Can stress cause anemia


What is anemia?

Anemia is defined as a decreased hemoglobin concentration, hematocrit, or total red blood cell count. It results in a decrease in the oxygen carrying capacity of the blood and compromised tissue oxygen delivery. In dogs, anemia can be categorized as mild, moderate, severe, or very severe. A mild anemia corresponds to a hematocrit of 30% to 37%, a moderate anemia to a hematocrit of 20% to 29%, a severe anemia to a hematocrit of 13% to 19%, and a very severe anemia to a hematocrit of less than 13%.


What causes anemia?

The causes of anemia can be thought of as occurring in one of the following three main categories:


Decreased production of red blood cells


Increased loss of red blood cells


Increased destruction of red blood cells


What are some causes of the decreased production of red blood cells in the dog?

There are a large number of causes of decreased red blood cell production. These can be divided into causes associated with conditions within the bone marrow itself (primary causes) or causes outside of the bone marrow (secondary causes). Primary bone marrow disorders resulting in decreased red blood cell production include toxicities arising from chemotherapeutics, immunosuppressants, estrogens, various other drugs, infectious diseases (e.g., chronic ehrlichiosis), marrow fibrosis, myelophthisis, ineffective erythropoiesis, and stem cell disorders including immune-mediated destruction of red blood cell precursors. Secondary causes of decreased red blood cell production include endocrine disease (e.g., hypothyroidism, hypoadrenocorticism), metabolic disease (e.g., renal disease, portosystemic shunt), nutritional deficiencies (e.g., iron or cobalamin deficiency), and chronic inflammatory disease.


What are some causes of increased red blood cell loss in the dog?

Traumatic injuries, gastrointestinal disease resulting in ulceration, excessive parasitism, ruptured tumors, and coagulopathies can all result in significant red blood cell loss.


What are some causes of increased red blood cell destruction in the dog?

Red blood cell destruction can arise as a result of various toxins (e.g., onions, zinc), certain infectious agents (Babesia spp.), metabolic defects, and cellular fragmentation (e.g., fibrin strand injury), or it can result from immune-mediated hemolysis.


How are anemias classified morphologically?

Mean cell volume (MCV) and mean cell hemoglobin concentration (MCHC) can be used to classify anemias based on red blood cell morphology. Macrocytic hypochromic, normocytic normochromic, and microcytic hypochromic are the three patterns of anemia identified most commonly in the dog and can typically be associated with regenerative anemias, nonregenerative anemias, and iron-deficiency anemias, respectively.


What is meant by a regenerative anemia?

The term regenerative indicates that the bone marrow is responding appropriately to the decreased total red blood cell mass by increasing red blood cell production. This is evidenced in the complete blood count by the presence of reticulocytes. Reticulocytes can be seen within 2 to 4 days after the onset of an anemia. Regenerative anemias can be seen with anemias caused by either red blood cell loss or increased red blood cell destruction. The absolute reticulocyte count is the best way to determine if an anemia is regenerative. The percentage reticulocytes is multiplied by the red blood cell number (per microliter) and then this is divided by 100 to determine the reticulocytes per microliter. A value greater than 60,000 is considered consistent with regeneration.


How should the anemic animal be assessed?

A thorough history, physical examination, and complete blood cell count, including a reticulocyte count and careful blood smear evaluation, are essential. Additional tests that might be indicated can be determined based on these initial results, but could include a serum biochemistry profile, a urinalysis, specific endocrine testing, a fecal flotation and occult blood test, bone marrow evaluation, a coagulation profile, and serum iron assays.


How does the body compensate for anemia?

The body has many compensatory mechanisms in place to help improve oxygen delivery to tissues in the presence of an anemia. Animals that have had enough time for these mechanisms to be fully activated are able to better compensate for their disease and are therefore commonly far less symptomatic at the same hematocrit level than are animals that have very acute disease. This is why animals with anemias resulting from decreased red blood cell production are less likely to display profound signs of anemia than are those with anemias resulting from acute increased red blood cell loss or destruction. Compensatory mechanisms include decreased red blood cell oxygen affinity through the increased production of 2,3-diphosphoglycerate, decreased tissue perfusion to nonvital organs, increased cardiac output primarily through an increase in heart rate, and increased erythropoietin secretion.


