Treatment Issues for Women

Anemia

If you're feeling tired, ask your doctor to do a blood test for anemia. Anemia is a shortage of red blood cells or hemoglobin, a protein found inside red blood cells that carries oxygen from your lungs to the rest of your body. If oxygen is in short supply throughout your body, you'll feel tired. You may also feel lightheaded or short of breath. Other symptoms include palpitations (irregular heart beat), unusually pale skin, and loss of appetite.

Anemia is extremely common in positive women. A chronic infection like HIV puts stress on your bone marrow, where red blood cells are made. Your bone marrow needs iron, folic acid, and vitamin B12 to make red blood cells. In HIV, anemia is more common in women, people with low CD4 counts and/or high viral loads, and African Americans. It's very important to treat anemia, since the risk of HIV disease getting worse is greater in people with anemia.

Anemia can have many different causes, including:

• A thyroid that's not working right
• Bleeding (heavy menstrual or internal)
• Bone marrow damage or infection
• Deficiencies in key vitamins and minerals like iron, folic acid (folate), B12, and selenium
• Kidney damage
• Medications: AZT (Retrovir, or as part of Combivir or Trizivir), Rebetol (ribavirin), amphotericin, and many others

Diagnosis: To figure out if you're anemic, ask your doctor for a complete blood count (CBC). The CBC looks at total red blood cell counts, percentages, size and shape of red blood cells, and hemoglobin. Hemoglobin levels for women should be at least 12 g/dL. A hemoglobin level less than 6.5 g/dL is too low to keep your organs functioning properly. Red blood cells should make up about 35% to 46% of the total blood volume in women. This is what a hematocrit count measures.

Treatment for anemia depends on what's causing the problem. It's important to stop any chronic bleeding (including frequent nosebleeds, hemorrhoids, and excessive bleeding during your periods) and to address any shortages of iron, folic acid, or vitamin B12.

Before supplementing your diet, make sure you know exactly what kind of anemia you have. Iron is often low in women. Taking iron tablets can restore levels, but too much iron isn't a good thing, especially if you have hepatitis. You can usually get enough iron by eating red meat, seafood, fish, and fortified bread and cereals. Folic acid is found in dark greens, asparagus, lima beans, spinach, and beef liver. Vitamin B12 levels are often low in people with HIV, and some of us aren't able to absorb this vitamin from food or oral supplements. If your B12 levels are low, you may need B12 injections or formulations of B12 you put under your tongue -- no matter how much you get in your diet.

If anemia is caused by a medication, it may be possible to switch to a different drug or, in some cases, lower the dose. If that's not possible, anemia can be treated using erythropoetin (EPO), a hormone made by the kidneys that stimulates your body to make red blood cells. Synthetic EPO (Procrit, Epogen) can be injected under the skin, usually once a week, to help your body make new red blood cells. It may take two to eight weeks for your counts to return to normal. Blood transfusions are possible but rarely necessary to treat anemia.