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Anaemia is a below normal blood count for which there are multiplecauses.Doctors think of possible causes under three headings. Some chronic condition which causes red blood cells tobe destroyed or to break down abnormally rapidly anaemia through losing blood somewherein the body anaemia through inadequate production of red blood cells.

Abnormal destructionof cells
These are relatively uncommon in the western world but elsewhere in the world are extremely important. Sickle cell disease is an important cause of ill health and anaemia in certain racial groups (see sickle cell disease). Spherocytosis is another not uncommon condition where the red cells are rounder than normal andtherefore more liable to break. There is a particular type of anaemia associated with kidney disease andthis is because of failureof production by the kidney of a hormone necessary for blood production (erythropoietin). Finally, cancers can also cause achronic anaemia, for reasons which are not understood.

Loss of blood
This is a very common reason for anaemia in women with heavy periods and whose intake of iron is not adequate to keep up with their blood loss. Inflammation within thedigestive tract e.g. a duodenal ulcer or inflammation of the gullet may allow small but significant amounts of blood to leak every day eventually causing aprofound anaemia. This is also a side effect of taking aspirin or anti-inflammatory drugs, widely used as painkillers and for treating rheumatic conditions.In older people anaemia unexplained for other obvious reasons may bethe earliest sign that a cancer is bleeding into the urine or into the bowel.

Failure of the bone marrow is basically what happens in leukaemia and a similar effect can follow from reaction to certain drugs.e.g. Methotrexate.Coeliac disease causes failure of absorption of essential nutrients withresulting anaemia.

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