Basic Science

Blue color can be perceived in a number of situations: (1) when the light source directly shined on the retina has a predominant frequency in the upper (shorter) end of the visual spectrum; (2) when a light source with multiple frequencies (including high ones) is shined on an object, absorbing all other frequencies except those at the blue end of the visual spectrum, which are reflected to the retina; and (3) when a white light is scattered by particles, the frequencies reflected are in the high end of the visual spectrum (Tyndall effect)—the blue sky is an example of this.

The normal color of flesh is thought to result from the combination of the pigments oxyhemoglobin, deoxyhemoglobin, melanin, and carotene, and from the optical effect of scattering. The importance of the latter effect has been disputed by at least one investigator, who attributes to collagen a major role in reflecting blue wavelengths. Blue skin coloration would result if the quantity of blue wavelengths reflected disproportionately increased or if the quantity of other wavelengths reflected disproportionately decreased.

Anyone who has observed a specimen of venous blood in a tube can confirm that it is not blue. Thus the blue skin color detected in individuals who have increased amounts of deoxyhemoglobin cannot be explained on the basis of reflection of increased quantities of high-frequency wavelengths from a “blue” pigment. One plausible theory to account for the observation of cyanosis under these circumstances is that deoxyhemoglobin is less red than oxyhemoglobin and therefore absorbs more red spectrum. By subtraction of red wavelengths, the blue spectrum is allowed to predominate in the reflected light (i.e., something that is less red is more blue). The bluish skin color observed with the other pigments listed in Table 45.1 is explained in a similar fashion.

Table 45.1

Selected Causes of Blue Skin Coloration.

According to Lundsgaard and Van Slyke (1923), as well as subsequent investigators, cyanosis generally becomes apparent when the subpapillary capillaries contain from 4 to 6 gm/dl of deoxyhemoglobin. Since this measurement was difficult to obtain directly, they proposed estimating it by averaging the amount of deoxyhemoglobin in arterial blood with that in venous blood. If one assumes a normal cardiac output, hemoglobin, and tissue extraction of O2, an arterial O2 saturation of approximately 80% would be required to cause cyanosis. It should be noted that the conclusion of Lundsgaard and Van Slyke was based on measurements of deoxyhemoglobin in peripheral venous blood and did not involve sampling of arterial blood. Their proposal of 5 gm/dl deoxyhemoglobin in mean capillary blood as a threshold for detecting cyanosis has not been confirmed or refuted by more sophisticated techniques.

Reduced arterial oxygenation can result if the amount of oxygen in the alveoli is lowered or if the gradient between the alveolar oxygen and the arterial oxygen is elevated. One can determine which of these is the explanation by measuring the arterial partial pressure of oxygen (Pao2) and calculating the alveolar partial pressure of oxygen (PAo2) and the a-a O2 gradient with the following formulas:


PB = barometric pressure

Ph2o37° = partial pressure water vapor at 37°C (47 mm Hg)

F1o2 = fraction of inspired air that is oxygen

PAco2 = partial pressure of carbon dioxide in arterial blood

R = respiratory quotient (Vco2/Vo2, generally about 0.8)

Even with normal arterial oxygenation, cyanosis can occur when there is increased extraction of oxygen at the capillary level because the average of arterial and venous oxygen saturation will be lower. Reduced flow through capillaries results in increased tissue extraction of oxygen (and therefore increased amounts of deoxyhemoglobin), favoring the appearance of cyanosis.

In anemic patients, much more profound decreases in tissue oxygen levels are required to produce 5 gm/dl of deoxyhemoglobin in capillary blood. For example, with a hemoglobin of 7.5 gm/dl, capillary blood would have to have a Po2 of about 19 mm Hg (33% sat.), contrasted with a Po2 of about 35 mm Hg (66% sat.) for a hemoglobin of 15 gm/dl.

Hemoglobins that have an abnormally low affinity for oxygen (high P50) have decreased amounts of hemoglobin bound with oxygen at usual levels of Pao2. Cyanosis can result on occasion.

