Rheumatoid anemia, an example of anemia caused by chronic diseases, involves effects like shortened life-cycle of red blood cells, less than sufficient formation of new red blood cells by the bone marrow and iron metabolism disorders. Believe it or not, all forms of anemia including mild and severe, impact roughly 24% of world’s population, rich and poor countries involved. (Source: WHO report – Global anemia prevalence and number of individuals affected)
Anemia is defined as hemoglobin level less than 12 g/ dl in women and 13 g/dl in men. In a study carried out by WHO on RA patients [source: Wolfe F, Michaud K Anemia and renal function in patients with Rheumatoid Arthritis, J Rheumatol 2006:33:1516-22], the prevalence of anemia was 30.4% in men with RA and 32% in women with RA. Anemia prevalence was 3 times higher in RA patients relative to a control group.
How much Iron is found in the human body?
Just 4 to 5 gram! Iron is absorbed from a part of our small intestine called duodenum, is used in the bone marrow, and stored in the liver and spleen. It cycles in our body from storage sites to the bone marrow, to the cells and back. Bone marrow uses an iron to synthesize nearly 200 billion cells a day, with all red blood cells combined carrying roughly 2.5 gram of iron in our body. A soluble form of iron in our body is called ferritin, and the insoluble form inside cells is lactoferrin and hemosiderin. Excessive intake of iron is dangerous as the human body has no mechanism to eliminate excess iron.
How a chronic inflammation, such as the one caused by RA, result in anemia?
A glycoprotein called Transferrin plays a vital role in the movement of iron in our body. Iron bound to this glycoprotein is received by the cells through transferrin receptors. The level of this protein is found to be low in patients suffering from RA. On the contrary, when anemia is caused by iron deficiency alone, transferrin levels are found to be high. Therefore, to treat the anemia caused by RA, it is critical to lowering the systemic inflammation in the body by use of various disease modifying drugs like methotrexate. Blood transfusion is rarely advised. Few other advanced treatments like erythropoietin therapy are reserved for extreme and hard to resolve cases through regular treatments.
What does this mean for an RA patient?
Among other things, keep a watch on your hemoglobin level. A low hemoglobin level can cause fatigue, dizziness, breathlessness and other symptoms that are associated with anemia.
Source: Joint Bone Spine, Volume 78 (2) – Mar 1, 2011
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