In this article I will briefly discuss cause and treatment of a few types of Anemia.



Most common cause is excessive blood loss such as heavy or prolonged menstrual cycles, or slow bleed in the gastrointestinal tract.  In addition to common symptoms of being tired and fatigues, lack of energy, etc., some patients also develop habit of eating/chewing ice.  In medical terms, it is called Pagophagia (a subtype of Pica).  The treatment is obviously iron therapy, in the form of iron pills, but if patient for some reason is not able to tolerate oral iron, due to side effects or absorption, then we treat with intravenous iron, which also produces quick response.


At the same time, it is also important to correct the cause of bleeding.  In our practice, we see most patients with iron deficiency are young females whom have heavy menstrual periods.  While we treat their anemia, they also work with their GYN physician to investigate and treat heavy menstrual blood loss.  In difficult cases sometimes, I also try to intervene; interestingly I have seen some success with DDAVP therapy, an agent approved for other bleeding disorders such as Von –Willebrands disease, etc.  Ease of administration and quick response, if achieved, is very gratifying for young professional females, who while working, also have to struggle with symptoms of anemia, which obviously can affect their full potential at work.


For middle age and elderly patients, we advise them to have colonoscopy, if indicated EGD (upper endoscopy) to rule out any slow bleeding, occult ulcer or lesion.



Vitamin B12 is absorbed at lower end of the small intestine, but whole process is much complicated and starts in the stomach.  Any issues involving stomach acidity or antibodies against B12 binding factor, such as intrinsic factor, along with other diseases of small intestine can cause B12 deficiency anemia.


In our practice, mostly we see this deficiency in patients who have gastric bypass surgery, or the elderly patients.  It may also be seen patients who are strict vegetarians.
Folate deficiency is seen diseases involving the small intestine or food deficient in folic acid.  Most of the time, since absorption is the issue, B12 is implemented in the form of an injection.  Folate is available in the form of a tablet, and is easily absorbed.



Causes of this type of anemia are many, but most commonly we see it in patients with kidney problems, or arthritis, such as rheumatoid arthritis, or lupus.  Also, in patients with cancer and certain blood disorders, such as myelodysplasia.

Treatment is Erythropoetin, given periodically in the form of a subcutaneous injection.  Erythropoetin is a hormone, normally secreted in the kidneys of healthy persons.  Before one considers treatment with Erythropoetin, it is important that other causes of anemia have been ruled out, or erythropoietin will not work.


Cancer and Blood Disorders Treatment Center
M. Ashraf Meelu, MD FACP
3200 Crain Highway, Suite 302
Waldorf, Maryland 20603

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