A tube of blood containing excess methemoglobin is reddish brown to brown in color and remains so even after shaking in air or 100% O2. Methemoglobin is an oxidized hemoglobin in which iron is in the ferric form. It does not bind oxygen. Some methemoglobin is normally formed in the body, but this is usually reduced to deoxyhemoglobin by the NADH methemoglobin reductase system. If this enzyme system is deficient or if it becomes overloaded by excess amounts of methemoglobin, elevated blood levels of methemoglobin result. In some patients with congenitally abnormal hemoglobins (Hgb Ms) the structure of the hemoglobin makes the heme unit susceptible to rapid oxidation. The level of methemoglobin capable of producing cyanosis is said to be about 1.5 gm/dl, although this value seems to have been less carefully scrutinized than that for deoxyhemoglobin.

As with methemoglobin, a tube of blood containing sufficient sulfhemoglobin has a reddish brown color that does not change upon shaking in 100% O2. Sulfhemoglobin is a pigment not normally formed in the body. Its chemical composition is not well defined, although it has the spectrophotometric characteristic of strongly absorbing light at 620 nm in the presence of cyanide. The mechanism of formation is not known, although many of the same toxins that result in the oxidation of deoxyhemoglobin to methemoglobin can also produce sulfhemoglobin. The explanation for the formation of sulfhemoglobin in one individual and methemoglobin in another exposed to the same toxin is not known. Once formed, the sulfhemoglobin molecule is stable and is not converted back to deoxyhemoglobin. Cyanosis is reported to be detectable at sulfhemoglobin levels as low as 0.5 gm/dl.

Methemalbumin, which produces a brown plasma, is a pigment formed by the union of albumin in the plasma with hemin. The pigment may be present in the blood when excessive breakdown of red cells results in saturation of haptoglobin with hemoglobin. Dissolution of the remaining free hemoglobin into globin and heme can occur. Heme is immediately oxidized to hematin and in the presence of chloride forms hemin, which complexes with albumin. The minimal amount of resulting methemalbumin required to produce cyanosis is not stated in the literature.

The link between iron deficiency anemia and hearing loss

A growing body of evidence is indicating that anemia and hearing loss are linked—particularly for a common type of anemia that causes low iron levels.

Iron helps red blood cells carry oxygen to
the body, including the auditory system.

In one study, people with iron-deficiency anemia (IDA) were twice as likely to have hearing loss than those without the blood disorder. To find the link, researchers with Pennsylvania State University College of Medicine analyzed the medical records of 305,339 adults between the ages of 21 and 90.

“An association exists between IDA and hearing loss,” the authors of the study wrote. “The next steps are to better understand this correlation and whether promptly diagnosing and treating IDA may positively affect the overall health status of adults with hearing loss.”

The study, published in 2017, was not designed to prove that iron-deficiency anemia causes hearing loss, only that there was a relationship between the two. Still, older studies have found similar relationships—one study from 2002 found a link between iron-rich diets and better hearing at high frequencies.

Why is iron-deficiency anemia linked to hearing loss?

Iron helps blood cells carry oxygen from the lungs to the body. Your inner ears require an oxygen-rich, healthy blood supply to function normally.

To function normally, your inner ears need an oxygen-rich, healthy blood supply.

“Although the role of iron in the inner ear has not been clearly established, blood supply to this area is highly sensitive to ischemic damage,” the researchers noted. Ischemia means a lack of blood supply.

In the inner ear, oxygen is necessary for the health of sensory hair cells involved in translating sound into electrical impulses. A lack of oxygen can damage these sensory hair cells or cause them to die, affecting the manner in which they are able to perform the translation and transmit the impulses to the brain for interpretation. This also can lead to tinnitus, or ringing in the ears.

Who gets iron-deficiency anemia?

Most people with this type of anemia have no symptoms, but chronically low iron can cause fatigue or tiredness, shortness of breath, or chest pain, according to the National Heart, Lung and Blood Institute.

Doctors sometimes recommend iron
supplements, depending on the cause of

Anyone can develop iron-deficiency anemia, although the condition is more common in women during childbearing years because of blood lost during menstruation. Changes in the blood during pregnancy can also cause anemia. In older adults, blood loss is a common cause, usually from problems with the gastrointestinal system.

Other types of anemia are hereditary, such as sickle cell anemia, or are caused by chronic disease, such as kidney disease or following chemotherapy. (Sickle cell anemia can cause hearing loss in adults, but iron supplements are not recommended for it, and can in fact be harmful.)

