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What is Anemia?

Anemia is a condition in which there aren’t enough healthy red blood cells or hemoglobin in the body. Hemoglobin is an essential protein in red blood cells that carries oxygen from the lungs and delivers it throughout the body. Therefore, normal levels of hemoglobin are essential for adequate tissue oxygenation. Red blood cells also carry carbon dioxide back to the lungs to be exhaled. 

There are different types of anemia and various reasons why you might develop anemia. Sometimes, anemia is a warning sign of a serious underlying condition. Symptoms of anemia can range from mild to severe, depending on the cause.

Anemia Symptoms

Common Symptoms of Anemia

• Fatigue

• Weakness

• Dizziness or lightheadedness

• Shortness of breath

• Pale or yellowish skin (this may be less obvious in darker skin tones compared to fair skin)

• Chest pain

• Irregular heartbeat

• Cold hands and feet

• Headaches

In addition to the above common symptoms, different types of anemia can cause the following signs and symptoms:

Iron Deficiency Anemia Symptoms

• Soreness and inflammation of the tongue

• Brittle nails or hair loss

• Pica (abnormal cravings for non-food items, such as ice, paper, dirt, clay, or starch)

• Loss of appetite, especially in children

• Restless legs syndrome

• Pounding or whooshing sound in the ears

Vitamin Deficiency Anemia

• Weight loss

• Muscle weakness

• Numbness or tingling in the hands and feet

• Unsteadiness

• Mental confusion 

• Memory problems

• Personality changes

Aplastic Anemia

• Nosebleeds 

• Bleeding gums

• Unexplained or easy bruising

• Prolonged bleeding from cuts

• Frequent infections

• Skin rash

• Fever

Sickle Cell Anemia

• Fatigue

• Periodic episodes of extreme pain lasting for a few hours to a few days

• Swelling of the hands and feet 

• Frequent infections

• Delayed growth and puberty in infants, children, and teenagers

• Vision problems

Thalassemia

• Abdominal swelling

• Deformities of the facial bones

• Slowed growth

• Dark urine

Hemolytic Anemia

• Yellowing of the skin (jaundice)

• Blood in urine (hematuria)

• Low blood pressure

• Enlarged spleen or liver

Causes of Anemia

Causes of Iron Deficiency Anemia

The body needs iron to make hemoglobin. Iron deficiency anemia develops if you aren’t getting enough iron or are losing too much iron through blood loss. This results in less hemoglobin and small red blood cells. Reasons why iron deficiency anemia occurs include:

• Lack of enough iron in your diet

• Blood loss, for example, due to heavy menstrual periods in women or a bleeding peptic ulcer

• Inability to absorb iron due to an intestinal disorder

• Pregnancy (without iron supplementation) due to an increase in blood volume and increased need for iron by the growing fetus

Causes of Vitamin Deficiency Anemia

The body needs vitamin B12 and folate (vitamin B9) to make enough red blood cells. Deficiencies of these vitamins can result in vitamin deficiency anemia. 

Causes of Vitamin B12 Deficiency

• Lack of vitamin B12 in the diet (vegetarians and vegans are at risk because vitamin B12 is mainly found in foods of animal origin such as milk, eggs, and meat).

• Pernicious anemia (an autoimmune condition in which there is a lack of intrinsic factor, a substance necessary for vitamin B12 absorption from the intestines)

• Intestinal conditions such as celiac disease that affect the absorption of nutrients

• Gastrointestinal surgery, which can affect intrinsic factor levels and nutrient absorption

Causes of Folate Deficiency

• Lack of folate (vitamin B9) in diet (this vitamin is mainly found in the liver and dark green leafy vegetables)

• Excessive alcohol consumption

• Intestinal conditions such as celiac disease, which can reduce vitamin absorption from the intestines

• Surgical removal or bypass of part of the intestines

• Medication side effects, for example, from taking anti-seizure drugs

Causes of Aplastic Anemia

This is a rare and serious type of anemia in which the body does not make enough blood cells in the bone marrow. Causes of aplastic anemia include:

• Temporary side effects of cancer treatments such as chemotherapy and radiation

• Exposure to toxic chemicals

• Side effects of medications, such as certain antibiotics and drugs used to treat rheumatoid arthritis

• Viral infections such as hepatitis, HIV (human immunodeficiency virus), CMV (cytomegalovirus), Epstein-Barr, and parvovirus B19

• Pregnancy (due to the immune system attacking the bone marrow)

• Unknown causes (this is called idiopathic aplastic anemia)

Causes of Hemolytic Anemia

Certain inherited conditions can cause hemolytic anemia, in which red blood cells break down or die faster than the body can replace them with new red blood cells. 

• Sickle cell anemia is an inherited condition in which the red blood cells are rigid, sticky, and shaped like a crescent moon or a sickle. The change in shape and texture causes the red blood cells to slow down or block blood flow.

• Thalassemia is an inherited disorder in which red blood cells don’t have enough hemoglobin, causing symptoms of anemia.

• Hereditary elliptocytosis, hereditary spherocytosis, and hereditary ovalocytosis are inherited disorders passed down in families where red blood cells are abnormally shaped. 

• Glucose-6 phosphate dehydrogenase deficiency (G6PD deficiency) is a genetic disorder that interferes with an enzyme (G6PD) that protects red blood cells from harmful substances.

• Hemolytic Anemia can also be caused by untreated infections, such as malaria, HIV, rocky mountain spotted fever, and H. influenza. It is important to discuss the risk of new medications with your doctor as well, as certain medications have the potential to cause hemolytic anemia like penicillin, quinine, methyldopa, and sulfonamides. Notably, hemolytic anemia is common among those with autoimmune conditions. In these conditions, the immune system mistakenly attacks the body's healthy tissues and organs. Similarly, these autoimmune responses can destroy healthy red blood cells, causing anemia. 

