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INTRODUCTION

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"The Sick Lady," a 17th century painting attributed to Caspar Netscher, from the Royal Collection, Buckingham Palace. The Royal Collection © 2010 Her Majesty Queen Elizabeth II.

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In common parlance, the word anemic connotes weakness, apathy, lifelessness. In medicine, anemia refers specifically to a reduction in red cell mass. These two concepts merge with the realization that oxygen is essential for all forms of life and that red cells are responsible for the transport of oxygen. This painting shows a pale young woman clutching her chest, apparently complaining of palpitations. Her physician is feeling her pulse, documenting her rapid forceful heartbeat. These signs and symptoms, common in patients with very low hemoglobin levels, can be readily explained by the cardiovascular adjustments discussed in Chapter 3.

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Physicians in the 17th century would readily conclude that this patient suffers from chlorosis, derived from the Greek word chloris (χλωριζ), meaning greenish yellow. This condition was also known as morbus virgineus (virgin's disease) or mal d'amour (love sickness) in recognition of its high prevalence in young women. We now realize that iron deficiency is by far the most prevalent cause of anemia worldwide.

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During the last century, studies of hemoglobin, red cells, and disorders thereof have laid the cornerstones of contemporary molecular and cell biology and have greatly deepened our understanding of hematopoiesis, genetics, and oxygen homeostasis.

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