For most people who are otherwise healthy, eating a balanced diet provides the body with an adequate supply of iron. Foods rich in iron include red meat, pork and poultry, seafood, beans, peas, dark leafy vegetables, dried fruit and iron-fortified cereals and pasta.

If you’re concerned, get your hearing checked

And although this type of anemia is very treatable, don’t stock up on iron supplements just yet to improve your hearing. The study authors emphasize further research is needed to understand the link iron plays in protecting our sense of hearing before supplementation can be used as a treatment plan for hearing loss and auditory problems. If you think you might have this type of anemia, seek out advice from your doctor.

Also, if you aren’t hearing as well as you used to, regardless of the cause, make an appointment to have your hearing tested by a hearing healthcare professional as soon as possible. Healthy Hearing’s directory can help you find a qualified practitioner in your community.

Read more: Risk factors for hearing loss that may surprise you

Iron Deficiency and Hearing Loss

Red blood cells cannot carry enough oxygen for your body without an adequate amount of iron. An iron deficiency, also known as anemia, results in low red blood cell levels and as a result can cause serious health complications, including hearing loss.

Red blood cells cannot carry enough oxygen for your body without an adequate amount of iron. An iron deficiency, also known as anemia, results in low red blood cell levels and can cause serious health complications, including hearing loss.

How does anemia affect your hearing?

Your body needs a balanced amount of iron in order for your auditory system and other organs to function properly. Too little of it can cause anemia, which results in a lack of hemoglobin (the protein that carries oxygen) in red blood cells. Cells without an adequate supply of oxygen can begin to perform poorly or die off. If that happens within your ear’s labyrinthine artery (main source of blood to your inner ear), you can lose your hearing. Anemia also interferes with myelin production (a substance around nerve fibers that helps with conduction), which can damage nerves, including the sensitive hair cells that conduct sound from your ears to your brain.

While research indicates an association between iron deficiency anemia and hearing loss, more is required to better understand the correlation, and whether prompt treatment of anemia could alleviate hearing difficulties. Studies have found that people with anemia are twice as likely to have hearing loss as those who don’t have the disorder. The form of hearing loss found to most commonly accompany iron deficiency is mixed. Sensorineural hearing loss affects the inner ear or neural pathways, and is usually due to damage to the inner ear or auditory nerve. Conductive hearing loss usually results from diseases or disorders affecting the outer and/or middle ear. A combination of both sensorineural and conductive is called mixed hearing loss, and was found in approximately 3.4 percent of anemic individuals studied.

How to get a good dose of iron

While improving your iron levels alone may not prevent hearing loss, healthy eating has been linked to better hearing. Combining foods high in iron like meat, dark leafy greens, nuts, and dark chocolate with foods high in vitamin C like orange juice, broccoli, and strawberries can help you maintain a healthy iron balance.

If you have an iron deficiency and start to develop hearing loss, schedule an appointment with a hearing care professional.

When people have low levels of iron in their blood, they may develop a condition called iron deficiency anemia, which is known to have wide-ranging effects throughout the body, and now, a new study suggests that this condition may be linked to hearing loss as well.

In the study, adults who had iron deficiency anemia were more than twice as likely to develop a specific type of hearing loss, called combined hearing loss, compared with those who did not have iron deficiency anemia, according to the study.

In the study, published Dec. 29 in the journal JAMA Otolaryngology-Head & Neck Surgery, the researchers looked at data from the medical records of more than 300,000 adults in Hershey, Pennsylvania. The participants’ ages ranged from 21 to 90; the average age was 50.

Based on the medical records, the researchers identified the people in the study who had iron deficiency anemia as well as any diagnoses of hearing loss.

Hearing loss was divided into three categories: sensorineural hearing loss, which results from damage to the inner ear, damage to the nerve that runs from the ear to the brain, or damage to the brain; conductive hearing loss, which occurs when sound cannot travel through the ear properly; and combined hearing loss, which is a combination of the two.

The researchers found that the people with iron deficiency anemia were 2.4 times more likely to have combined hearing loss compared with those who did not have iron deficiency anemia. The people with iron deficiency anemia were also 1.8 times more likely to have sensorineural hearing loss. There was no link, however, between iron deficiency anemia and conductive hearing loss, according to the study.

