What is anemia?

One speaks of anemia when there is a lack of red blood pigment ( hemoglobin ) and/or red blood cells ( erythrocytes ) and thus an insufficient proportion of blood cells ( hematocrit ) in the body. These are the decisive parameters for diagnosing anemia.

Important to know: The number of red blood cells does not always correlate with the red blood pigment. The number of red blood cells can still be normal or even increased, although there is already a reduction in the red blood pigment.

More than half of the blood consists of blood plasma. Numerous substances are dissolved in it – from hormones and other messenger substances to nutrients (proteins, salts and sugar). These substances finally reach all regions of the body with the blood and supply the organs and tissues there.

The other half of the blood is made up of cells. This proportion is measured by the hematocrit value. These cells are divided into three major groups: the white blood cells ( leukocytes ) are part of the body’s defense system and protect the body against infections; the blood platelets ( thrombocytes ) are involved in hemostasis and the red blood cells ( erythrocytes ) transport the oxygen in the body.

The vast majority of blood cells are made up of red blood cells. They take over one of the most important tasks of the blood system: transporting oxygen and carbon dioxide. Essential for this task is a molecule called hemoglobin, which is found in the erythrocytes and is responsible for the red color of the blood.

The oxygen that enters the blood through the lungs binds to certain regions of this molecule. The hemoglobin carries it throughout the body and eventually delivers it to the organs and tissues where it is needed. In exchange, the metabolic product carbon dioxide (CO2) binds to the hemoglobin. Carbon dioxide is thus transported back to the lungs and exhaled.

If there are too few erythrocytes or too little hemoglobin in the body, the organs receive too little oxygen. This can cause symptoms – however, those affected experience the symptoms to varying degrees as weak or strong. Not all symptoms are always present.

The classic symptoms of anemia include:

  • tiredness and lack of concentration
  • Headache
  • dizziness
  • Shortness of breath to heart palpitations under stress.

The often described pallor of the skin is a rather unspecific sign. It occurs because the blood vessels constrict in response to the lack of oxygen. You can read more about the possible signs of different forms of anemia below in the "Symptoms of anemia" section.

The family doctor can diagnose anemia with the help of a simple blood test. If anemia is present, it is important to determine the causes in order to be able to take appropriate measures. Depending on the cause and severity, a change in diet, medication, or medical intervention (for example, to remove a source of bleeding) may be necessary. If the symptoms of anemia are very pronounced, it may also be necessary under certain circumstances to supply the missing amount of red blood cells via a blood transfusion.

Causes of anemia

Normally there is a balance between blood formation and blood breakdown or blood loss. In the case of anemia, this balance is disturbed. The causes of anemia can be varied and also combined. Thus, in addition to disturbed blood formation, increased blood breakdown or loss can prevail at the same time.

Symptoms of anemia

If there are not enough red blood cells in the circulatory system, this can cause those affected to feel tired and exhausted. It happens that the skin loses color and a pallor appears. As described, however, the pallor of the skin is a rather uncertain sign of anemia. Concentration can also be impaired, and those affected can also feel dizzy during exertion. Some patients complain of noise or throbbing in the ears or freeze quickly.

If the degree of anemia is greater, the heartbeat may accelerate (tachycardia). The pulse weakens, there is sweating, dizziness, and possibly even shortness of breath and fainting. Especially in patients with a pre-damaged heart, the lack of oxygen supply to the pumping organ and the increased stress caused by the increased heartbeat can lead to a heart attack.

Blood loss sometimes occurs gradually. If smaller amounts of blood are lost over a longer period of time, anemia may occur without the affected person noticing. The body compensates for the slow loss. Up to two-thirds of blood cells can be lost insidiously, without those affected feeling more than some tiredness and exhaustion.

However, such blood losses may still be dangerous – which is why you should consult a doctor if you have a frequent feeling of weakness and persistent fatigue and have possible causes clarified.


Blood counts and cancer 

Morphology is something we frequently overlook, but it needs to be done at least once a year. If you are experiencing unsettling symptoms, do not put off getting your blood tested. 

What symptoms should prompt us to perform a morphology?

I believe that even in the absence of disease symptoms, a complete blood count should be performed once a year. Additionally, this test needs to be done if there are any severe disease symptoms.

In particular, prolonged infection, severe weakness, hemorrhages, or the emergence of petechiae should prompt a blood examination. It is crucial to raise awareness of the signs and symptoms of blood disorders and to remind people that many diseases, not just those affecting the blood, can be identified using this straightforward test. Disorders of other organs are also reflected in the blood, which functions as a kind of mirror.

How high of an ESR can indicate cancer?

I advise the ESR test in addition to morphology. This straightforward test can detect a variety of diseases. These are either inflammatory or neoplastic diseases. When the OB is greater than 20 but less than 40, the outcome should be concerning. If it persists or worsens, you must first repeat the test and continue the diagnosis. Diagnostics should be initiated without undue delay if the ESR is greater than 40. If the ESR is greater than 100, we are considered to be seriously ill. However, it’s crucial to keep in mind that severe disease can occasionally arise without an accelerated ESR, so other symptoms need to be kept an eye on.

A general urine test is also worthwhile because it can speed up the detection of cancer by revealing the presence of blood or protein. Everyone should get these tests done at least once a year, even those who are asymptomatic. These affordable tests have the potential to save our lives.

Can we diagnose cancer based on blood counts?

In the peripheral blood, specific blood cell types are either insufficient or excessive. This examination can pick up on a wide range of leukemias, polycythemia, thrombocythemia, primary myelofibrosis, some lymphomas, and myeloma, as well as a large number of tumors in other organs that are secondary to anemia.

Such anemia might be a cancer precursor. A postmenopausal man or woman with particularly mild iron deficiency anemia may experience gastrointestinal bleeding, which is frequently the result of a tumor in this system. However, it does carry out diagnostics that will eventually result in a diagnosis. Finally, you can identify blood cell deficiencies using morphology.

When should morphology results be of concern? When can they indicate cancer?

The most typical signs of leukemia are elevated monocyte or lymphocyte levels. An increase in red blood cells may then be a sign of polycythemia vera, which we include in the so-called myeloproliferative neoplasms. In essential thrombocythemia, there is a very high concentration of platelets, or thrombocytes.

The incorrect values are typically indicated by the letters L (for low) or H (for high) in the result. The more the values marked in this manner deviate from the norms listed next to them, the more cause for concern and medical attention should be sought. In contrast, it is unlikely that we are in danger if the results are within the normal range.

Can the morphology clearly determine that we have cancer, or are other tests needed to confirm it?

Usually, even if a blood cancer is suspected, further tests are needed to determine exactly what type of cancer it is.

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