Anemia can be common with heart disease

Did you know that anemia is a relatively common complication in heart patients? The medicines used to treat heart disease, and the connection with the heart and the kidneys can often contribute. Initially following bypass surgery most patients have low blood counts for a few months. Many large studies have shown anemia is common in 17-48% of people with heart failure. One study showed that 43% of people who were hospitalized after a heart attack had anemia.

So what is Anemia?

Anemia occurs when your body has a below-normal level of hemoglobin, which in turn prevents your body from getting enough oxygen. In certain cases, this lower level of oxygen causes your heart to work harder. These effects on your heart can make you susceptible to heart disease or worsen existing heart disease

 Hemoglobin is the protein in red blood cells that carries oxygen to all parts of the body. Anemia can be a temporary condition, such as following bypass surgery, a gastro intestinal bleed of other health conditions, or it can be a chronic problem. People with mild anemia may not have any symptoms or may have only mild symptoms. People with severe anemia may have problems carrying out routine activities and can feel tired or experience shortness of breath with activity, or note their heart rate is faster than normal with activity. 

Normal Hemoglobin ranges 

• Adult males: 14 to 18 gm/dL
• Adult women: 12 to 16 gm/dL
• Men after middle age: 12.4 to 14.9 gm/dL
• Women after middle age: 11.7 to 13.8 gm/dL

 Anemia can lead to severe chest pain because parts of the heart are not getting enough oxygen. Lack of oxygen makes a heart work harder, so the muscles in its left-lower chamber may get too thick. This condition is called left ventricular hypertrophy, which can worsen heart disease and increase the chance of heart failure.

Symptoms

Symptoms usually develop when anemia is moderate to severe, and can include fatigue, weakness, pale skin, chest pain, dizziness, irritability, numbness or coldness in your hands and feet, trouble breathing, a fast heartbeat, and headache.

Causes

Some heart medications can contribute. These include Aspirin, Non steroidal anti inflammatorys (NSAIDS) Plavix, Effient, Coumadin, Pradaxa or other blood thinning agents. Other causes include GI bleed, ulcers, gastritis, severe liver or kidney disease, severe high blood pressure, vascular grafts, clotting disorders, iron deficiency. There are other causes but these are the more common causes in patients with heart disease.

If you are a heart patient a regular question you should ask your physician is to please review all your lab values. Keep a copy of these, trend your values, are they improving or worsening.

Treatments

Goals of Treatment – from the National Heart Lung and Blood Institue

The goal of treatment is to increase the amount of oxygen that your blood can carry. This is done by raising the red blood cell count and/or hemoglobin level. (Hemoglobin is the iron-rich protein in red blood cells that carries oxygen to the body.)

Another goal is to treat the underlying cause of the anemia.

Dietary Changes and Supplements

Low levels of vitamins or iron in the body can cause some types of anemia. These low levels might be the result of a poor diet or certain diseases or conditions.

To raise your vitamin or iron level, your doctor may ask you to change your diet or take vitamin or iron supplements. Common vitamin supplements are vitamin B12 and folic acid (folate). Vitamin C sometimes is given to help the body absorb iron.

Iron

Your body needs iron to make hemoglobin. Your body can more easily absorb iron from meats than from vegetables or other foods. To treat your anemia, your doctor may suggest eating more meat—especially red meat (such as beef or liver), as well as chicken, turkey, pork, fish, and shellfish. Iron is more readily absorbed when paired with foods that are rich in vitamin C.

Nonmeat foods that are good sources of iron include:

• Spinach and other dark green leafy vegetables
• Tofu 
• Peas; lentils; white, red, and baked beans; soybeans; and chickpeas
• Dried fruits, such as prunes, raisins, and apricots
• Prune juice
• Iron-fortified cereals and breads

You can look at the Nutrition Facts label on packaged foods to find out how much iron the items contain. The amount is given as a percentage of the total amount of iron you need every day.

Iron also is available as a supplement. It’s usually combined with multivitamins and other minerals that help your body absorb iron.

Doctors may recommend iron supplements for premature infants, infants and young children who drink a lot of cow’s milk, and infants who are fed breast milk only or formula that isn’t fortified with iron.

Large amounts of iron can be harmful, so take iron supplements only as your doctor prescribes.

Vitamin B12

Low levels of vitamin B12 can lead to pernicious anemia. This type of anemia often is treated with vitamin B12 supplements.

Good food sources of vitamin B12 include:

• Breakfast cereals with added vitamin B12
• Meats such as beef, liver, poultry, and fish
• Eggs and dairy products (such as milk, yogurt, and cheese)
• Foods fortified with vitamin B12, such as soy-based beverages and vegetarian burgers

Folic Acid

Folic acid (folate) is a form of vitamin B that’s found in foods. Your body needs folic acid to make and maintain new cells. Folic acid also is very important for pregnant women. It helps them avoid anemia and promotes healthy growth of the fetus.

Good sources of folic acid include:

• Bread, pasta, and rice with added folic acid
• Spinach and other dark green leafy vegetables
• Black-eyed peas and dried beans
• Beef liver
• Eggs
• Bananas, oranges, orange juice, and some other fruits and juices

Vitamin C

Vitamin C helps the body absorb iron. Good sources of vitamin C are vegetables and fruits, especially citrus fruits. Citrus fruits include oranges, grapefruits, tangerines, and similar fruits. Fresh and frozen fruits, vegetables, and juices usually have more vitamin C than canned ones.

If you’re taking medicines, ask your doctor or pharmacist whether you can eat grapefruit or drink grapefruit juice. This fruit can affect the strength of a few medicines and how well they work.

Other fruits rich in vitamin C include kiwi fruit, strawberries, and cantaloupes.

Vegetables rich in vitamin C include broccoli, peppers, Brussels sprouts, tomatoes, cabbage, potatoes, and leafy green vegetables like turnip greens and spinach.

Procedures

If your anemia is severe, your doctor may recommend a medical procedure. Procedures include blood transfusions and blood and marrow stem cell transplants.

Blood Transfusion

A blood transfusion is a safe, common procedure in which blood is given to you through an intravenous (IV) line in one of your blood vessels. Transfusions require careful matching of donated blood with the recipient’s blood.

Blood and Marrow Stem Cell Transplant

A blood and marrow stem cell transplant replaces your faulty stem cells with healthy ones from another person (a donor). Stem cells are made in the bone marrow. They develop into red and white blood cells and platelets.

During the transplant, which is like a blood transfusion, you get donated stem cells through a tube placed in a vein in your chest. Once the stem cells are in your body, they travel to your bone marrow and begin making new blood cells.

Surgery

If you have serious or life-threatening bleeding that’s causing anemia, you may need surgery. For example, you may need surgery to control ongoing bleeding due to a stomach ulcer or colon cancer.

If your body is destroying red blood cells at a high rate, you may need to have your spleen removed. The spleen is an organ that removes wornout red blood cells from the body. An enlarged or diseased spleen may remove more red blood cells than normal, causing anemia.