Anemia refers to low hemoglobin levels in the blood and/or a low count of red blood cells (the ones that contain hemoglobin). Because hemoglobin's function is to carry oxygen to tissues, inadequate hemoglobin makes people tired and mentally less alert. Anemia may result from several different causes:
- iron deficiency anemia either from inadequate iron intake or from blood loss (as from a GIST bleeding into the GI tract)
- vitamin-deficiency anemia from inadequate intake of vitamin B-12, folate, or vitamin B-6, or from inadequate absorption of these vitamins.
- pernicious anemia from lack of intrinsic factor (made by cells in the stomach) which is needed to absorb vitamin B-12 from food. This may occur due to an auto-immune condition, but in many gastric GIST patients it results post-surgery when part or all the stomach has been removed, and therefore intrinsic factor is not produced.
- drug-induced anemia: Gleevec may decrease production of new red blood cells.
Treatment for anemia must take into account the cause in order to select the correct treatment. Your physician can use blood tests to check for low iron, low cobalmin (associated with vitamin B-12), and other factors. It will not help you to take extra iron if your anemia is not due to iron deficiency, and excess iron may be harmful.
For detailed information about types of anemia see 
"Anemia of Chronic Disease: A harmful disorder or an adaptive, beneficial response?" http://www.cmaj.ca/cgi/reprint/179/4/333.pdf This analysis published by hematology/oncology professor Donald Houston points out that treating anemia in many chronic illnesses worsens mortality. The implication is anemia is protective in various diseases.
For Iron Deficiency Anemia
Iron is an essential component of hemoglobin, the oxygen carrying pigment of blood. Deficiencies in iron may indicate internal bleeding, and symptoms are pale skin color, fatigue, weakness, irritability, shortness of breath, sore tongue, brittle nails, unusual food cravings (pica), decreased appetite, frontal headache, blue tinge to sclera (whites of eyes).
If your serum iron is low, you can eat more foods high in iron, which include clams, oysters, liver, and meat. Iron absorption from your intestines is improved by Vitamin C, so include some citrus fruits or broccoli at the same time as your iron foods. Dietary sources also include prune juice, walnuts, egg yolks, peas, beans, raisins, whole grain bread, and iron-fortified cereals. For information about iron and its dietary sources, see . For information on iron-rich foods see 
Iron supplements can help rebuild iron stores quickly. Some types that members have recommended include: Slo-Fe, generic version of Slo-Fe sold at Target, Repliva, and Niferex. Daily multivitamin + minerals tablets for adults (NOT the iron-free ones for seniors) usually contain 18 mg of iron. Some iron supplements can cause upset stomach or constipation. The slow-absorption types are less likely to cause these problems.
Taking iron with a source of vitamin C greatly aids in its absorption. For example, take the iron supplement with orange juice. Several patients who had little improvement after months on iron supplements did show hemoglobin rising rapidly after beginning to take the pill with orange juice.
Taking iron with a source of caffeine, like coffee or tea, will inhibit absorption. Be wary of aspirin or other medications containing caffeine.
"I was struggling for almost a year, with low hemoglobin and low iron stores. I was taking iron supplements , with no results. I also had low potassium, which I could barely get into a normal range with the YUCKY powder supplement. As soon as I started taking my Ferrous Gluconate iron on an EMPTY Stomach with 8 oz. of orange juice -- I had and instant increase in the Hemoglobin. The Orange juice helps Me absorb the iron. The fact that I was taking the Orange Juice to help absorb the iron, had a SURPRISE great effect on My Potassium levels ! NO MORE POTASSIUM SUPPLEMENTS."
For Vitamin Deficiency Anemia
If you have not had gastric surgery but you have a dietary deficiency of B vitamins (B-12, B-6, and folate), then eating foods rich in these vitamins can help you. For information on daily needs as well as dietary sources, see these links:  for B-12;  o B-6, and  for folate.
You can link to a free-access article about B12 by nutrition experts Liz da Silva and Stacey McCray: Vitamin B12: No One Should Be Without It.
Deficiencies of Vitamin B12, folic acid (folate) and iron can exacerbate anemic conditions. Consuming certain foods daily may gradually improve and maintain RBC. Vitamin C also assists in increasing absorption and is essential in hematocrit production. Here are further suggestions and more info on these deficiencies and their symptoms:
- Vitamin B12's primary functions are in the formation of red blood cells, the maintenance of a healthy nervous system, and the rapid synthesis of DNA during cell division. This is especially important in tissues where cells are dividing rapidly, like the bone marrow tissues responsible for red blood cell formation. Strict vegetarian diets, chronic alcoholism, Crohns and malabsorption disorders can initiate this deficiency as well. Symptoms of vitamin B-12 deficiency are numbness or tingling in the arms and legs, weakness and loss of balance, difficulty walking and diarrhea, depression and smooth, sore tongue. Dietary suggestions: eggs, meat, poultry, shellfish, milk and milk products.
