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The Sick Lady, a 17th-century painting attributed to Caspar Netscher, from the Royal Collection, Buckingham Palace. (Used with permission from The Royal Collection © 2010 Her Majesty Queen Elizabeth II.)

In common parlance, the word anemia connotes weakness, apathy, and lifelessness. In medicine, anemia refers specifically to a patient with a reduction in red cell mass, but these two concepts converge with the realization that oxygen, a gas essential for life, is transported by red cells. 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, are readily explained by cardiovascular adaptations to anemia that are discussed in Chapter 3.

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 also was 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.

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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