hemoglobinuria

If you have anemia, your blood does not carry enough oxygen to the rest of your body. The most common cause of anemia is not having enough iron. Your body needs iron to make hemoglobin. Hemoglobin is an iron-rich protein that gives the red color to blood. It carries oxygen from the lungs to the rest of the body.

Anemia has three main causes: blood loss, lack of red blood cell production, and high rates of red blood cell destruction.

Conditions that may lead to anemia include:

• Heavy periods
• Pregnancy
• Ulcers
• Colon polyps or colon cancer
• Inherited disorders
• A diet that does not have enough iron, folic acid or vitamin B12
• Blood disorders such as sickle cell anemia and thalassemia, or cancer
• Aplastic anemia, a condition that can be inherited or acquired
• G6PD deficiency, a metabolic disorder

Anemia can make you feel tired, cold, dizzy, and irritable. You may be short of breath or have a headache.

Your doctor will diagnose anemia with a physical exam and blood tests. Treatment depends on the kind of anemia you have.

NIH: National Heart, Lung, and Blood Institute

Your blood is living tissue made up of liquid and solids. The liquid part, called plasma, is made of water, salts and protein. Over half of your blood is plasma. The solid part of your blood contains red blood cells, white blood cells and platelets.

Blood disorders affect one or more parts of the blood and prevent your blood from doing its job. They can be acute or chronic. Many blood disorders are inherited. Other causes include other diseases, side effects of medicines, and a lack of certain nutrients in your diet.

Types of blood disorders include:

• Platelet disorders, excessive clotting, and bleeding problems, which affect how your blood clots
• Anemia, which happens when your blood does not carry enough oxygen to the rest of your body
• Cancers of the blood, such as leukemia and myeloma
• Eosinophilic disorders, which are problems with one type of white blood cell.

Bone marrow is the spongy tissue inside some of your bones, such as your hip and thigh bones. It contains stem cells. The stem cells can develop into the red blood cells that carry oxygen through your body, the white blood cells that fight infections, and the platelets that help with blood clotting.

With bone marrow disease, there are problems with the stem cells or how they develop:

• In leukemia, a cancer of the blood, the bone marrow makes abnormal white blood cells
• In aplastic anemia, the bone marrow doesn't make red blood cells
• In myeloproliferative disorders, the bone marrow makes too many white blood cells
• Other diseases, such as lymphoma, can spread into the bone marrow and affect the production of blood cells

Causes of bone marrow diseases include genetics and environmental factors. Tests for bone marrow diseases include blood and bone marrow tests. Treatments depend on the disorder and how severe it is. They might involve medicines, blood transfusions or a bone marrow transplant.

Normally, if you get hurt, your body forms a blood clot to stop the bleeding. For blood to clot, your body needs cells called platelets and proteins known as clotting factors. If you have a bleeding disorder, you either do not have enough platelets or clotting factors or they don't work the way they should.

Bleeding disorders can be the result of other diseases, such as severe liver disease or a lack of vitamin K. They can also be inherited. Hemophilia is an inherited bleeding disorder. Bleeding disorders can also be a side effect of medicines such as blood thinners.

Various blood tests can check for a bleeding disorder. You will also have a physical exam and history. Treatments depend on the cause. They may include medicines and transfusions of blood, platelets, or clotting factor.

You have two kidneys. They are fist-sized organs on either side of your backbone above your waist. The tubes inside filter and clean your blood, taking out waste products and making urine. Kidney cancer forms in the lining of tiny tubes inside your kidneys.

Kidney cancer becomes more likely as you age. Risk factors include smoking, having certain genetic conditions, and misusing pain medicines for a long time.

You may have no symptoms at first. They may appear as the cancer grows. See your health care provider if you notice:

• Blood in your urine
• A lump in your abdomen
• Weight loss for no reason
• Pain in your side that does not go away
• Loss of appetite

Tests to diagnose kidney cancer include blood, urine, and imaging tests. You may also have a biopsy.

Treatment depends on your age, your overall health and how advanced the cancer is. It might include surgery, chemotherapy, or radiation, biologic, or targeted therapies. Biologic therapy boosts your body's own ability to fight cancer. Targeted therapy uses drugs or other substances that attack specific cancer cells with less harm to normal cells.

NIH: National Cancer Institute

You have two kidneys. They are fist-sized organs on either side of your backbone above your waist. Your kidneys filter and clean your blood, taking out waste products and making urine. Kidney tests check to see how well your kidneys are working. They include blood, urine, and imaging tests.

Early kidney disease usually does not have signs or symptoms. Testing is the only way to know how your kidneys are doing. It is important for you to get checked for kidney disease if you have the key risk factors - diabetes, high blood pressure, heart disease, or a family history of kidney failure.

