Certain illnesses, including lymphoma, can remain hidden for a significant period without exhibiting obvious signs or symptoms. Lymphoma, in particular, can be a condition that individuals may have without realising it.

It is possible to have lymphoma without knowing as low-grade lymphoma can progress slowly and often without noticeable symptoms. This means that individuals may live with lymphoma without being aware of its presence. Even in more aggressive forms of lymphoma, some patients may not experience initial symptoms until the tumour has reached an advanced stage.

In addition, there are certain conditions that can be mistaken for lymphoma. Generalised swelling of lymph glands can be due to conditions other than Lymphoma. This could be due to an infection such as TB, generalised inflammation (from an autoimmune disorder), or even a drug reaction. Hence a detailed general assessment is required to confirm a diagnosis of Lymphoma.

In this article, we will explore the potential causes of lymphoma and discuss common signs and symptoms associated with the condition. Understanding the underlying factors that can contribute to lymphoma and being aware of the signs can help individuals recognise potential warning signs and seek appropriate medical attention.

What Could Cause Lymphoma?

Unfortunately, the cause of Lymphoma is often unknown in the majority of Lymphomas. Some Lymphomas can be triggered by prior infection and inflammation, such as H. Pylori infections which are implicated in gastric MALT Lymphoma, or EBV infection in certain other forms of Lymphoma.

Prior exposure to substances such as cancer-causing agents or radiation can also be a cause in some patients diagnosed with Lymphoma.

Patients often also ask if stress can cause lymphoma. However, within the existing studies and research surrounding Lymphoma, there is not enough clear evidence to determine if stress is responsible for or worsens Lymphoma.

Symptoms To Look Out For

Recognising the potential symptoms of lymphoma is crucial for early detection and effective treatment. While these signs can be subtle, it is important not to ignore them.

Some of the most common first signs of Lymphoma include painless swellings in the neck, armpits, or groin, persistent fatigue, and night sweats. 

Patients may also report shortness of breath and unexplained weight loss as some of the first signs of Lymphoma.

Seeking Advice

Lymphoma is not hard to diagnose and in the majority of suspected cases, a detailed disease and workout will establish the diagnosis of Lymphoma. A Lymphoma diagnosis is usually confirmed through a detailed clinical assessment, blood tests, a PET-CT scan, and a biopsy of the affected lymph nodes. In many patients, a bone marrow evaluation will also be performed as part of staging to assess whether there is Lymphoma involvement in the bone marrow.

If you are experiencing any of the mentioned symptoms, it is important to seek medical advice to determine whether further investigations are necessary. Contact our team at CFCH to arrange a consultation with one of our experienced doctors who can provide the guidance and assistance you need. Your health and well-being are our top priorities, and we are here to support you on your journey towards better health.

Blood is essential to life. Blood circulates through our body and delivers vital substances such as oxygen and nutrients to the body’s cells. Additionally, blood transports metabolic waste products away from those same cells. There is no substitute for blood, and it cannot be made or manufactured artificially. Therefore, patients in need of a blood transfusion can only rely on generous blood donors.
.

What are the Components of Blood?

Blood is a bodily fluid that transports substances throughout the body. It is made up of plasma and blood cells..

Plasma constitutes 55% of blood. It is 92% water, and the other 8% is made up of proteins, glucose, mineral ions, hormones, carbon dioxide, and blood cells. Plasma is also the primary medium for the transport of waste products.
.

Blood Cells

There are 3 main type of blood cells:

• Red blood cells (Erythrocytes)
• White blood cells (Leukocytes)
• Platelets (Thrombocytes)
  .

Red Blood Cells
These cells give blood its red colour as they are the most abundant type. Red blood cells contain a substance called haemoglobin which binds to oxygen and transports it around the body.
.

White Blood Cells
White blood cells account for only about 1% of blood. They are part of our immune system, and each type of white blood cell has a different role to play in terms of protecting the body against pathogens..

There are 5 main types of white cells: neutrophils, lymphocytes, eosinophils, monocytes and basophils. Neutrophils main function is to attack and destroy and bacteria that enters the blood stream. Lymphocytes attack viruses and other pathogens; they also create antibodies to destroy them.
.

Platelets
Your blood also contains platelets. Platelets help the blood to clot at a site of injury, and prevent excessive blood loss..
.

Where do Blood Cells come from?

.

Blood cells develop from hematopoietic stem cells which are formed in the bone marrow. There are two main types of stem cells within the bone marrow – myeloid and lymphoid – which transform to form the different blood cells in our blood. Once the blood cells are mature, they are released from the bone marrow into the bloodstream. Donor stem cells sources may be used to treat a variety of diseases, including leukaemia, lymphoma, bone marrow failure, and some immune disorders.
.

