Anemia, Bleeding, and Clotting
Anemia is a condition that occurs when there are too few properly
functioning red bloods cells to carry oxygen throughout the body. There
are many different causes of anemia. Sickle-cell anemia, also called sicklecell
disease, is a hereditary disorder in which abnormal hemoglobin*
within the red blood cells interferes with their functioning and survival.
Hemorrhage (HEM-or-ij) is significant bleeding that can lead to anemia.
Clotting is the process that changes blood into a thick, jellylike substance
that stops bleeding. Hemophilia* is a hereditary disorder in which the
blood does not clot normally, leading to excessive bleeding and possibly
hemorrhage and anemia.
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What Is Anemia?
Anemia is a condition in which the blood does not contain enough properly
functioning red blood cells to carry oxygen to all the cells of the body.
There are several dozen types of anemia that fall into three broad categories
according to their underlying causes:
■ The process for making red blood cells, called erythrocytes (e-RITHro-
sites), is not functioning normally: Either the bone marrow—
the tissue in the center of most bones—does not make enough
erythrocytes, the erythrocytes do not contain enough hemoglobin,
or the hemoglobin does not function correctly.
■ Erythrocytes are destroyed faster than the bone marrow can replenish
them. Sickle-cell anemia, caused by defective hemoglobin genes*
inherited from one’s parents, is an example of this type of anemia.
■ The body’s total blood volume is lost faster than it can be replaced,
caused by hemorrhage or impaired clotting such as in cases of
The life of an erythrocyte Blood contains red and white blood cells,
platelets, and plasma—the yellow-tinted portion made up of water and
other substances. Erythrocytes are the most abundant cells in the blood
and give blood its red color. They are produced from stem cells* in the
bone marrow by a process called hematopoiesis (he-ma-tow-po-EE-sis).
As erythrocytes mature in the bone marrow, they fill up with hemoglobin.
Hemoglobin consists of four protein chains, called globins, and
four heme molecules. Heme contains iron that binds to and transports
oxygen and carbon dioxide. This characteristic enables hemoglobin to
absorb oxygen in the lungs, release oxygen to the cells of the body, and
transport carbon dioxide from the cells back to the lungs.
As an erythrocyte matures, it rids itself of most of the normal cell
components (including the nucleus) to make room for about 300 hemoglobin
molecules, which take up most of the cell’s volume. Without the
usual components, erythrocytes cannot grow and divide, and each erythrocyte
survives for only about 120 days. The spleen, an oval organ located
between the stomach and the diaphragm on the left side of the body, contains
cells called macrophages (MAK-ro-fayj-ez). The macrophages engulf
and break down the old, dying erythrocytes and recycle the iron from the
hemoglobin to be used to make more hemoglobin. More than 2 million
erythrocytes die every second, and they must be replaced by hematopoiesis
at exactly the same rate. If there are too few erythrocytes, the kidneys
(and to a lesser extent, the liver) make a hormone called erythropoietin
(ee-rith-ro-po-EE-tin). This protein is secreted into the blood and signals
the bone marrow to make more red blood cells. Blood production is a complex process that requires communication
between many parts of the body, including the bone marrow, the kidneys,
and the spleen. There are many places in the process where something can
go wrong. Problems with stem cells, with the production and maturation
of erythrocytes, with the manufacture of hemoglobin, and with spleen
function, and problems caused by improper signaling between the kidney
and bone marrow can all lead to anemia. A person can have anemia
due to an inherited blood disorder, because of an acquired blood condition,
or as a side effect of a disease or condition not directly related to
the blood. Sometimes anemia can be related to the ingestion of certain
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Types of anemia Among the many different conditions and disorders
that can cause the low production of erythrocytes leading to anemia are
■ An iron-deficient diet, as in Carrie’s story, is the most common
cause of this type of anemia.
■ Folate-deficiency anemia is caused by a lack of folate (folic acid) in
the diet or poor absorption of the nutrient.
■ Pernicious anemia is caused by vitamin B12 deficiency.
■ Sideroblastic (sid-er-o-BLAS-tik) anemia is a disorder in which the
heme portion of hemoglobin does not correctly bind iron.
■ Thalassemia (thal-a-SEE-me-a) is a group of inherited disorders in
which the rate of hemoglobin production in the bone marrow is
low because of a defect in the globin portion of hemoglobin.
■ Diamond blackfan anemia is a very rare blood disorder in which
the bone marrow does not make enough red blood cells.
■ Aplastic anemia refers to a group of disorders in which the
hematopoietic cells of the bone marrow are defective or destroyed.
Hemolytic anemias are caused by the premature destruction of red
blood cells. Sickle-cell anemia is the best-known hemolytic anemia. In
this disorder abnormal hemoglobin—called hemoglobin S—causes the
erythrocytes to be sickle- or crescent-shaped rather than rounded and
flattish like a saucer. Because of their shape, sickle cells cannot flow easily,
and they tend to bunch up and clog blood vessels and break apart.
This action can cause inflammation, pain, and tissue damage. Sickle
cells are also more easily destroyed than normal red blood cells, having
a lifespan of only 10 to 20 days. Although people with sickle-cell
disease make red blood cells faster than healthy people, their bodies
cannot keep up with the destruction of their red blood cells, resulting in anemia.
Hemorrhage, which means losing a lot of blood very quickly, can
result in anemia because the body cannot make new blood as fast as it
is being lost. Hemorrhages can be caused by injury, a burst blood vessel,
childbirth, or surgery.