162 patients, and hemoglobin (Hb) concentrations were <10 g/dL in 197 patients. Fifty-five MMM patients were treated with anabolic steroids, and their effect on anemia during MMM was evaluated in 39 patients. A “good” response was defined as an Hb increase of >or=1.5 g/dL, cessation of transfusion dependence, and an Hb concentration of >10 g/dL maintained for at least 8 weeks. A “minimum” response was defined as an Hb increase of >or=1.5 g/dL and transfusion independence for at least 8 weeks. Both good and minimum responses were considered “favorable.” Favorable responses were achieved in 17 patients (44%, 8 good and 9 minimum responses). None of the pretreatment variables, such as the lack of transfusion dependence, a higher Hb concentration at the start of treatment, or the absence of cytogenetic abnormalities, were associated with a response to anabolic steroid therapy. Adverse events associated with anabolic steroid therapy were moderate and transient. Two patients required definitive withdrawal of treatment. Thus, anabolic steroids are well tolerated and effective for the treatment of anemia in a subset of MMM patients.
ANABOLIC STEROIDS ARE USED TO TREAT ANEMIA.