What Does Blood Do?

Blood has many different functions, including:

• Transportation
  Blood carries oxygen with red blood cells from the lungs to the rest of the body. Then it takes any waste products and transports it to where it can be passed out of the body appropriately.
  .
• Regulation
  It balances the acidity and alkalinity of your body. It also helps to regulate your body temperature.
  .
• Protection
  White blood cells are responsible for a significant role in helping the body’s immune system by attacking and destroying pathogens. Platelets are responsible for blood clotting, which prevents the excessive loss of blood after an injury.
  .

Blood Groups

Red blood cells have specific proteins on their surface; they are called antigens. Your plasma also contains antibodies which will attack specific antigens if they are found. While there are various types of red blood cell antigens – the ABO and rhesus types are the most important. Your blood group depends on which antigens which occur on the surface of your red blood cells..

If you have Type A antigens on the surface of your red blood cells, you also have anti-B antibodies in your plasma. You have blood group A..

If you have Type B antigens on the surface of your red blood cells, you also have anti-A antibodies in your plasma. You are blood group B..

If you have both Type A and Type B antigens on the surface of your red blood cells, you do not have antibodies A or B antibodies in your plasma. You are blood group AB..

If you have neither Type A nor Type B antigens on the surface of your red blood cells, you have both A and B antibodies in your plasma. You are blood group O..

The blood group is considered positive or negative based on the presence or absence of the Rhesus antigen respectively.
..

.

Disclaimer:
The information on the Centre For Clinical Haematology website is intended for educational use.  It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.

Commentary on D-ALBA Study

Dr Ng Chin Hin,
Senior Consultant Haematologist, CFCH
Former Head of Adult Leukaemia Service, National University Cancer Institute, Singapore
.

Do we see the arrival of chemotherapy-free treatment for Philadelphia positive acute lymphoblastic leukaemia?
.
Philadelphia positive acute lymphoblastic leukaemia (Ph+ALL) has been conventionally regarded as a form of poor risk ALL that requires intensive chemotherapy and allogeneic stem cell transplant (alloSCT). In the pre-TKI (tyrosine kinase inhibitor) era, the overall survival at five years was between 30-40% with alloSCT1..

The introduction of TKI, i.e. Imatinib, Dasatinib and Ponatinib into standard intensive chemotherapy, has improved the outcomes Ph+ALL with or without alloSCT. For example, the 5-year overall survival for imatinib, Dasatinib and ponatinib with HyperCVAD regimen is 43%, 46% and 71% respectively 2-4. Treatment of elderly Ph+ALL remains a significant challenge as most of these patients are unfit for intensive chemotherapy and ineligible for alloSCT. Elderly Ph+ALL who receive Dasatinib with low-intensity chemotherapy may attain up to a 36% long term survival5. However, in clinical practice, many of the older Ph+ALL are unable to tolerate even low-intensity chemotherapy..

Blinatumomab is a bi-specific monoclonal antibody that targets both CD3 (normal T-cells) and CD19 (the B-lymphoblasts). It activates T-cells and brings them near the B-lymphoblasts resulting in the killing of leukemic cells..

The GIMEMA group designed a chemotherapy-free treatment strategy for newly diagnosed Ph+ALL, incorporating Dasatinib with Blinatumomab. Patients received Dasatinib plus steroid during the induction phase (85 days) followed by consolidation phase with five cycles of Blinatumomab..

Dasatinib was also continued during and after the consolidation phase. A total of 63 patients were recruited with a median age of 54 years (range: 24-82). At the end of the induction phase, 98% of those who completed the induction achieved complete haematologic remission. At the end of cycle 4 of Blinatumomab, 81% achieved a molecular response. With a median follow-up of 18 months, the overall survival was 95% while the disease-free survival was 88%. The cumulative incidence of relapse was 8%. Blinatumomab effectively cleared seven patients who developed mutations (6 T315I, 1 E255K) during the induction phase during the consolidation phase..

The combination therapy appeared to be well tolerated with no early death reported. Twenty-four patients eventually underwent alloSCT. Impressively, only one transplant-related mortality (TRM) reported (4%). The authors believed that a prior chemotherapy-free regimen could have contributed to a low TRM..

Though this was a phase 2 single-arm study, the results were overwhelmingly impressive. This could be a new standard of care, especially for older Ph+ALL. A phase 3 randomised study comparing this to the standard TKI plus intensive chemotherapy is eagerly awaited and the results, if positive, could set a new standard of care for Ph+ALL.
.

