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Q: My son, who is 59, was told that he is anemic. His doctor performed a bone marrow test but can't tell him why he is anemic. He also didn't prescribe anything to correct his problem. Is there any harm in being anemic? -- O.S., Daytona, Fla.

A: It's great that as a father you are concerned about your son's anemia. I hope much of your concern is unwarranted because the anemia is mild and does not require treatment.

Also, your son may have been told about likely possibilities for the anemia, even if the doctor could not pinpoint a precise reason. You may want to ask your son about it.

Anemia simply means that your blood has less than the normal percentage of red blood cells. Red blood cells contain hemoglobin that carries oxygen from your lungs to the other cells in your body. Oxygen is required by every human cell to function normally.

Someone with anemia may not be able to deliver enough oxygen to the cells and many problems can develop. However, with mild cases of anemia the body is able to respond by pumping the blood faster and delivering oxygen more efficiently.

There are many causes of anemia. You can classify anemia into types. One, in which the red blood cells are being lost too fast, and the second, in which the red blood cells are not being made fast enough.

The most common cause of red cell loss is bleeding, especially in women who are menstruating. But it may be a sign of bleeding in the stomach or intestines as the result of gastritis, ulcers, infections, colitis or tumors, among other things.

Many different diseases can cause the red cells to be more fragile and break apart too fast inside the blood stream. These include sickle cell anemia, spherocytosis, infections, toxins and burns.

It's more common for anemia to be caused by inadequate production of red blood cells. And the most common reason for this is getting too little nutrients such as iron and vitamin B12. In fact, much of the anemia due to menstruation could be eliminated if a woman had enough iron in her diet.

Often, a simple blood test looking at the amount and type of red blood cells will give an excellent idea as to the cause. And for some types of anemia, looking at the bone marrow (where the red blood cells are made) under a microscope will be very helpful as well.

Looking at the bone marrow can also tell what it isn't. Often cancers of the bone or other blood cells, which can cause anemia, will be detected in this way. I hope that no news here is good news.

Update on bicycle injuries: We, as parents and public health officials, have paid much more attention recently to getting children to wear bicycle helmets. But what about all those bareheaded adults?

For what seems to be such a pastoral pastime, the number of injuries can be shocking. More than 125,000 adults go to an emergency room for treatment of a bicycle injury every year. There could be five times that many who have injuries but don't go to an emergency room.

And about 500 adults are killed every year from bicycle injuries. The majority of these deaths are caused by head injuries. It's also estimated that the risk of bicycle-related head injuries can be reduced by 80 percent by wearing helmets.

Please don't let these bicycle injury statistics scare you out of the fabulous recreational and health benefits of cycling. But rather use them as a reminder to practice a few simple bicycle safety rules:

Always wear a helmet.

Pay strict attention to large moving objects like cars.

Keep your bicycle in a good state of repair.

Do other exercises to maintain strength and flexibility for better riding.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, IL 60611.

This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.

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