Earlier research suggested several potential reasons why iron deficiency anemia may be linked to hearing loss and, in particular, to sensorineural hearing loss, the researchers, led by Kathleen Schieffer, a doctoral student at Pennsylvania State University College of Medicine, wrote in the study.

Sensorineural hearing loss can develop when damage occurs to the tiny blood vessels in the ear, and iron deficiency anemia can put a person at risk for such damage. For example, iron deficiency anemia has been linked to several blood disorders that can cause such damage to these delicate blood vessels. In addition, the condition has been linked to problems with myelin, a sheath that surrounds nerve cells, including the nerve that runs from the ear to the brain, the researchers wrote.

Indeed, the researchers had hypothesized that iron deficiency anemia would be more likely to be linked to sensorineural hearing loss than to conductive hearing loss. An earlier study from Taiwan, for example, found a link between iron deficiency anemia and sudden sensorineural hearing loss, a type of hearing loss that develops in less than 72 hours, the researchers wrote.

Conductive hearing loss, on the other hand, is often caused by more “mechanical” problems, such as blockages in the ear, including those caused by earwax or fluid, or perforated eardrums. Therefore, the researchers did not hypothesize that conductive hearing loss would be linked to iron deficiency anemia, they wrote.

The authors noted that the findings suggest that there is an association between iron deficiency anemia and certain types of hearing loss, and that the study does not prove a cause-and-effect relationship between the two. In addition, there were several limitations to the study, they noted. For example, although the researchers were able to adjust the results to account for differences between the sexes, they were not able to account for other risk factors for hearing loss, such as smoking status, high blood pressure and diabetes. More research is needed to tease out the possible effects of these other factors.

Iron deficiency anemia can be treated easily with iron supplements, so future studies should focus on whether this can help prevent hearing loss, the researchers wrote.

Originally published on Live Science.

Always Thirsty? You Might Be Anemic, Dehydration Can Be a Symptom of Some Health Disorders

If an 8 km run make you drained out and excessively thirsty, it is understandable. But if you be of water for a 2 minute walk in the park, then there could be a problem. Experts found that constant feeling of dehydration can be a sign of a health disorder.

According to Laura M. Hahn, MD, a primary care physician at Mercy Medical Center, “Any condition that alters your water or salt balance in the body can trigger thirst.” Thus if even a person drinks the right amount of water every day, yet still feel thirsty, he must be experiencing a more serious health condition such as listed below.

Anemia – According to Healthline, Anemia happens when one has a lesser amount of red blood cells (RBCs) in her blood compared to normal count. Some of its symptoms are fatigue, weakness, short of breath and dizziness which can lead to extreme want of water. “Your body loses red blood cells faster than they can be replaced, and will try to make up for the fluid loss by triggering thirst,” stated Dr. Heather Rosen, MD, medical director of UPMC Urgent Care North Huntingdon in Pennsylvania.

(Photo : Getty Images)

Diabetes – Excessive thirst is one of the symptoms of type 2 diabetes. It is a constantly recurring illness that is usually brought by high blood sugar (glucose) level. Other than feeling thirsty, uncontrollable need to pee is also one of the most common sign of diabetes 2. “Frequent urination, another common symptom, will bring on thirst. This leads to drinking more fluids, which compounds the problem,” explained Rosen.

Xerostomia- Dry mouth makes one hungry for water. According to Dr. Rosen, “”It’s an abnormal dryness of the mucous membranes in the mouth, due to a reduction of the flow or change in the composition of saliva.” Bad breath and problem with chewing are some of the health illnesses that can be experienced once this health problem becomes severe.

Other than these health ailments, a person’s diet may also contribute to extreme thirst. Jessica Cording, RD, a dietician at the Hospital for Special Surgery in New York stated, “Foods that have a diuretic effect (think celery, asparagus, beets, lemon, melon, ginger, and parsley) can make you thirsty because they cause you to urinate more.” Cording suggested adding lots of fruits and vegetables in one’s daily meal to provide the water needed by the body.

The signs of anemia can be sneaky. Its symptoms can be similar to many other disorders. And unless your doctor does bloodwork, you won’t know for sure whether you have it or not.

Sometimes it’s helpful to look for signs of anemia on your own before going to a doctor. Or maybe you’ve already been diagnosed with anemia and told to treat it yourself by taking an iron supplement like Solgar Gentle Iron whenever you feel fatigued. (You can order Solgar online and use your Rakuten account get cash back.)