Reference:

1. 1. Preti HA, O’Brien S, Giralt S, Beran M, Pierce S, Kantarjian HM. Philadelphia-chromosome-positive adult acute lymphocytic leukaemia: characteristics, treatment results, and prognosis in 41 patients. Am J Med. 1994 Jul;97(1):60-5
   2. Daver N, Thomas D, Ravandi F et al. Final report of a phase II study of imatinib mesylate with hyper-CVAD for the front-line treatment of adult patients with Philadelphia chromosome-positive acute lymphoblastic leukaemia. Haematologica. 2015 May;100(5):653-61.
   3. Ravandi F, O’Brien SM, Cortes JE et al. Long-term follow-up of a phase 2 study of chemotherapy plus Dasatinib for the initial treatment of patients with Philadelphia chromosome-positive acute lymphoblastic leukaemia. Cancer. 2015 Dec 1;121(23):4158-64.
   4. Jabbour E, Short NJ, Ravandi F, et al. Combination of hyper-CVAD with ponatinib as first-line therapy for patients with Philadelphia chromosome-positive acute lymphoblastic leukaemia: long-term follow-up of a single-centre, phase 2 study. Lancet Haematol. 2018 Dec;5(12):e618-e627
   5. Rousselot P, Coudé MM, Gokbuget N et al. European Working Group on Adult ALL (EWALL) group. Dasatinib and low-intensity chemotherapy in elderly patients with Philadelphia chromosome-positive ALL. Blood. 2016 Aug 11;128(6):774-82
      Foà R, Bassan R, Vitale A, et al. GIMEMA Investigators. Dasatinib-Blinatumomab for Ph-Positive Acute Lymphoblastic Leukemia in Adults. N Engl J Med. 2020 Oct 22;383(17):1613-1623
      

.

Disclaimer:
The information on the Centre For Clinical Haematology website is intended for educational use.  It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.

Commentary on VIALE-A Study

Dr Ng Chin Hin,
Senior Consultant Haematologist, CFCH
Former Head of Adult Leukaemia Service, National University Cancer Institute, Singapore
.

A new standard of care for newly diagnosed elderly and unfit AML
.
AML has a median age of around 65 years old, and many older patients have comorbidities, making them unsuitable for intensive chemotherapy. The current standard of care for older and unfit AML patients includes drugs such as low dose cytarabine or hypomethylating agents (azacitidine or decitabine) with complete response rates of less than 10% and 20-30% respectively..

Venetoclax, a highly specific oral BCL-2 inhibitor, has limited activity when given as a single agent but has shown promising clinical activity when used in combination with HMA or cytarabine in phase 2 studies. On November 21, 2018, the U.S. Food and Drug Administration (FDA) granted accelerated approval to venetoclax (Venclexta) together with azacitidine or decitabine or low-dose cytarabine for the treatment of newly diagnosed acute myeloid leukaemia (AML) in adults who are age 75 years or older or who have comorbidities that preclude the use of intensive induction chemotherapy..

VIALE-A is the confirmatory phase 3 study comparing Venetoclax plus Azacitidine (Ven+Aza) versus Azacitidine (Aza) in newly diagnosed elderly AML age 75 years and above or those who are unfit for intensive chemotherapy. A total of 433 patients were randomised at 2:1 fashion with 286 patients on Ven+Aza arm and 145 patients on Aza arm..

The primary endpoint was overall survival, while secondary endpoints include response rate, transfusion independence rate and event-free survival. The median age was 76 years old. Poor risk cytogenetic constituted 36% and 39% of the Ven+Aza and Aza arms, respectively. TP53 mutations were present in 23% of Ven+Aza arm compared to 16% in Aza arm. At a median follow-up of 20.5 months, the overall survival of Ven+Aza was 14.7 months (95%CI: 11.9-18.7) while Aza was 9.6 months (95%CI: 7.4-12.7), with a hazard ratio of 0.66 (95%CI: 0.52-0.85), p<0.001. The overall survival benefit was seen across different subgroups and most prominently in IDH1/2 mutated AML..

The composite response rate (CR+CRi) was 66.4% and 28.3% in Ven+Aza and Aza arms, respectively. The median time to composite response was 1.3 months and 2.8 months, respectively. The duration of response was also significantly longer in Ven+Aza treated patients. In patients with IDH1/2 mutation, the incidence of composite remission was 75.4%. Interestingly, the response rate among FLT3 mutations was more than 70% as well. TP53 mutated AML showed a respectable composite remission of 55.3%. About 50% of the Ven+Aza treated patients were converted to platelet and red cells transfusion independence for more than eight weeks..

