Q&A: Anemia

i’ve looked around and haven’t really found much on the topic, so i was hoping you guys would have a better idea. i have a fighter character who has anemia (as well as chronic pain). they definitely aren’t zipping around, but I’d be curious to what specific limitations these would give for someone who uses hand to hand and blades? thank you either way for your time!

Chronic pain is a problem, but anemia is a showstopper. The pop culture frame of reference is that anemia impairs or prevents clotting. If that was the extent of the condition, it would be serious enough to make combat exceptionally dangerous. If you can, literally, bleed to death from minor bruises, that’s going to make hand to hand exceptionally dangerous. However, that’s not what anemia is, and the reality is so much worse.

Anemia itself is a general condition where you lack sufficient red blood cells. The inability to clot is related to this, because the blood isn’t thick enough, however, this is only one of the symptoms, and while it can be life threatening, it’s not the biggest problem for a fighter.

Common symptoms for anemia include weakness, fatigue, and dizziness (among other things.) The simple version is that the body uses red blood cells to transport oxygen through to where it’s needed. In an anemic, there simply isn’t enough blood to transport enough oxygen. I can’t find concrete confirmation, but based on the cause, I’m almost certain that strenuous physical activity will aggravate the symptoms. This means an anemic fighter will exhaust very quickly, and is at particular risk for tachycardia (in addition to injury.)

Worth noting that anemia doesn’t, necessarily, prevent exercise, and in some cases it’s probably still a good idea, but the patient needs to be very mindful of their condition.

Also, not all forms of anemia are as dire as I’m making it out to be. I probably experienced mild anemia as a result of my excessive use of aspirin when I was younger. Seeing the symptom list now, I can say some of that was there, but at the time, it wasn’t severe enough for me to realize anything was wrong. The tipping point was when I was looking at watery blood from a nose bleed, and attributed that to aspirin being an anti-coagulant.

Additionally, anemia can be caused by a number non-self-sustaining causes. Aspirin is one (I suspect, the chronic use of any anti-coagulant will have similar results), heavy blood loss, and iron deficiency are also possible. In the case of blood loss, this is something your body will recover from with time. With iron deficiency, your body simply doesn’t have the materials it needs to make red blood cells, but if you adjust your diet, or take supplements you can manage this.

There are other causes, For example: I’ve been ignoring sickle cell anemia. In this case the blood cells exist, but they’re deformed, and can’t interact with the body properly. The resulting symptoms are similar, though the cause is distinct. I probably should point out that “pain crises” are a symptom of sickle cell anemia, if that’s the specific form of anemia you’re talking about, there’s a lot of literature on the subject, and some of the details vary significantly.

So, if your character has any condition which impairs the production of red blood cells, they may have very mild symptoms. They’re anemic, but might not even realize it, until they start losing blood. The problem comes in when their body can’t replenish lost blood fast enough. Initially their clotting factor may be close to normal. They won’t be impaired in combat. However, their injuries will stack up and over time their ability to recover, and even their ability to heal from prior wounds will go off a cliff.

Thing is, that can happen to anyone. An anemic condition will further aggravate, or jump start it, but if you’re losing a lot of blood, that will have knock on effects until you can fully heal. Again, serious blood loss will result in a form of anemia. It’s not a chronic condition, but your body simply doesn’t have enough blood, and it’s working to get back to where it should be.

If your melee fighter is anemic, it’s going to be a downward spiral. This is a condition where your body really cannot take a lot of abuse, and hand-to-hand combat places a harsh toll on your body. It’s even worse with blades, because you will bleed. That’s blood that you cannot afford to lose, and you won’t be able to stop bleeding.


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