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My Approach to Anemia

9/23/2013

6 Comments

 
This is part of a series I call "My Approach Mondays" where I discuss how I approach different symptoms and diseases. I hope you find this information helpful! Anemia is a remarkably misunderstood problem. Most people, doctors and patients, see it as a straight forward nutritional deficiency. Not eating enough Iron? Take some Iron. But what if there was more to it than we once believed?

1. Properly diagnosing the type of anemia is the first  and most crucial step in ensuring that you receive proper treatment. The most common cause of anemia today is Iron Deficiency Anemia (IDA) but another common culprit, Anemia of Inflammation, can mimic IDA on blood work. When running any lab work to evaluate for anemia it is crucial to run the marker that tells these two apart- Total Iron Binding Capacity (TIBC). If you have been diagnosed with anemia in the past go look at your blood work and make sure that TIBC was run. If it was not run I strongly suggest that you get new blood work done to include that marker and have the results interpreted by someone who knows how to do so.

Sadly, running the appropriate blood work does not necessarily guarantee that the doctor will reach the proper diagnosis. I learned first hand that not all doctors are good at interpreting blood work.  A few years ago I asked my GP to run some blood work for me that included an anemia panel. When the results came back I was told to take Iron despite the fact that my results very clearly indicated a different type of anemia! I believe that finding yourself a functional medicine practitioner who routinely orders such tests is the best way to ensure that you get the proper diagnosis and treatment.

There are many, many things that can cause anemia. Some are more obscure than others, while some are quite common. Make sure that you find yourself a doctor (preferably a functional medicine doctor) who is well versed in this area. Don't be afraid to ask them questions- it's the best way to judge weather they're worth their salt and it can give you a good indication of their character. It takes humility and guts for a doctor to admit when they don't know something, and I believe that their reaction to a question they don't know the answer to can tell you a lot of valuable information.

2. If you do need Iron or a vitamin, make sure it's a form that is easily digestible. I call the normal Iron pills "Home Depot special pills" because they look like Iron filings when they are ground. This form of Iron is not only poorly digested and notorious for causing constipation, but "inorganic Iron" such as this has now been linked to inflammation and Alzheimer's Disease.

3. The question needs to be asked, "why do you need this vitamin or mineral now?" Do you legitimately not get enough Iron or B vitamins in your diet, or is something hindering your ability to absorb them? Ulcer medications like acid blockers and proton pump inhibitors are notorious for causing IDA because you need stomach acid to break down the Iron in your food. Some people get B12-vitamin deficiency anemia because of an autoimmune disease called pernicious anemia.

If you or somebody you know is interested in working with a functional medicine doctor please call my office at (919) 238-4094 and see if we are the right fit for you. Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham "triangle" area.
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6 Comments
Ellen Lovelace link
3/10/2015 03:31:50 am

So interesting Nikki, I wish more doctors knew about and put this into practice!

Reply
Dr. DiNezza link
3/10/2015 11:29:18 am

You and me both, Ellen!

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Sandra
3/10/2015 05:30:12 am

Informative article. I am curious, what will having your TIBC tested show differently? Will it specifically say what type of anemia you are dealing with?

Reply
Dr. DiNezza link
3/10/2015 11:28:47 am

Hello, Sandra

TIBC is the marker needed to differentiate a true iron deficiency from something called anemia of inflammation (also called anemia of chronic disease). Unfortunately, most physicians don't run this marker, which leads to a lot of people unnecessarily taking Iron. Think of TIBC as how "hungry" your body is for Iron- the higher it is, the more your body wants Iron. Thus, a high TIBC indicates a true Fe deficiency, while a TIBC that is normal (along with other anemia markers) may indicate anemia of inflammation.

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Caroline link
10/6/2017 12:21:58 pm

If TIBC is normal, does that mean it is true anemia? IF TIBC is not normal does that mean it is anemia of inflammation or vice vera? Please explain! thanks!

Reply
Dr. Nicole DiNezza, DC, NTP link
10/6/2017 12:40:28 pm

Hi, Caroline!

The criteria for anemia are low RBC, hemoglobin, and hematocrit. Everything else (MCV, MCHC, RDW, Ferritin, TIBC, Iron Sat) just tells you what type of anemia it is. Here's my explanation of TIBC from a previous comment:

"TIBC is the marker needed to differentiate a true iron deficiency from something called anemia of inflammation (also called anemia of chronic disease). Unfortunately, most physicians don't run this marker, which leads to a lot of people unnecessarily taking Iron. Think of TIBC as how "hungry" your body is for Iron- the higher it is, the more your body wants Iron. Thus, a high TIBC indicates a true Fe deficiency, while a TIBC that is normal (along with other anemia markers) may indicate anemia of inflammation."

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