Addition of Venetoclax to the standard Azacitidine therapy significantly improves the overall response rate across different subgroups of AML patients. This translates to substantially longer overall survival in older unfit AML, even in subgroups of elderly AML patients with poor risk cytogenetic and TP53 mutation. The VIALE-A Study findings support the use of venetoclax + azacitidine as a new standard of care for newly diagnosed elderly and unfit AML.
.

Disclaimer:
The information on the Centre For Clinical Haematology website is intended for educational use.  It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.

Improving outlook for older patients with AML – Commentary on CAVEAT Study

Dr Ng Chin Hin,
Senior Consultant Haematologist, CFCH
Former Head of Adult Leukaemia Service, National University Cancer Institute, Singapore
.

#The prognosis of older patients with AML is generally poor. However, newer novel treatments mean that the outcomes for older AML are improving significantly over the past 2-3 years.
.
The addition of the oral targeted agent Venetoclax to the previous standard of care in elderly unfit AML has led to significant improvement of response rate and survival in the phase 2 studies. Recently reported phase 3 studies – VIALE-C (Venetoclax plus Cytarabine) and VIALE-A (Venetoclax plus Azacitidine) have confirmed the superiority of outcomes in these combinations as compared to the standard of care (Azacitidine or Low dose cytarabine). The combination of Venetoclax with Azacitidne or low dose cytarabine have since become the new standard of care for older unfit AML above 60 years old. The overall response rate, ORR (complete remission and complete remission with incomplete count recovery) were 48% and 68% for Cytarabine and Azacitidine combination, respectively. The results were even appealing to those who are deemed fit for intensive chemotherapy in older AML patients.
.

The CAVEAT Study is a phase 1b study using a relatively more intensive induction chemotherapy regimen (5 days of IV Cytarabine 100mg/m2 and 2 days of idarubicin 12mg/m2) with an addition of 14 days Venetoclax (dose ranging from 50mg to 600mg od) in fit older AML patients (age >60 years old). This is followed by 4 cycles of consolidation which consist of 2 days of IV Cytarabine 100mg/m2, 1 day of Idarubicin 12mg/m2 and 14 days of Venetoclax. Among the 51 evaluable patients, there was no significant added toxicity for the induction phase with a median neutrophil count (>0.5) and platelet count (>50) recovery of 25 days and 26 days, respectively. The 30-day all-cause mortality was 6%. The reported overall response rate was 72% (CR rate 41% and CRi rate 31%). The ORR in de novo AML was very impressive at 97% (CR 68%, CRi 29%). The ORR in secondary AML was 43% (CR 9%, CRi 34%). The response was particularly poor in TP53 mutated AML (no CR but CRi 33%). Venetoclax plus Azacitidine may produce a higher ORR (55%) as reported in VIALE-A study. With a median follow-up of 22.9 months, median Overall Survival (OS) of 31.3 months was seen in de novo AML while only 6.1 months in secondary AML.
.

.

.
The results appeared to be more impressive than those in reported VIALE-A or VIALE-C study especially those with de novo AML. However, the study population in CAVEAT Study might be slightly fitter. We are eagerly awaiting the confirmation from phase 2 and 3 studies. Venetoclax added to 5+2 regimen may become the new standard of care in older and fit AML.
.

Reference:

1. 1. Chua CC, Roberts AW, Reynolds J, et al. Chemotherapy and Venetoclax in Elderly Acute Myeloid Leukemia Trial (CAVEAT): A Phase Ib Dose-Escalation Study of Venetoclax Combined With Modified Intensive Chemotherapy [published online ahead of print, 2020 Jul 20]. J Clin Oncol. 2020;JCO2000572. doi:10.1200/JCO.20.00572
   2. Wei AH, Strickland SA Jr, Hou J-Z, et al: Venetoclax combined with low-dose cytarabine for previously untreated patients with acute myeloid leukemia: Results from a phase Ib/II study. J Clin Oncol 37:1277-1284, 2019
   3. Wei AH, Montesinos P, Ivanov V. MD, et al: Venetoclax plus LDAC for patients with untreated AML ineligible for intensive chemotherapy: Phase 3 randomized placebo-controlled trial. Blood 135:2137-2145, 2020
   4. DiNardo CD, Pratz K, Pullarkat V, et al: Venetoclax combined with decitabine or azacitidine treatment-naive, elderly patients with acutemyeloid leukemia. Blood 133:7-17, 2019

.