- Folic acid or folate is important for cells and tissues that rapidly divide and is involved in the synthesis, repair, and functioning of DNA. Deficiency of folate may result in damage to the DNA that may lead to cancer. Oral or intravenous folic acid supplementation may correct, however, lifelong support may be required if poorly absorbed or loss of small intestines. Symptoms of folic acid deficiency are sore mouth and tongue, tiredness, headaches, pallor. Dietary suggestions: green leafy vegetables and citrus fruits (juice, juice, juice...)
For Pernicious Anemia
After major gastric surgery B-12 from food cannot be absorbed adequately because the remnant stomach does not produce enough intrinsic factor.
B-12 Supplements: There is evidence that even without intrinsic factor, massive B-12 doses can achieve adequate absorption. See the following free-access summary in PubMed:
Kripke C., Is oral vitamin B12 as effective as intramuscular injection? Am Fam Physician. 2006 Jan 1;73(1):65, PMID: 16417065 
B-12 Prescription Treatments:
- sublingual (under-the-tongue) B-12 supplements
- nasal spray containing B-12 to be absorbed through the membranes of the nose
- injections of B-12 monthly (you can learn to give these to yourself or have your spouse learn)
For Impaired Blood Cell Production
Prescription treatments include injections of blood-production stimulants such as Aranesp and Procrit. Your physician may prescribe this if your anemia becomes more severe. However, most people taking Gleevec do not develop anemia serious enough to need these treatments.
For the long haul, may I suggest that you talk to the doctor about getting a prescription for Chromogen/Feogen, which is an iron supplement NOT like pre-natal ones! It digests easily, doesn't add to unfortunate digestion problems and absorbs well. Most doctors don't seem to be aware of it and fall back onto standard prenatal type suppliments. I had a nurse-practisioner when I was younger who prescribed them for me and I went from a crit count of 2 (yes, _2_) to 45 in about six weeks. Simply by taking one a day and drinking a glass of orange juice in the morning.
My hemoglobin steadily went down once I started Gleevec as adjuvant treatment in May. It never went so low to treat, but my doc would reduce the adjuvant dose if it dropped low. BUT, I talked to a friend into herbal medicine who recommended an herbal tea with Astragalus and a granule herbal supplement called SHBU. I don't really like the tea but can tolerate the granules in my morning coffee (since it tastes like tree bark it's kinda like chicory in your coffee). You can get the herbal tea at most health food stores. The granules I buy on line at liferising.com.
Try "Slo-Fe", an iron supplement that is absorbed slowly, thereby avoiding the ususal problem of constipation. Yes, taking it with something acidic is best for absorption. The real "Slo-Fe" is a bit pricey, but I've found the store brand at Target --about 1/3 the cost of the brand name. Nothing worked for me, not iron-rich foods or Procrit which is about $1200 per injection. "Slo-Fe" seems to have done it, my anemia is gone after a 3 year battle! Huzzah!
The real "Slo-Fe" is a bit pricey, but I've found the store brand at Target --about 1/3 the cost of the brand name. "Slo-Fe" seems to have done it.
Procrit is about $1200 per injection.
If your hemoglobin is very low, I would check with your doctor. Eating foods high in iron should help the hemoglobin count if you are mildly iron anemic, generally the foods that help are red meat and liver.
I've also had to take iron supplements. It is usually suggested iron supplements be taken with OJ for better absorption.
My husband gives himself monthly B-12 shots since he has very little stomach tissue left to absorb it. Low B-12 can lead to anemia.
He also takes a prescription vitamin high in iron -- Repliva
Liver if you like it and spinach are two that come to mind. I make a tortellini soup that has spinach in it..or wedding soup...and both have spinach and are iron rich.
I had to self-inject Aransep. It is a solution of darbepoetin alfa with a few other fun ingredients. It worked, only needed it about 3-4 times
I consulted with Dr. Frankl at MDA. He is the alternative medicine doctor. I learned a lot.
I wanted to share his observations on B-12 because it is contrary to what I had always understood. He said that a good sublingual(with the potency it claims to have) is as effective as a shot for absorption. And that a B-12 pill is not absorbed (much) if swallowed. So, at least, I am sticking the sublinguals under my tongue.
The 27 mg taken 2 - 3 per day has raised my hemoglobin SIGNIFICANTLY. 27 mg. does not translate the same as "400 mg of Gleevec...or "250 mg of ibuprofin " .
Ferrous Gluconate is a High Potency supplement. Ferrous Gloconate 27 mg. iron because It is gentler on the stomach and causes less intestinal upset. (Ferrous Sulfate is said to cause a bit more gastro disturbance than the Ferrous Gluconate)
My maxiumum dose is 3 tablets which would be 81 mg per day.... The pharmacist can explain the milligram issue and what the numbers translate to actually mean as far as the amount of iron that they provide.
The brand is Fergon: http://www.bayercare.com/Fergon.cfm
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