But you might want a way to tell if your fatigue is just anemia bothering you again – or something new. These little self-checks will help you know when it’s time to see a doctor.

Just remember: they’re not actual medical tests. They are only indicators that your already properly diagnosed anemia might be back.

Stressed? Exhausted?

Feeling lethargic and unable to cope? Needing more sleep and not feeling rested even when you get it? Those are typical anemia symptoms. You may also get headaches, cold feet and hands, and dizziness.

But a lot of other health issues can bring on any or all of those symptoms. You don’t want to be self-treating anemia like usual, only to find out this time you’ve got something else that needs different treatment. Especially if it’s something serious.

Check it out: should you avoid these foods if you have anemia?

Signs of anemia

These three signs don’t prove whether you do or don’t have anemia. The only way to be sure is with bloodwork drawn by a doctor and tested in a lab. The bloodwork will show your iron levels, and your doctor can tell you if you’re anemic or not.

Remember, you can be anemic without having any of these signs – or any symptoms at all. These little self-tests are useful if you’re trying to decide whether to have a doctor test you for anemia, or if you’re managing your own anemia care on a doctor’s advice.

1. Check your eyelids

Healthy pinkish inner eyelid

Look in the mirror, and get up close to it so you can see your face very well. Quickly pull your lower eyelid down and look at the skin inside that eyelid. You’re examining the color.

If you’re healthy, it will start off a very pale whitish color and then quickly become more pink (close to the color of raw chicken). But if the switch to pink takes a few seconds – or seems not to be happening at all – this could indicate you’re anemic.

And, yes, this tip works for people of all skin colors, as the inner eyelid goes through the same process in everyone. In fact, the doctor who taught me this trick was African American.

2. Check your lips

Healthy pinkish lips

Anemia tends to make you pale, and this is often most obvious at the lips . If your lips seem paler than usual, that’s an indicator of anemia.

This tip also works for people of all skin tones, even though what’s pale for you may be a different shade than what’s pale for someone else. Every skin tone can have a lot of different lip colors ranging from very light pinkish to shades of brown.

3. Check your nails.

Healthy pinkish fingernails

Your nails, and in particular the nail beds (the little half-moon near the cuticle), can also turn pale when you’re anemic. This tip is considered a bit less reliable for people of color because the skin under nails can be many shades of brown, pink and even yellow with warmer skin tones.

The trick here is to notice what color your nails and nail beds are normally, when you’re feeling fine. Then you can check to see if they’re becoming paler. If so, that could be a sign of anemia.

  • 5 diseases that can be detected in a routine eye exam

    “Diabetes produces an alteration that is often identified through a leakage of fluid or an abnormal accumulation of fluid in the retina. These symptoms are very common especially if the diabetes is uncontrolled and blood glucose levels are very high.”

    It is worth emphasizing that controlling glycemic levels may delay the appearance of alterations in the retina or reduce its seriousness. That is why it is always important for people with diabetes to have their vision monitored by an ophthalmologist.

    3. ANEMIA
    According to the World Health Organization (WHO), anemia is defined as a condition in which the hemoglobin content of the blood is lower than normal as a result of deficiency of one or more essential nutrients, whatever the cause of such deficiency. The disease can be caused by a lack of various nutrients, like iron, zinc, vitamin B12, and proteins.

    The diagnosis is made “by realizing the vascularization of the eyes, whether they are white or red.” Therefore, it is essential that the patient receives medical monitoring by a general practitioner in addition to the ophthalmologist, since some diseases are related to the systemic vascular condition of the person.

    Diagnosis can be made by a doctor based on observing the symptoms and results of tests. “Patients begin to turn yellow and have yellow eyes, which may explain the alterations in the liver,” he says.

    5. CANCER
    “Some types of bleeding in the eyes can indicate hematologic alterations, like some coagulation disorders, or even cancerous diseases like leukemia, which may lead to specific alterations in the back of the eye,” warns the eye surgeon. By means of a “characteristic stain”, it is also possible to identify “primary tumors in the breast or prostate.”

    Although an eye test is not necessarily a preventive procedure, it can help in the early diagnosis of diseases and contribute to the adoption of measures to monitor their evolution. If you have any questions, please write to us.

