Detecting and dealing with anemias

Donya Betancourt, Pediatrician, drdonya@hotmail.com

Doctors diagnose vitamin deficiency anemias through blood tests, including tests that measure the number and appearance of red blood cells. If you have anemia, you will have fewer red blood cells. In vitamin deficiency anemia, your red blood cells will appear large and underdeveloped.

Blood tests also check the amount of folate, vitamin B-12 and vitamin C in your blood. Folate and vitamin B-12 levels are measured at the same time, because these two often become deficient together. Not every hospital can give blood tests, but if a doctor suspects anemia, they will probably conduct further tests.

If blood tests reveal a vitamin deficiency, your doctor may perform other tests to determine the type and cause. Diagnosing vitamin B-12 deficiency in particular may involve more tests, such as an antibodies test, also called a Schilling test.

Before undergoing a Schilling test, you must first ingest a tiny amount of radioactive vitamin B-12, after which your blood is checked to see if your body absorbed the vitamin B-12. Then, you must ingest a combination of radioactive vitamin B-12 and an intrinsic factor. If the radioactive B-12 is absorbed only when taken with intrinsic factor, it confirms you lack the vitamin; but if your body doesn't absorb vitamin B-12 with or without an intrinsic factor, it is likely that you have a more general absorption problem.

To diagnose vitamin deficiency anemias, your doctor may also take a sample of your bone marrow. Using a needle, your doctor extracts a sample of bone marrow from your hipbone and examines it under a microscope to rule out other blood disorders with similar signs and symptoms.

Why is checking for vitamin deficiency important? Being deficient in vitamins increases the risk of many health problems, such as birth defects. A lack of folate in pregnant women can lead to birth defects of the brain and spine. During pregnancy, the fetus needs supplemental folic acid to develop healthy blood and nerve cells.

Vitamin B-12 is also important for the production of red blood cells and a healthy nervous system. Untreated, vitamin B-12 deficiency can lead to neurological problems, such as a persistent tingling in your hands and feet known as peripheral neuropathy. It can also lead to mental confusion and forgetfulness, because vitamin B-12 is necessary for healthy brain function. Vitamin B-12 deficiency can cause these and other health problems before it leads to anemia.

Vitamin C deficiency, on the other hand, can lead to scurvy, a rare disease. Its symptoms include bleeding under the skin and around the gums.

Vitamin deficiency anemias can be treated with supplements and dietary changes.

Folic acid (folate) deficiency: Maintain a healthy diet and take folic acid supplements as prescribed by your doctor. In almost all cases, folic acid supplements are taken orally every day. It usually takes a month or longer to correct folate deficiency anemia. If you can't absorb folate easily, you may need to take folic acid supplements for life.

Vitamin B12 deficiency (pernicious anemia): Vitamin B-12 deficiency caused by a poor diet can be treated by changing your diet and taking vitamin B-12 supplements, under a doctor's supervision. If your body can't absorb vitamin B-12, you'll need lifelong injections of vitamin B-12. At first, you'll need the shots, which you can administer yourself, daily. Eventually, you need them just once a month.

Vitamin C deficiency anemia: Treated by taking vitamin C tablets as directed by your doctor. Additionally, increase your intake of foods and beverages that contain vitamin C.

You can prevent some forms of vitamin deficiency anemias by eating a balanced diet and taking multivitamin supplements during pregnancy and while breast-feeding.

Foods rich in folate include citrus fruits and juices and dark-green, leafy vegetables. Some breakfast cereals and enriched grain products are fortified with folic acid. Vitamin B-12 is abundant in red and white meats and dairy products. Vitamin C is plentiful in citrus fruits and juices, tomatoes, green peppers and potatoes.

Most adults need 2.4 micrograms of vitamin B-12, 400 micrograms of folate or folic acid and 75 to 90 milligrams of vitamin C a day. A balanced diet provides these daily recommended amounts. Ask your doctor whether you need vitamin supplements.