Disclaimer:
The information on the Centre For Clinical Haematology website is intended for educational use.  It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.

Blood is essential to life. It carries oxygen and essential nutrients to all the organs of the body. Maintaining good blood health can ensure our organs and body tissues function effectively. It can also prevent anaemia and improve your general health. Hence, it is necessary to ensure that your body receives the necessary nutrients required for healthy blood.
.

5 Important Functions of Your Blood

1. Carries Oxygen
   Blood carries oxygen and nutrients such as vitamins, minerals, and antioxidants to all our organs to support their functions.
   .
2. Controls bleeding
   Blood contains platelets and clotting factors which help the blood to clot if there is bleeding.
   .
   
3. Fights infections
   Our immune system uses our blood to carry immune cells and antibodies to the site of infection. Improving blood health will enhance your body’s ability to fight and clear infections rapidly.
   .
   
4. Cleanses the body
   Blood helps to carry waste products from our organs to our kidneys and liver. The blood is filtered in the liver and kidneys, allowing the toxic metabolites and other waste products to be expelled from the body.
   .
   
5. Regulates body temperature
   Blood can also help to maintain our body temperature by absorbing and distributing heat throughout our body.
   .
   

What are the key nutrients needed for maintaining blood health?

The blood is a very active organ with many cells that turn over rapidly. If you do not provide your body with the right nutrients, your blood production can deteriorate, and you increase the risk of anaemia, bleeding or bruising..

While your blood needs several vitamins and minerals to function effectively, there are three key nutrients which promote the production of red blood cells:

1. Iron
2. Folic Acid
3. Vitamin B12
   .
   

1. Iron

.
Iron is vital for haemoglobin production. Nearly 70% of the body’s iron is present as haemoglobin in the red blood cells and as myoglobin in the muscle cells..

Haemoglobin helps to transfer oxygen from the lungs to all our organs and body tissues. When our haemoglobin level is low, we experience symptoms of anaemia which include fatigue, weakness, pale skin, shortness of breath and chest pain..

The risk of iron deficiency is greater in women of childbearing age, pregnant women, people with poor diets, infants and children (especially those born prematurely or experiencing a growth spurt) and vegetarians who do not replace meat with other iron-rich food..

The Health Promotion Board recommends 6mg of iron for adult males aged 18 and above. Women aged between 18 and 59 require 19mg of iron, while women aged 60 years and above require 6mg of iron a day..

Iron in food comes from two sources- animals and plants. Iron from animal sources includes red meats, poultry and fish. Good plant sources of iron include fortified cereals, beans, lentils, tofu, spinach, dried fruits (apricots, prunes, raisins), prune juice, enriched bread, and nuts.
.

2. Folic Acid

.

Folic acid supports the formation of red blood cells. A deficiency of folic acid can increase the risk of anaemia..

Folic acid is also essential for the repair and synthesis of genetic material, including DNA. It helps in regulating the division of cells and cell growth. This is especially important for pregnant women to promote foetal development. Deficiency in pregnant women can increase the risk of birth defects affecting the brain and spinal cord. It is recommended that folic acid is taken before and during pregnancy to help prevent this..

The recommended daily amount of folic acid for adults is 400 micrograms (mcg). An adult woman who is pregnant or is planning a pregnancy is advised to increase their intake to 800 mcg of folic acid a day..

Food rich in folic acid includes dark green leafy vegetables, beans, peas and nuts. Fruits rich in folate include oranges, lemons, bananas, melons and strawberries.
.

Vitamin B12

.

Vitamin B12 is another important nutrient that helps to create and regulate the functions of DNA. It is also required for red blood cell production and hence a deficiency in vitamin B12 may cause anaemia..

One of the severe side effects of long term vitamin B12 deficiency is nerve damage as it is crucial for myelin which is a fatty substance that protects your nerves. Vitamin B12 deficiency may also affect your mood, and low levels have been linked to depression..

The recommended daily amount of vitamin B12 for adults is 2.4 micrograms. Vitamin B12 is naturally found in animal products, including fish, meat, poultry, eggs, milk, and in most dairy products. Vitamin B12 is generally not present in plant foods, but fortified breakfast cereals are a readily available source of vitamin B12..

Eating a balanced diet consisting of all the essential nutrients is the simplest and fundamental way to maintain your blood health, in turn contributing to your overall health.

.

.

