Fact Sheet 552ANEMIA
WHAT IS
ANEMIA?
Anemia is a shortage of hemoglobin (HGB). HGB is a protein in red
blood cells. It carries oxygen from the lungs to the rest of the
body.
Anemia causes fatigue and shortness of breath. People with
anemia don't feel as good as people with a normal level of HGB.
They find it harder to work. This is called having a lower
quality of life.
HGB levels are measured as part of a complete blood count
(CBC.) See Fact Sheet
121 for more information on these laboratory tests. HGB is
measured as grams per deciliter, the amount in a specific volume
of blood.
Anemia is defined by the level of HGB. Most doctors agree that
HGB levels below 6.5 indicate life-threatening anemia. Normal
levels are at least 12 for women and at least 14 for men.
Overall, women have lower levels of HGB. So do very old and very
young people. More African-Americans have anemia than people in
other ethnic groups.
WHAT CAUSES
ANEMIA?
The bone marrow produces red blood cells. This process requires
iron, the vitamins B12 and folic acid (or folate.) Erythropoietin
(EPO) stimulates the production of red blood cells. EPO is a
hormone made by the kidneys.
Anemia can be caused by low production of red blood cells. It
is also caused by their loss or destruction. Several factors can
cause anemia:
- Too little iron, vitamin B12 or folate. A shortage of folate
can cause megaloblastic anemia with large, pale red blood cells
(see Fact Sheet
121)
- Damage to bone marrow or kidneys
- Blood loss from internal bleeding or a woman's menstrual
cycle
- Destruction of red blood cells (hemolytic anemia)
HIV infection can cause anemia. So can many opportunistic infections
(see fact sheet 500)
related to HIV disease.
Many drugs that are commonly used to treat HIV and related
infections can cause anemia.
ANEMIA AND
HIV
Serious anemia used to be much more common. Over 80% of people
with an AIDS diagnosis had some degree of anemia. People with
more advanced HIV disease, or a lower CD4 count, had higher rates
of anemia.
The rate of anemia went down when people started using highly
active antiviral therapy (HAART.) Severe anemia has become rare.
However, HAART has not eliminated anemia. A large study found
that about 46% of patients had mild or moderate anemia, even
after one year of HAART.
Several factors are linked to a higher rate of anemia in
people with HIV:
HIV disease progression is about 5 times more common in people
with anemia. Anemia is also linked to a higher risk of death.
Treatment of anemia seems to eliminate these risks.
HOW IS ANEMIA
TREATED?
Treating anemia depends on its cause.
- First, treat any chronic bleeding. This could be internal
bleeding, hemorrhoids, or even frequent nosebleeds.
- Next, correct any shortages of iron, vitamin B12 or
folate.
- Stop using, or reduce the doses of medications that cause
anemia.
These approaches might not work. It may not be possible to stop
using all medications that cause anemia. Two additional
treatments are injections of EPO, and transfusions.
EPO (erythropoietin) stimulates the production of red
blood cells. In 1985, scientists learned how to make synthetic
EPO. It is injected under the skin, usually once a week. The most common brand of EPO is Procrit®.
Blood transfusion used to be the only treatment for
severe anemia. However, transfusions can cause infection and
suppress the immune system. They appear to cause faster
progression of HIV disease and to increase the risk of death for
HIV patients.
A large study of people with HIV found that transfusions seemed
to increase the risk of death, while EPO injections decreased it.
Because of the risks of transfusions, they are rarely used to
treat anemia.
THE BOTTOM
LINE
Anemia has always been a problem for people with HIV and AIDS.
The rate of serious anemia has dropped considerably since people
started using HAART. However, almost half of people with HIV
still have mild or moderate anemia.
Anemia increases fatigue and makes people feel bad. It
increases the risk of disease progression and death. It can be
caused by HIV infection or other diseases. Many drugs used to
treat HIV and related infections also cause anemia.
Treating anemia improves the health and survival of people with
HIV. Correcting bleeding or shortages of iron, or vitamins are
the first steps. If possible, medications that cause anemia
should be stopped. If necessary, the patient should be treated
with erythropoietin, or, in rare cases, with a blood transfusion.
Back to Index of Fact Sheets
|
|
The New Mexico AIDS InfoNet is a project of the New
Mexico AIDS Education and Training Center at the University of New Mexico Health
Sciences Center. |
|
|
Partially funded by the National Library of Medicine |
|