Anemia: The most common blood disorder among Thai people

When talking about blood diseases, it is important to understand that blood consists of red blood cells, white blood cells, platelets, and the blood coagulation system. When there is an abnormality in the blood, it can cause problems such as anemia, polycythemia, low white blood cells, high white blood cells, low platelets, high platelets, blood clots, and easy bleeding with difficulty stopping, etc.

Anemia is a common blood disease in Thai people

Anemia is the most common blood disorder in Thai people. It occurs when the body has fewer red blood cells than normal or less than what the body needs to use oxygen. Normally, red blood cells are responsible for transporting oxygen to the cells and tissues in each organ of the body. When anemia occurs, it is like the organs receive less oxygen. Important organs such as the brain and heart have low tolerance to this condition, so symptoms often appear first. Each person shows different symptoms because their ability to adapt varies.

Problems or symptoms found in anemia

The problems usually come with symptoms such as dizziness, lightheadedness, easy fatigue, palpitations, chest pain, weakness, or being told by others that they look pale or yellowish (which is not true jaundice, but commonly misunderstood; observe the sclera which remains normally white). Sometimes patients come after consulting emergency doctors due to trauma or bleeding under the skull, or sometimes from abnormal blood test results, heart failure, or risk factors from existing chronic diseases.
Currently, patients often come after health check-ups without clear symptoms of anemia because health screening is more accessible, allowing detection of anemia abnormalities before symptoms appear. Once detected, doctors always recommend investigating the cause since it is an early sign of abnormality before other symptoms develop. However, many people neglect this advice, causing problems later.

Anemia must be diagnosed for the true cause for treatment

Anemia or pallor is just a problem that brings patients to see a doctor, not a diagnosis of disease. Therefore, the cause must always be investigated to treat according to each patient’s cause. Anemia does not always mean blood transfusion or taking blood supplements. There are many types of blood supplements. Sometimes patients feel their fatigue improves after taking supplements, but blood tests show no improvement or even worsen because the treatment is not targeted. Many patients want advice without cause investigation, which is inappropriate.

3 main causes of anemia

1. Decreased red blood cell production due to
   • Deficiency of nutrients such as iron, vitamin B12, folic acid
   • Chronic kidney failure causing lack of hormones and factors stimulating red blood cell production
   • Bone marrow abnormalities such as bone marrow degeneration, bone marrow aplasia, bone marrow infection, bone marrow cancer
   • Chronic diseases that interfere with red blood cell production such as arthritis, immune system disorders
2. Increased destruction of red blood cells, often accompanied by jaundice
   • Thalassemia is a congenital genetic disorder with varying severity. It was more common and severe in the past, causing abnormal facial structure and a stocky build due to enlarged liver and spleen because of lack of family planning or premarital health screening. It is still found today but usually in milder forms.
   • G-6-PD enzyme deficiency found in males. Normally asymptomatic without anemia, problems occur when infections or certain drugs trigger sudden red blood cell destruction. Patients become very pale, jaundiced, severely hypotensive, with dark urine, and have a high risk of death.
   • Autoimmune disorders causing red blood cells to break down easily, found in women of reproductive age
   • Viral infections such as malaria, mycoplasma, clostridium
3. Blood loss from the body due to menstruation, gastrointestinal bleeding from gastritis or intestinal cancer, blood in urine, or trauma

When to see a doctor

When knowing there is anemia, one should promptly see a hematologist to investigate the cause because each person usually has different causes of anemia. A family history of anemia and the patient’s anemia may have the same or different causes, or multiple causes. It cannot be assumed that the anemia is caused by the same reason as family members. Many times, the cause is missed because of the misunderstanding that the anemia is inherited from parents and thus not treated. The most dangerous is that sometimes it may be a warning sign of cancer.

Diagnosis and treatment of anemia

Investigation starts with detailed history taking and physical examination, complete blood count, blood smear staining, testing for other associated conditions such as kidney function, vitamin levels, thalassemia screening, G-6-PD enzyme level, immune deficiency testing, stool examination, urine examination, viral infection screening, or finally bone marrow aspiration. These tests do not require fasting before the procedure.

Treatment depends on the diagnosed cause of anemia. The duration of treatment and prognosis vary accordingly.