Disclaimer:
The information on the Centre For Clinical Haematology website is intended for educational use.  It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional

The most common cause of anaemia in Singapore​ is iron deficiency. Your body requires iron to make haemoglobin in red blood cells that enable them to carry oxygen. When there is insufficient iron in your body, your red cell count falls, and you become anaemic. Iron-deficiency anaemia affects more women than men, and the risk of iron-deficiency anaemia is highest for women who:

1. Are pregnant. Pregnant women require additional iron during pregnancy to support foetal development. Severe anaemia during pregnancy could increase the risk of premature birth, a low birth weight baby and postpartum depression. 
2. Have heavy menstrual periods. Women of childbearing age with heavy bleeding during their periods may develop iron-deficiency anaemia because of the excessive blood loss, depleting the body’s iron stores. This may cause fatigue, hair loss and frequent infections.

According to a survey carried out by Sata CommHealth, almost half of the women in Singapore could have an iron deficiency and are unaware of it. In addition, some recent studies have indicated that more than half of pregnant Singapore women are iron deficient during the late phases of pregnancy..

The symptoms of iron deficiency can easily be ascribed to other causes; hence many women tend to have had them for years without ever knowing why. The symptoms include physical and mental fatigue, hair loss and brittle fingernails, which women may put down to stress and a lack of sleep.
.

.

How much iron do I need?

Health Promotion Board recommends 19mg of iron for women between the ages of 18 and 59 years old, while women aged 60 years and above require 6mg of iron a day. During pregnancy, your iron needs rise to 27 mg to support the needs of the foetus.
.

How can I tell if I have Iron-deficiency anaemia?

Iron-deficiency anaemia can go unnoticed due to its mild symptoms. However, as the conditions worsen, the signs and symptoms intensify..

Iron deficiency anaemia signs and symptoms include:

• Extreme fatigue and weakness
• Pale skin, brittle nails and hair loss
• Chest pain, fast heartbeat or shortness of breath
• Headache or dizziness
• Cold hands and feet
• Inflammation or soreness of the tongue
  .
  

When should I see a doctor?

If you develop signs and symptoms that suggest iron deficiency anaemia, refrain from self-diagnosing or taking iron supplements on your own. We recommend that you see a doctor for a diagnosis and treatment. Overloading the body with iron can be dangerous because excess iron accumulation can damage your liver and cause other complications.
.

.

.

How can I prevent Iron-deficiency anaemia if I am pregnant?

• Treat the cause of blood loss. Talk to your doctor if you have digestive system problems, such as frequent diarrhoea or blood in your stool.
• Eat foods high in iron. Chicken, lean meat, dark leafy vegetables, and beans are good sources of iron.
• Eat foods that help absorb iron. Include orange, strawberries, broccoli, or other fruits and vegetables with vitamin C into your diet.
• Talk to your doctor about supplements. For women who do not get enough iron from their regular diet.
  .

Does birth control help to improve Iron-deficiency anaemia?

Yes, if the cause of the iron deficiency is heavy menstrual periods. Birth control such as the oral contraceptive pill and hormonal intrauterine device (IUD) help to lighten the menstrual flow which reduces the risk of iron-deficiency anaemia.
.

What are the causes of iron deficiency anaemia in women? 

Causes of iron deficiency anaemia include:

• Inadequate iron intake
  Lack of adequate iron in the diet is the most common cause of iron deficiency anaemia. Vegetarians are at higher risk because meat is high in iron.
  
• Pregnancy
  Iron is essential for the growth and development of the foetus. Hence, the requirement of iron increases during pregnancy. Pregnant women may develop iron deficiency anaemia when the increased demand of the body is not compensated by increasing iron intake. Excessive blood loss during childbirth can also cause iron deficiency.
• Blood loss due to menstruation
  Women who suffer from heavy menstrual flow may develop iron deficiency anaemia.
• Internal bleeding
  Certain conditions that cause internal bleeding may increase the risk of iron deficiency anaemia. Such conditions include peptic ulcers, polyps in the intestines, ulcerative colitis, or colon cancer. Regular use of medications such as non-steroidal anti-inflammatory drugs (eg. ibuprofen, aspirin) may also cause bleeding in the stomach.
• Inability to absorb iron
  Disorders affecting the intestines may interfere with the process of absorption of nutrients from the food. As a result, you may develop a deficiency of vitamins and minerals including iron in spite of eating a nutritious diet.
  
• Endometriosis
  Excessive blood loss caused due to uterine conditions such as endometriosis and fibroids can lead to iron deficiency anaemia.

.

What are the signs & symptoms of iron deficiency anaemia in women?