    Version: Rob Dinham
    Revision: Rosana Bertolin

    ELI5: What causes someone to look pale or lose their color when sick?

    Doctor here. That doesn’t make any sense. Right idea, wrong line of thought.

    Flow through the heart = flow back to the heart. This is a closed system. The only exceptions are with bleeding wounds or hematomas (abnormal internal collections of blood). Different organs get different percentages of the cardiac output which varies based on physiological conditions. In general, your liver and kidneys gets a huge volume of the cardiac output because they both act to remove waste elements from the bloodstream. Thus, the vital organs are always getting huge amounts of blood because they are essential to life.

    I am not aware of a specific reason why people “look pale” when they are mildly ill. I suspect it is in part due to others’ perception of them as being sick.

    In certain serious illnesses a sepsis syndrome can develop. The terms sepsis and septic are used loosely, however sepsis carries a strict definition and has quantifiable criteria for diagnosis.

    In a true sepsis syndrome there is an infection that causes a severe inflammatory response within the body. This in turn leads to circulatory compromise (similar to bleeding, except there is no loss of blood volume, just dilation of the vessels that carry the blood, thus an apparent reduction in circulating blood volume). Thus the term “septic shock.” This triggers a huge catecholamine surge (adrenalin) from the sympathetic nervous system (the “fight or flight reponse”)with the specific goal of maintaining a reasonable blood pressure and by extension perfusion. If you talk to physiologists many will say the goal of the body is to preserve brain function. I don’t like to assume. I think they goal of the body is to keep living.

    Organs tend to fail in a predictable manner with they kidneys usually taking the earliest hit as the renal arteries constrict to increase blood pressure. Similarly, the catecholamine surge causes the smaller superficial vessels in the skin to constrict. These seriously ill patients tend to be pale, cool and clammy as their sympathetic nervous system kicks into high gear in a desperate attempt at preserving life in the face of overwhelming infection.

    Other than that certain illnesses that cause hemolysis (red blood cell breakdown) can cause people to look pale, or just anemia in general.

    MikeHawkward is correct that blood flow does increase to areas of infection (like when you get a huge zit and it’s glowing red for all to see), but that is not sufficient to make the rest of you pale.

    TL;DR This was more like ELI15, but you get the idea. I think it’s mostly a subjective paleness because people act “sick” when they feel bad and we perceive them as pale. In some cases, people truly do get pale for a specific reason, as described above.

    Do you wake up looking tired or with dull skin? Here’s what your morning face says about your health

    By Hansa Venkateswaran
    You may not look the same when you wake up every morning. On some days, there’s an enviable glow on your face, on some you are just okay and on other days, you look completely sapped of energy as if you battled a storm the previous night. You may brush off these different looks as something routine, but they can reveal a lot about your inner health. Some may indicate common ailments while others can point to something more serious for you to act upon.
    “Since the skin is the largest organ of the body, it clearly reflects what goes on inside your body and what the status of your health is,” said Dr Neha Mittal, cosmetic physician at Dermaworld Skin & Hair Clinics, Delhi. “There are various signs and symptoms that your body starts exhibiting that depict that something is not normal… One should be aware of these sudden changes in the skin, which are quite noticeable early in the morning.”
    Here are some ailments you can read from your wake-up face:
    What it may mean:
    Sleep is a natural reset button for our brain and body, which is even more required these days because of increased work pressure and stress. “Face is the index of the mind… a skipped sleep is easily identified on the face,” said Dr Jaidev Yadav, consultant dermatologist at Vikram Hospital, Bengaluru.

