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Anemia and Mental Health

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The brain needs nutrients and oxygen, which is from appropriate blood circulation in the body. Along with assessment of blood pressure and distal perfusion, ruling out anemia is critical for mental health symptoms given that oxygen is bound to hemoglobin and carried in red blood cells (RBC's). The world health organization (WHO) reports that over 1 billion people have anemia of a certain type with most cases being iron deficiency anemia. Now, this is more common in third world countries where iron-rich foods are sparse, yet, iron depletion and anemia is also seen in the states. Have you been checked lately? Although there's many forms of anemias, the most common is iron deficient anemia and the one I see often in my practice. Other common microcytic, hypochromic anemias include anemia of inflammation, blood loss, and on occasion, thalassemia, which is a genetic condition from dysfunctional hemoglobin. On the other end of the anemia spectrum, the macrocytic anemias include either pernicious anemia or non-pernicious anemia, which is megaloblastic. Basically, in this case, it's important to evaluate B12 and Folate, as these are commonly low leading to inefficient RBC function.


Anemia Definition: a condition marked by a deficiency of red blood cells or of hemoglobin in the blood, resulting in pallor and weariness.


Anemia Symptoms:

Symptoms most commonly found with anemia include being fatigued, having blue fingertips (cyanosis) and shortness of breath. Being low on iron or B12 is also associated with multiple psychological symptoms such as depression, anxiety and bipolar disorder. (R)


Key Blood Markers:


The first step is to identify anemia with a blood test. Asking your provider for a complete blood count (with differential) and an iron panel is a good start. So many people go years without properly evaluating iron or other iron-related markers such as Ferritin, transferrin and total iron binding globulin (TIBC). A serum B12 and Folate should be ran as well.


Iron Deficient Anemia:


Iron deficient anemia develops because of low iron intake (think vegans and vegetarians), iron loss from RBC's or poor absorption of iron in the gut. This is seen in inflammatory bowel disease or the consequence of gastric bypass surgery usually. Studies have suggested that being iron deficient and having anemia are associated with mental health symptoms.


Macrocytic Anemia (megaloblastic):


A macrocytic anemia commonly happens with a B12 and/or B9 deficiency. This may happen from malabsorption, dietary practices that are deficient in B vitamins, or autoimmunity to parietal cells or intrinsic factor, which impairs the mobilization of B12 to the small intestine. It's also common for alcoholics to have these deficiencies, too. (R)


Anemia of Inflammation:


Chronic conditions that cause inflammation such as infections, autoimmune disease, cancer and chronic kidney disease (CKD) may cause anemia. This form of anemia is illustrated by acute phase proteins being elevated (generally C-reactive protein (CRP), Ferritin and/or Erythrocyte Sedimentation Rate (ESR) from inflammation. Inflammation raises a protein called Hepcidin that plays an intricate role of iron homeostasis. Hepcidin impairs the mobilization of iron from macrophages, decreases productivity of RBC's from bone marrow and lowers EPO expression from the kidneys through various mechanisms. In regard to mental health, inflammation control seems to be a key mechanism that needs attention and not just for depression, but also other psychological conditions such as Autism, Schizophrenia, OCD, trauma, Bipolar and Stress, among others.


The key with any type of anemia is resolution of inflammation and identifying the root cause. If any of these anemias exist, appropriate management from a provider is suggested. Again, the idea is to make the connection with anemia to psychological symptoms, which may be more common than one thinks. I hope this helps.









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