Anemia

Sex and Gender-based Analysis of this topic

Definition

Anemia is a health condition occurring when there is a lack of hemoglobin or too few red blood cells to carry oxygen needed to the organs and tissues [1]. Anemia may occur when (1) the body loses a lot of blood; (2) the body does not make enough red blood cells (RBCs); (3) RBCs cannot carry oxygen; and/or (4) RBCs are destroyed faster than they can be replaced [2]. Even moderate anemia can cause symptoms including: fatigue, weakness, shortness of breath, rapid or irregular heartbeat, and poor concentration [3]. Among children, anemia is associated with psychomotor and cognitive deficits and poor school performance [3]. Severe anemia may cause symptoms similar to heart failure and even lead to death [4]. There are many types of anemia with different causes.  Worldwide, the most common type is iron-deficiency anemia (IDA), about 2-5% among men and postmenopausal women, which may be caused by loss of blood or not enough iron in the diet. Deficiencies in vitamin B12 and folic acid may also lead to anemia. Anemia can also be caused by kidney disease and is common to other diseases, including arthritis, Crohn’s disease, aplastic anemia, celiac disease and certain cancers. Finally, some types of anemia, such as thalassemia and sickle cell disease, are hereditary [5].

 
 
Sex Issues

Women are more vulnerable to IDA than men. Teenage girls and premenopausal women are at greater risk of developing anemia if they have heavy periods. Pregnant women may not take in enough iron to meet increased needs. For men (and women), common causes of IDA are ulcers, polyps, colon cancer, infections, and injury [6]. Some medications may cause anemia, including aspirin or nonsteroidal anti-inflammatory medicines (NSAIDS), and certain chemotherapy and HIV/AIDS drugs [5,7].

 
 
Gender Issues

Societal pressures that portray thin/slim body types as desirable can cause women to restrict their dietary intake, which can increase their risk for nutrient deficiency and anemia. Similarly, vegetarian diets popular among teen girls and young women, increase the risk of not enough iron intake.  Women who are anorexic/bulimic are at greater risk of developing iron and/or B12 deficiency anemia [8]. In Canada, more women than men are low income and may be at greater risk of food insecurity, malnutrition and anemia [9]. Additionally, low-income women have been found to sacrifice their own nutrition to feed their children, further increasing the likelihood of nutrient-deficiency anemia [10].

 
 
Diversity

Iron deficiency anemia is approximately five times higher among women in Nunavik compared to the general population [11]. A recent Canadian study in Nunavik estimates IDA to be present in 40% of women of childbearing age, and approximately one third of pregnant women. This could be due to replacement of traditional foods that are high in iron with less nutritious alternatives [11]. Anemia is also prevalent among refugee women, due to high prevalence of nutrient-poor diets and anemia in low-income countries of origin [12]. Genetic factors also play a role among certain ethnic groups.  People from the Mediterranean regions (southern Italy, Greece, Cyprus, Southeast Asia) carry the gene for thalassemia and those from northern Africa carry the gene for sickle cell disease[14]. Both of these forms of inherited anemia can lead to severe and life-threatening complications [12, 13].

 
 
Critique

Anemia is a prevalent and potentially serious condition but it is poorly diagnosed. Family physicians receive very little education on the diagnosis and treatment, even though it can be successfully treated, in most cases. Simple laboratory tests can differentiate the types of anemia and it is important that the healthcare professional be trained to identify the underlying causes, which may vary.

 
 
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