    (Image: Thinkstock)
    Along with tiredness, depression can appear as skin lesions too. A trained dermatologist can recognise this symptom and guide the patient to a psychiatrist for treatment. A major reason for skin eruptions is alcohol and drug abuse, said Yadav. Other symptoms include vertigo and insomnia.
    What it may mean: Dehydration
    Lack of adequate intake of water is the prime reason for dehydration, said Mittal. The person can also suffer from increased thirst, headache, dizziness, dry mouth and a feeling of cold at times.
    What it may mean: Anaemia
    Improper eating habits are the main reason for this. Moving away from traditional eating to western foods and the eating-out culture are causing nutritional imbalance. For example, taking lesser green leafy vegetables, dates and ragi that provide the required iron has led to a drop in daily consumption.
    Eating fried foods has reduced the protein intake in the diet. Lack of enough lentils (dal) and vegetables has led to reduced vitamin B intake, said Dr Dharini Krishnan, a consultant dietitian based in Chennai. Those suffering from anaemia may experience hair loss and weakness too. Women are more prone to this condition.
    What it may mean: Cold and/or sinusitis
    It is usually accompanied by a stuffy nose and a heavy head. While the common cold is caused by a virus, stuffy nose, specially if it isn’t running, could be because of dust allergy, improper ventilation and clogged air-conditioning filters. Unclean carpets and upholstery of the furniture also cause a cold due to the dust, explained Krishnan. There can also be external sources causing the puffy face, according to Yadav. “Infections from bacteria, fungi or viruses bear a direct correlation to the immunity of an individual and are seen as a puffy face,” he said.
    What it may mean: Heart diseases
    The yellow spots on the eyelids are cholesterol-filled lesions, called xanthelasmata. They are a warning sign that the person is at a higher risk for heart diseases. However, it is not wise to wait for a heart disease symptom to show up on the skin. Adopt a heart-healthy lifestyle, know about other symptoms of heart trouble and visit your doctor if you experience any of those.
    What it may mean: Hormonal imbalance
    Hormonal triggers lead to an oily face and, thereby, acne. If accompanied by unwanted facial hair, irregular periods and weight gain, it may be an indication of polycystic ovarian syndrome in women. Brainrelated ailments are known to show up as acne, especially among teens and tweens.

    (Image: Thinkstock)
    For a Glowing Wake-up Face, Make Yourself Healthy from Inside
    A healthy and smiling face can be the simplest way to tell if a person’s inner health is fine, which is clearly reflected on the skin. “In Ayurveda, this concept is called Sara Pariksha (examination of the health of the tissues). The primary factor that influences this is the diet the person consumes and the lifestyle the person follows,” said Dr Madhumitha Krishnan, Ayurvedic physician at Aster CMI Hospital, Bengaluru.

    “When a person is healthy, the agni (digestive fire) is proper, which indicates that the food consumed is properly and adequately converted into the various physiological factors that make up the human body. In turn, when all these physiological factors work in harmony, the mental status of the person is good and a person glows with health,” she said.
    Since the face depicts the inner health, the solution is to consume healthy, nutritious foods rich in vitamins, minerals and fibres, so that the body is healthy from within, said Mittal from Dermaworld.
    One must also follow a skincare routine based on his/her skin type, which should include cleaning, toning and moisturising, she added. “Include exercise in your routine. Start with brisk walking and top it with easy exercise for a fit body. Exercising improves blood circulation and makes your body flexible,” she said, adding, “Limit the amount of alcohol and caffeinated drinks”. In short, adopt a healthy lifestyle and wake up to see a healthy you.

    Paleness when pregnant

    If you look in the mirror and see that your natural blush has faded, it probably isn’t the first sign that you don’t feel your best. You can look extra pale when you’re pregnant as a result of the rollercoaster of symptoms you may be experiencing, like morning sickness and iron deficiency.

    What causes it?

    One of the most common causes of paleness is anemia, a condition in which your body doesn’t have enough red blood cells to transport and circulate oxygen. You are particularly susceptible during pregnancy since your blood flow has increased and you need extra iron and folate to produce enough healthy red blood cells. Paleness could also be a result of general fatigue, inadequate sleep, or vomiting, all common symptoms of pregnancy.


    Pale skin might mean you’re feeling faint, so make sure to get plenty of rest and eat and drink well. Though it may be difficult due to fatigue, getting some light exercise can also really help improve your circulation. Don’t forget to stick to your prenatal vitamin regimen to get an adequate amount of iron and folic acid (the synthetic form of folate); your healthcare provider might recommend additional supplements if your symptoms worsen. To treat morning sickness, make sure you’re eating small meals and try to incorporate ginger into your diet to soothe your stomach.

    Women who notice other symptoms of anemia, like shortness of breath, exhaustion, dizziness, or lightheadedness should probably call their healthcare providers, as anemia is not something to play around with during pregnancy, and could put both you and Baby at risk.

    Reviewed by Dr. Jamie Lo
    • Iron: making blood that’s tough as …iron
    • Skin changes when pregnant

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