The common symptoms of iron deficiency anaemia in women include:

• General fatigue or unusual weakness
• Shortness of breath
• Pale skin
• Tingling and crawling sensation in the legs
• Dizziness
• Coldness of the hands and feet
• Swelling and soreness of the tongue
• Brittle nails
• Fast and irregular heartbeat
• Frequent headaches

How is iron deficiency anaemia in women treated?

Even if the cause of iron deficiency can be identified and treated, it is still usually necessary to increase iron intake. Click here to learn more about iron therapy.

There are several ways in which to increase iron intake:

Increasing dietary intake of iron
Foods high in iron:

• Iron-fortified breads and cereals
• Beans and lentils
• Oysters
• Liver
• Green leafy vegetables, especially spinach
• Tofu
• Red meat
• Fish
• Dried fruit, like prunes, raisins and apricots

Vitamin C helps to improve iron absorption so consuming fruits high in vitamin C such as oranges will help to increase the iron level. Vitamin C supplements may be prescribed.
.

Oral iron supplements
Oral iron therapy offers an easy and convenient way to replenish iron stores. It is the recommended treatment for patients who suffer from mild iron deficiency anaemia where there is no urgency to replenish the iron stores quickly.

As antacids may reduce the absorption of iron, it is advisable to avoid taking iron supplements together with antacids or medications that relieve heartburn. You may take iron supplements 4 hours after or 2 hours before the doses of antacids.
.

Intravenous iron infusion
Intravenous iron is the recommended therapy for patients suffering from severe iron deficiency or existing intestinal conditions that affect the absorption of oral iron supplements. 

.

Who should receive Intravenous Iron therapy?

• Those who cannot tolerate oral iron supplements.
• Those who are unable to absorb iron adequately such as those with chronic malabsorption conditions.
• Those with continuous blood loss where oral iron supplements are unable to replenish the iron stores fast enough. For example, women with heavy periods.
• Those who require rapid correction of their iron deficiency.
  .
  

What are the advantages and disadvantages of Intravenous Iron Therapy?

Advantages:

• Patients having iron infusions can avoid the side effects of oral supplements such as nausea, abdominal pain, diarrhoea and constipation.
• It works faster than oral iron therapy to improve haemoglobin levels. Patients should start feeling improvements shortly after their treatment.
  .

Disadvantages:

• It is less convenient compared to oral iron therapy as it requires venous access and the procedure needs to be done in clinic.  
• In some cases, patients may develop allergic reactions or low blood pressure during treatment.

.

What are the common side effects of Intravenous Iron Therapy?

You may experience some side effects right after the procedure, most of which are mild. These include:

1. Temporary changes in your taste of food and drinks
2. Headache
3. Nausea and vomiting
4. Muscle and joint pain
5. Breathlessness
6. Itchiness and rash
7. Increased or decreased blood pressure or heart rate
8. Burning sensation or swelling at the site of injection

.

Red blood cell transfusion
Red blood cell transfusions may be given to patients with severe iron deficiency anaemia who are actively bleeding or have significant symptoms such as chest pain, shortness of breath, or weakness. Transfusions are given to replace deficient red blood cells and will not completely correct the iron deficiency.

For more information on iron deficiency anaemia, click here.

.

Disclaimer:
The information on the Centre For Clinical Haematology website is intended for educational use.  It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.

Every year on June 14, the World Health Organization (WHO) and countries worldwide celebrate World Blood Donor Day (WBDD). Focusing on the contribution and impact an individual giver can make, the WBDD theme for this year is “Safe blood saves lives” alongside the tagline “Give blood and make the world a healthier place,” – with the emphasis on building a healthier community.

Through the campaign, we call on more people all over the world to become life-savers by volunteering to donate blood regularly so that communities worldwide have sufficient access to safe and quality-assured blood and blood products during times of need.

Unfortunately, the Singapore national’s blood stocks are low at the moment, and we strongly urge people who are healthy and eligible to visit the blood banks or community blood donation camps to donate blood.

.

Understanding Blood Type

.

There are very specific ways in which blood types must be matched for a safe blood transfusion. Blood types are determined by the presence or absence of certain antigens – substances that can trigger an immune response if they are foreign to the body.  Since some antigens can trigger a patient’s immune system to attack the transfused blood, safe blood transfusions depend on careful blood typing and cross-matching.

With around 40 blood group categories, the International Society of Blood Transfusion recognises the Rhesus (RhD) and ABO blood group classifications as the most common and important ones.

In the ABO category, the main groups are A, B, AB, and O that are determined by the absence or presence of antigen A or antigen B on the surface of red blood cells.

For example; people with blood group A have antigen A on their red blood cells while patients with blood group B have antigen B on their red blood cells.