Specific kidney tests include:

• Glomerular filtration rate (GFR) - one of the most common blood tests to check for chronic kidney disease. It tells how well your kidneys are filtering.
• Creatinine blood and urine tests - check the levels of creatinine, a waste product that your kidneys remove from your blood
• Albumin urine test - checks for albumin, a protein that can pass into the urine if the kidneys are damaged
• Imaging tests, such as an ultrasound - provide pictures of the kidneys. The pictures help the health care provider see the size and shape of the kidneys, and check for anything unusual.
• Kidney biopsy - a procedure that involves taking a small piece of kidney tissue for examination with a microscope. It checks for the cause of kidney disease and how damaged your kidneys are.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Sickle cell disease (SCD) is a group of inherited red blood cell disorders. If you have SCD, there is a problem with your hemoglobin. Hemoglobin is a protein in red blood cells that carries oxygen throughout the body. With SCD, the hemoglobin forms into stiff rods within the red blood cells. This changes the shape of the red blood cells. The cells are supposed to be disc-shaped, but this changes them into a crescent, or sickle, shape.

The sickle-shaped cells are not flexible and cannot change shape easily. Many of them burst apart as they move through your blood vessels. The sickle cells usually only last 10 to 20 days, instead of the normal 90 to 120 days. Your body may have trouble making enough new cells to replace the ones that you lost. Because of this, you may not have enough red blood cells. This is a condition called anemia, and it can make you feel tired.

The sickle-shaped cells can also stick to vessel walls, causing a blockage that slows or stops the flow of blood. When this happens, oxygen can't reach nearby tissues. The lack of oxygen can cause attacks of sudden, severe pain, called pain crises. These attacks can occur without warning. If you get one, you might need to go to the hospital for treatment.

The cause of SCD is a defective gene, called a sickle cell gene. People with the disease are born with two sickle cell genes, one from each parent.

If you are born with one sickle cell gene, it's called sickle cell trait. People with sickle cell trait are generally healthy, but they can pass the defective gene on to their children.

In the United States, most of the people with SCD are African Americans:

• About 1 in 13 Black or African American babies are born with sickle cell trait
• About 1 in every 365 Black or African American babies are born with sickle cell disease

SCD also affects some people who come from Hispanic, southern European, Middle Eastern, or Asian Indian backgrounds.

People with SCD start to have signs of the disease during the first year of life, usually around 5 or 6 months of age. Early symptoms of SCD may include:

• Painful swelling of the hands and feet
• Fatigue or fussiness from anemia
• A yellowish color of the skin (jaundice) or the whites of the eyes (icterus)

The effects of SCD vary from person to person and can change over time. Most of the signs and symptoms of SCD are related to complications of the disease. They may include severe pain, anemia, organ damage, and infections.

A blood test can show if you have SCD or sickle cell trait. All states now test newborns as part of their screening programs, so treatment can begin early.

People who are thinking about having children can have the test to find out how likely it is that their children will have SCD.

Health care providers can also diagnose SCD before a baby is born. That test uses a sample of amniotic fluid (the liquid in the sac surrounding the baby) or tissue taken from the placenta (the organ that brings oxygen and nutrients to the baby).

Treatments for SCD include:

• Bone marrow or stem cell transplantation, which can cure SCD. Because these transplants are risky and can have serious side effects, they are usually only used in children with severe SCD. For the transplant to work, the bone marrow must be a close match. Usually, the best donor is a brother or sister.
• Gene therapies to treat SCD in people who are 12 years and older and have had repeated sickle cell crises. These new therapies involve taking some of your blood stem cells and either adding new DNA to them or changing their existing DNA. Then these cells are given back to you, and they can make a type of hemoglobin that is healthy. This can reduce the complications of SCD, including the SCD crises.
• Treatments that can help relieve symptoms and lessen complications, including:
  • Antibiotics to try to prevent infections in younger children
  • Pain relievers for acute or chronic pain
  • Hydroxyurea, a medicine that has been shown to reduce or prevent several SCD complications. It increases the amount of fetal hemoglobin in the blood. This medicine is not right for everyone; talk to your provider about whether you should take it. This medicine is not safe during pregnancy.
  • Blood transfusions for severe anemia. If you have had some serious complications, such as a stroke, you may have transfusions to prevent more complications.
  • Other treatments for specific complications, such as medicines to lower blood pressure and vitamins to treat a vitamin deficiency.

To stay as healthy as possible, make sure that you:

• Get regular medical care
• Get your routine vaccinations
• Live a healthy lifestyle
• Avoid situations that may set off a pain crisis

NIH: National Heart, Lung, and Blood Institute

Thalassemias are inherited blood disorders. If you have one, your body makes fewer healthy red blood cells and less hemoglobin. Hemoglobin is a protein that carries oxygen to the body. That leads to anemia. Thalassemias occur most often among people of Italian, Greek, Middle Eastern, Southern Asian, and African descent.

