Red cells primarily consist of a protein made in bone marrow called hemoglobin. In men, anemia is typically defined as a hemoglobin level of less than 13.5 gram/100 ml and in women as hemoglobin of less than 12.0 gram/100 ml.
Anemia happens for different reasons. Survivors in a prolonged disaster setting are unaccustomed to being off the grid, and could easily injure themselves and bleed heavily from a wound. This is the most sudden cause of severe anemia, but it can also occur from lack of production due to malnutrition or medical conditions that destroy red blood cells or shortens their life span (normally, about 115-120 days).
Depending on the cause, signs and symptoms of anemia may vary. If your patient’s case is mild and they’ve had it for a while, their body may have accommodated to the extent that they might not have symptoms. If they do occur, they might include:
- Fatigue
- Weakness
- Headache
- Pale or yellowish skin
- Cold hands and feet
Simple blood tests could identify the problem, but won’t be available off the grid. Just checking under the lower eyelid, however, may reveal a hemoglobin deficiency. Normally, the inside of the eyelid is light red or pink; in anemia, it’s very pale or yellow. Worse cases can cause major symptoms:
- Irregular or fast heart rates
- Shortness of breath
- Dizziness or lightheadedness
- Chest pain
The worse the anemia, the less productive your group member will be, so it’s important to do everything possible to treat it and increase the hemoglobin level.
Iron deficiency is the most common cause of anemia. It’s often seen in women who are or were recently pregnant. Heavy periods will also cause iron-deficiency anemia. Treatment usually involves oral supplements like ferrous sulfate or ferrous gluconate. The usual dose is 325 mg (65 mg of elemental iron) three times a day. Some complain of intestinal issues at that dose: dark stools, constipation, nausea, and cramps. This can take a lot out of a person, so consider a lower dose or every other day dosing in those afflicted. Be aware that caffeinated beverages may delay iron absorption, while vitamin C at 500 mg promotes it.
In addition to iron, your body needs folate (vitamin B9) and vitamin B12 to produce enough healthy red blood cells. A diet lacking in these and vitamin C can impair the production of red cells. Some people get enough B12 but can’t absorb it due to an autoimmune reaction, causing a condition called “pernicious anemia”. Special B12 injections are given for this and other conditions.
Anemia can also be related to inflammation. Certain diseases, such as cancers like leukemia and lymphoma, AIDS, rheumatoid arthritis, kidney disease, Crohn’s disease and other inflammatory ailments can lower production of red blood cells or destroy them. For these, you have to treat the main problem, a major challenge for the off-grid medic.
Another group of anemias are known as “hemolytic” (blood disintegraters). They develop when red blood cells are destroyed faster than bone marrow can replace them. You can inherit a hemolytic anemia, or you can develop it later in life.
Sickle cell anemia (sometimes called “sick-as-hell” anemia) is a type of hemolytic anemia. It’s caused by a defective form of hemoglobin that forces red blood cells to assume an abnormal (sickle) shape instead of a disc. These irregular blood cells die prematurely, resulting in a chronic shortage. Patients, often African Americans, go into what we call “crises” that can be very painful when these abnormally shaped cells clog small blood vessels.
Hemolytic anemias can also be caused by certain drugs, which can cause the immune system to mistake your own red blood cells for foreign substances. The body responds by making antibodies to attack and destroy its own cells. Make sure your healthcare provider knows if you take any of these medicines:
- Cephalosporins like Keflex
- Fluoroquinolones like Levaquin
- Penicillins
- Nitrofurantoin (Macrodantin) and phenazopyridine (Pyridium; used for bladder infections)
- Levodopa for Parkinson’s disease
- Dapsone for skin disease
- Quinidine for irregular heartbeats
- Methyldopa for high blood pressure
- Aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs
Dietary sources of iron may be helpful, so adjust your food storage and survival garden goals accordingly. Eating a diet high in meats, especially red meats, may help. Nonmeat iron sources include:
- Spinach and other dark green leafy vegetables
- Peas and certain other legumes like chickpeas
- Beans
- Dried fruits, such as prunes, raisins, and apricots
Some foods are Iron-fortified, like certain cereals and breads. Many also have B12 added, as well. Other food sources of B12 are:
- Meats, such as liver, beef, fish, and poultry
- Eggs
- Dairy products
For folic acid:
- Spinach and other dark green leafy vegetables
- Black-eyed peas and other dried beans
- Beef liver
- Eggs
- Bananas, oranges, and related fruits and juices
As mentioned earlier, vitamin C is a tool to help absorb iron. Good sources of vitamin C can be found in many fruits as well. Fresh and frozen fruits, vegetables, and juices usually have more vitamin C than canned ones. Vegetables rich in vitamin C include tomatoes, peppers, broccoli, brussels sprouts, potatoes, and spinach.
Joe Alton MD
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