Similarly, the blood group is determined as AB when both the antigens A and B are present on red blood cells.  People who are blood group O do not have antigen A or B on the surface of their red blood cells.

The blood group is considered positive or negative based on the presence or absence of the RhD antigen respectively.

A patient can receive blood that has the same ABO antigens as theirs, or O type blood. Patients who are RhD antigen positive can receive RhD positive or RhD negative blood, while RhD negative patients should preferably receive RhD negative blood. However as RhD negative blood is less common, it is usually reserved for women of child bearing age who are RhD negative as they have higher risk of complications if there is RhD incompatibility.

During an emergency, if the blood type is unknown, doctors will transfuse type O RhD negative blood – also known as the universal blood type.
.

Why Should You Donate Blood?

Blood transfusions are vital in times of emergencies and for patients who are undergoing major surgeries to replenish blood loss.

Patients with blood disorders such as leukaemia or aplastic anaemia may need frequent blood transfusions in order to support the bone marrow functions. Additionally, those undergoing stem cell transplantation may need up to 2 to 3 units of blood a week during critical phases of their treatment.

The HSA (Health Sciences Authority), which manages the blood banks in Singapore, says that it needs to collect around 400 units of blood a day to maintain an adequate blood inventory of 6 days to support bleeding emergencies and urgent transfusion needs.
.

The Blood Donation Process

Before proceeding with the blood donation, your haemoglobin level will be measured by a finger prick test to ensure that you can give blood.  A medical screener will go through your health assessment questionnaire with you and measure your weight, pulse, blood pressure and temperature to confirm you are fit for donation.

Your arm is cleaned and a painkiller cream is applied to ensure minimal pain when donating. The actual withdrawal of blood takes about 5 to 10 minutes and 350-450 ml of blood is collected.
.

Eligibility for Blood Donation

There are some basic requirements you need to fulfil to become a blood donor.

• You should be between 16 to 60 years of age and weigh at least 45 kg.
• Teenagers between the age of 16 and 17 years need to provide a signed consent form from their parents.
• In addition, you should be in good health and should not have experienced any signs of infection such as a runny nose, cough, sore throat, or diarrhoea for at least seven days prior to blood donation. You should also not have had a fever in the past four weeks.
• You should not have taken medication, herbal supplements or traditional herbal remedies for at least 3 days. If you have taken antibiotics, you’ll need to wait at least 1 week before donating.
• You will need to have a haemoglobin level of at least 13.0 gm/dL in men and 12.5 gm/dL in women.
  .
  

You may check your eligibility to donate blood using the Health Sciences Authority self-help tool or email donate.blood@redcross.sg.
.

Where Can You Donate Blood?

Blood donation is an essential service, and the need for blood products never stops. You can visit any of the four blood banks or a community blood donation camp near you for blood donation.

You can donate at:

• Bloodbank@HSA – Health Sciences Authority, opposite Outram Park MRT
• Bloodbank@Dhoby Ghaut – Dhoby Ghaut MRT, Dhoby Xchange Basement 1
• Bloodbank@Westgate Tower Westgate Tower Level 10 Jurong East MRT, Exit D (walk through Westgate Mall)
• Bloodbank@Woodlands Woodlands MRT, Woodlands Civic Centre, Level 5
  .
  

For the full list of locations, please visit the Red Cross website.

You may make an appointment with the Health Sciences Authority (SingPass needed) or call 6220 0183.  You should also check the opening hours of the blood banks before heading down.

On 6 June, Dr Chin Hin was invited as a guest speaker by Healthway Medical as part of their Webinar Series program. The talk was titled, ‘When do you refer to a haematologist?’

Aimed at doctors, Dr Chin discussed his approach to the interpretation of the full blood count and its correlation with clinical history and physical signs. There was also an interactive Q&A portion at the end of the session.
.

The process of infusion of stem cells is a significantly life-changing moment for patients and their families. We are often asked about how we reinfuse blood stem cells into patients during the transplant procedure.

It is a common myth that a stem cell transplant is an operation where we surgically replace the bone marrow of the patient or inject the stem cells directly back into the bone. But the actual procedure itself is more like a blood transfusion, and not as dramatic as it may seem..

Stem cells are slowly injected back into the patient’s bloodstream, and these stem cells are then able to find their way back into the bone marrow to start regenerating and making new blood cells..

The pictures below show the process of infusion of stem cells using cells which had been stored in advance and re-infused into a patient.

.

.

FAQs

.

.

Disclaimer:
The information on the Centre For Clinical Haematology website is intended for educational use.  It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.