Thalassemias can be mild or severe. Some people have no symptoms or mild anemia. The most common severe type in the United States is called Cooley's anemia. It usually appears during the first two years of life. People with it may have severe anemia, slowed growth and delayed puberty, and problems with the spleen, liver, heart, or bones.

Doctors diagnose thalassemias using blood tests. Treatments include blood transfusions and treatment to remove excess iron from the body. If you have mild symptoms or no symptoms, you may not need treatment. In some severe cases, you may need a bone marrow transplant.

NIH: National Heart, Lung, and Blood Institute

Tuberculosis (TB) is a bacterial disease that usually attacks the lungs. But it can also attack other parts of the body, including the kidneys, spine, and brain.

Not everyone infected with TB bacteria (germs) becomes sick. So, there are two types of TB conditions:

• Latent TB infection, where the TB germs live in your body but don't make you sick.
• TB disease (active TB) where you get sick from the TB germs. TB disease can almost always be cured with antibiotics. But if it's not treated properly, it can be fatal.

TB is found in the U.S., but it is more common in certain other countries.

TB is caused by bacteria (germs) called Mycobacterium tuberculosis. The germs spread from person to person through the air. People who have TB disease in their throat or lungs spread the germs in the air when they cough, sneeze, talk, or sing. If you breathe in the air that has the germs, you can get TB. TB is not spread by touching, kissing, or sharing food or dishes.

You're more likely to catch TB from people you live or work with than from people you see for shorter amounts of time.

Anyone who is near a person with TB disease can get infected with the germs. You are more likely to be near someone with TB disease if you:

• Were born in or often travel to countries where TB disease is common
• Are a health care worker
• Work or live in a place where TB is more common, such as shelters for people without homes, jails, and nursing homes

Certain people are more likely to get sick with TB disease after they get infected. They include people who:

• Have HIV
• Became infected with TB in the last 2 years
• Have other diseases, such as diabetes, that make it hard for your body to fight TB germs
• Have alcohol use disorder or inject illegal drugs
• Were not treated correctly for TB in the past
• Are under age 5
• Are an older adult

Most people who have TB germs in their bodies don't get sick with TB disease. Instead, they have latent TB infection. With a latent TB infection, you:

• Don't have symptoms
• Can't spread TB to others
• Could get sick with active TB disease in the future if your immune system becomes weak for another reason
• Need to take medicine to prevent getting sick with active TB disease in the future

If you have TB disease, the TB germs are active, meaning that they are growing (multiplying) inside your body and making you sick. If the TB is growing in your lungs or throat, you can spread the TB germs to other people. You can get sick with TB disease weeks to years after you're infected with TB germs.

With TB disease, your symptoms will depend on where the TB is growing in your body:

• General symptoms may include:
  • Chills and fever
  • Night sweats (heavy sweating during sleep)
  • Losing weight without trying
  • Loss of appetite
  • Weakness or fatigue
• Symptoms from TB disease in your lungs may include:
  • A cough that lasts longer than 3 weeks
  • Coughing up blood or sputum (a thick mucus from the lungs)
  • Chest pain

Your health care provider or your local health department can test you to find out if you have TB germs in your body. They will give you either a TB skin or blood test.

If your test shows that you have TB germs, you'll need to have other tests to see if the germs are actively growing:

• Tests for TB disease in the lungs usually include testing samples of your sputum and having chest x-rays.
• Tests for TB disease in other parts of your body may include tests of urine and tissue samples.

You may need a TB test if you have symptoms of TB disease or if you are at high risk because you are more likely to be near someone with TB disease.

The treatment for both latent TB infection and TB disease is antibiotics. To make sure you get rid of all the TB germs in your body, it's very important to follow the directions for taking your medicine.

If you don't follow the directions, the TB germs in your body could change and become antibiotic resistant. That means the medicine may stop working and your TB may become hard to cure.

• For latent TB infections, you usually take medicines for 3 to 9 months. Treatment helps make sure you don't get TB disease in the future.
• For active TB disease, you usually need to take medicines for 6 to 12 months. Treatment will almost always cure you if you take your pills the right way.
• For TB disease in your lungs or throat, you'll need to stay home for a few weeks, so you don't spread disease to other people. You can protect the people you live with by:
  • Covering your nose and mouth.
  • Opening windows when possible.
  • Not getting too close to them.

By following medical advice for TB testing and treatment, you can keep yourself healthy and help stop the spread of TB.

Centers for Disease Control and Prevention