Illness causing anemia in more than 1 way

[caters]

Alma gets this viral illness but it is not your usual virus. This is a virus that can affect any tissue. Here are the ways this virus causes anemia:

Nutritional deficiency(this is when the virus infects the digestive system causing severe diarrhea and vomiting)

There are all kinds of nutritional deficiencies with different types of anemia:

Sideroblastic anemia:

This can be caused by B6 deficiency or copper deficiency and is where there are erythroblasts with iron granules in them instead of your normal erythrocytes. Both B6 and copper are needed to integrate iron into hemoglobin.

B12 deficiency/Folate deficiency anemia
Iron deficiency anemia

There is 1 other way that this virus causes anemia as if 5 deficiencies weren't enough. That is hemolysis. The viruses multiply in red blood cells and lyse the red blood cells.

During treatment the B vitamin deficiencies can easily be treated via nutrient IV. Copper deficiency is not very common even in severely ill individuals so this leaves the common, not as easily treated Iron Deficiency Anemia.

I have seen mechanisms of Iron deficiency Anemia and they all involve at least 1 of these 2 things:

Iron malabsorption

and/or

Polycythemia using up iron

This polycythemia using up iron is specific for blood loss related iron deficiency anemia in most individuals but pregnant women naturally have a polycythemic state and the unborn baby needs iron both of which decrease the amount of iron that is stored. Those women that don't know they are pregnant are putting themselves in a state of Iron Deficiency Anemia for no good reason.

Anyway I was wondering, if this iron deficiency is difficult to treat while the digestive system is infected with a risk of either oxygen free radicals in the tissue or worsened nausea and vomiting and this virus forms granulomas(meaning the digestive system can and will be infected multiple times before all the viruses are gone) and it is a year long illness, then how are they going to go about treating the Iron Deficiency Anemia? Blood transfusion isn't an option because viruses in the bloodstream can cause hemolysis and if you have hemolysis + blood transfusion, guess what? You get aquired hemochromatosis(iron overload) which while temporary, is much more serious than chronic Iron Deficiency Anemia and certainly more serious than acute IDA. But iron pills will worsen the nausea or cause nausea in a person who doesn't already have it. And iron via IV risks damage from free radicals by reacting with hydrogen peroxide.

So if all the normal routes of getting iron into the body are out(transfusion because of hemochromatosis, pill because of nausea, and IV because of free radicals) then how would they treat it? Would they just wait until the illness is over(and by that I mean no viruses in any part of the body) and then give iron pills to get the iron levels back up along with a diet rich in meat?

 

[Alyssa]

Intravenous transferrin (iron loaded apoferrin).
Lipid core polymeric micelles for targeted drug delivery (copy and paste text prior to this for a research paper) of haemoglobin into erythrocytes.

With haemolysis however, you're going to get a lot of bilirubin in the blood, resulting in jaundice, etc. Not bad in itself, but something to note. In the long run it might have some bad effects on the liver and will produce gallstones. You generally won't get to the long run, the Hb released into the blood will give you hypertension, oedema and heart failure. Not to mention a significant rise in K+ level

It all depends on how long the virus takes to be cleared out, if it takes a while your patient is going to be dead. As a last resort you might be able to do magnetically assisted haemodialysis to filter out stuff you don't want.
I'm assuming the virus lasts a while as nutritional anemia takes a while to manifest. If it lasts long enough to cause an anemia of the Bs, as your body has small stores of them for 3 months up to several years in rare cases, then your patient is probably dead. And if you can get haemochromatosis from a blood transfusion due to the virus causing rapid and extensive haemolysis... your patient will die in 1-2 days and there's pretty much nothing you can do about it.

This virus will start up, infect a few hundred people and then kill all its hosts. It might cause a small panic but forcing everyone to wait inside for 3 days for the infected people to die will cull the living from the walking dead.

The issue is the rapidity of this virus. It's too much of an efficient killer to survive, or evolve to such a level in the first place. Unless it's an engineered virus, in which case it can be easily and efficiently distributed. Unfortunately due to the turnover rate of this virus, EVERYONE WHO GETS IT DIES. 5 million RBCs for 1 microliter of blood. 5 quadrillion RBCs in a litre. ~ 10 quadrillion for the 4.6 units of blood in the average transfusion. 2/5s of the body's blood supply, obliterated before it can make a difference. It's not a subtle killer either, chest pain, jaundice etc. so everyone who gets it is a walking exclamation mark for "virus carrier" and with such rapid viral multiplication it makes the time between infection and symptoms very low indeed.