Diagnosis of Anemia

Your healthcare provider can make a diagnosis of anemia based on your medical history, physical exam, and blood tests. Some of the tests that can help to identify anemia and/or its causes include:

Complete Blood Count (CBC)

Using a blood sample, CBC is a test that measures the number of red blood cells, white blood cells, platelets, hemoglobin, hematocrit, and mean corpuscular volume (MCV). CBC is used as a diagnostic tool for a wide range of health conditions, including anemia. Normal values are as follows:

• Hemoglobin: 14-18 grams per deciliter (g/dL) for men and 12-16 g/dL for women.

• Hematocrit: 40-52% for men and 35-47% for women.

Blood Smear

A blood smear is done to check the number, size, shape, and color of red blood cells.

Other Tests

You may have other blood tests such as ferritin, transferrin, and total iron binding capacity (TIBC) to have iron deficiency anemia diagnosed. Other tests for an anemia diagnosis may include reticulocyte count (to check the number of immature new red blood cells called reticulocytes in your bone marrow). A fecal occult blood test may be done to check for blood in stool.

Imaging Tests

Depending on the results of your initial testing, your healthcare provider may order further tests to find the cause of your anemia. These may include imaging studies such as ultrasound. Endoscopy or colonoscopy may be done to find the source of gastrointestinal bleeding. 

Management and Treatment

How to Treat Iron Deficiency Anemia?

Treatments for symptoms of iron deficiency anemia include:

• Eating iron-rich foods. Foods that are a good source of dietary iron include red meat, poultry, dark green leafy vegetables, beans, and iron-fortified breads, cereals, and pastas.

• Eating foods containing vitamin C, which helps the body absorb iron.

• Taking iron supplements (oral iron by mouth is given for mild iron deficiency anemia).

• Getting intravenous (IV) iron therapy or a blood transfusion (this may be necessary to quickly replenish your body’s iron stores if you have severe iron deficiency anemia).

• Treating the underlying cause that made you iron deficient and caused you to develop iron deficiency anemia. For example, treatment of conditions that affect iron absorption, oral contraceptives to control heavy menstrual flow, antibiotics and other medicines to treat stomach ulcers; or surgery to remove a bleeding fibroid or tumor that is causing chronic blood loss.

Treatment of Vitamin Deficiency Anemia

Treatment for vitamin deficiency anemia may include:

• Eating foods rich in vitamin B12 and folic acid.

• Taking dietary supplements.

• Getting vitamin B12 shots if you have difficulty absorbing nutrients.

Treatments for Other Types of Anemia

• Treatment of the underlying disease causing anemia. 

• Blood transfusions for severe anemia.

• Erythropoietin shots (this is a hormone that stimulates red blood cell production).

• Oxygen therapy, pain relievers, intravenous fluids, and a cancer drug called hydroxyurea (Hydrea, Droxia, Siklos) to treat anemia such as sickle cell anemia.

• Blood transfusions, folic acid supplements, medications, bone marrow stem cell transplant, and rarely, splenectomy (surgical removal of the spleen) for severe thalassemia. 

Frequently Asked Questions

What Is A Quick Fix For Anemia?

The fastest way to fix iron deficiency anemia (the most common type of anemia) is to increase dietary iron intake or take an iron supplement. If a medical condition is preventing your body from absorbing iron properly, treatment of the underlying condition can help to build up iron stores in your body and prevent iron deficiency anemia. Keep in mind that there is no overnight cure for anemia. Talk to your doctor if you experience anemia symptoms to be appropriately diagnosed and treated. 

How Serious Is Being Anemic?

Anemia is a serious condition that should be diagnosed and treated. If left untreated, anemia can cause health complications such as: 

• Extreme fatigue due to fewer red blood cells carrying oxygen to the body’s tissues

• Heart arrhythmias (irregular heartbeat) and heart failure because the heart has to work harder when red blood cells carry oxygen at lower levels than normal.

• Pregnancy complications (pregnant women with folate deficiency are at an increased risk of giving birth to babies with neural tube defects).

• Life-threatening complications, even death, if you lose blood in large amounts or experience complications of inherited anemias, such as sickle cell anemia.

What Aggravates Anemia?

Risk factors that can aggravate or cause anemia include:

• Not enough iron intake from iron-rich foods in your diet.

• Lack of vitamin B12 and folate-containing foods in your diet.

• Not taking a prenatal vitamin during pregnancy resulting in folic acid and iron deficiency.

• Medical conditions that affect how you absorb iron and other nutrients from the intestines, such as celiac disease and inflammatory bowel disease.

• Heavy menstrual periods, leading to blood loss.

• Chronic blood loss (slow internal bleeding), for example, from an ulcer or fibroid, which can deplete the body’s iron stores. 

• Chronic health conditions such as diabetes, chronic kidney disease, kidney failure, cancer, which can lead to too few red blood cells and anemia of chronic disease. 

• Family history of inherited blood disorders such as sickle cell anemia and thalassemia. 

• Certain infections, blood disorders, and autoimmune diseases.

• Excessive alcohol consumption.

• Exposure to toxic chemicals. 

• Medication side effects.

• Age above 65. 

How Long Does Anemia Last?

Iron deficiency anemia usually resolves within about 6 weeks of starting oral iron therapy. However, you may need to continue taking an iron supplement for up to 6 months to restore normal iron levels in your body.