Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 11, 2016

Anemia is a common condition that can be caused by many different factors. It can be mild or serious, but a doctor should always be consulted if there is any question of anemia. It is usually very treatable, but certain serious forms can only be controlled and not cured.


Definition & Facts

Anemia occurs when a person's blood doesn't have enough red blood cells (RBC's) or hemoglobin. Hemoglobin, a component of red blood cells, binds with oxygen and circulates throughout the body to get oxygen to the cells. Without sufficient oxygen, the organs in the body can't function normally.

There are types of anemia that are hereditary. Babies might even get the illness as soon as they are born. Women are susceptible to anemia during the years that they menstruate. This is both from the loss of blood during menstruation and the need for increased blood supply during pregnancy.

Symptoms & Complaints

Symptoms of anemia may include:

Symptoms of severe anemia include:


There are many types of anemia with different causes. Iron deficiency anemia is caused by not having enough iron, which the bone marrow uses to make hemoglobin. Heavy menstrual bleeding, an ulcer, cancer, or polyps in the digestive tract can cause this deficiency. Also non-steroidal anti-inflammatory drugs (NSAID's) can cause it.

Vitamin deficiency anemia is caused by diets that lack sufficient folate, vitamin B12, and other key nutrients. A severe form of anemia can result from the inability of the body to process vitamin B12.

Diseases such as cancer, HIV, rheumatoid arthritis, Crohn's disease, and other inflammatory illnesses can affect the production of red blood cells and cause anemia of chronic disease.

Aplastic anemia is a very dangerous and rare form of anemia caused by a lowering of the bone marrow's ability to make red blood cells. Infections, drugs, and autoimmune diseases can cause aplastic anemia.

Leukemia can also cause anemia by inhibiting the blood production in the bone marrow while certain blood diseases can cause hemolytic anemia in which the red blood cells are destroyed faster than the body can replace them.

Sickle cell anemia is inherited and caused by a defective form of hemoglobin that makes the red blood cells take on the shape of a sickle. These cells die which results in a shortage of red blood cells.

Diagnosis & Tests

The diagnosis of anemia starts with the doctor taking a detailed history of the patient and giving him or her a physical examination.

First, the doctor asks about the patient's diet. This way, they can check for a lack of iron and vitamin B12 or folate. Next, the doctor inquires about any medications that the patient may be taking. Aspirin, for example, can lead to bleeding stomach ulcers.

The doctor will ask about menstrual patterns and any heavy bleeding. The patient's family history also is important. The doctor then checks for an enlarged spleen or enlarged liver. Jaundice, kidney disease, and cancers are also checked for.

The following tests may be administered by the doctor as well:

  • A routine blood count. If the hemoglobin is low, then that could be a sign of anemia.
  • Ferritin. Ferritin is a protein that stores iron. A low level of ferritin is a sign of iron deficiency anemia.
  • Mean cell volume mean cell volume (MCV). This measures the average volume of a red blood cell.
  • Reticulocyte count. This is a measure of young red blood cells and shows if the red blood cell production is normal.
  • Vitamin B12 and folate levels. These may be deficient.

Treatment & Therapy

Treating anemia requires treating the low level of hemoglobin and red blood cells. When there is an underlying cause for the deficiency, then it must be addressed.

Iron deficiency anemia treatment consists of taking iron supplements. Many times, the prescribed supplement is ferrous sulphate. It is taken by pill two or three times a day. It is recommended that ferrous sulphate be taken with food to reduce its side effects.

Anemia due to folate deficiency is treated with folic acid tablets. Folate tablets are usually given along with vitamin B12 supplements. This is due to the fact that folic acid can sometimes improve the symptoms and mask an underlying vitamin B12 deficiency.

Sickle cell anemia has no cure and complications include increased risk for stroke, bacterial infection, and kidney failure. However, its severity can be diminished. Hydroxyurea is a drug that's used to stimulate production of fetal hemoglobin. It is treated through a healthy diet, supplements of folic acid, vitamin D, and zinc. Blood transfusions and in rare cases, bone marrow transplants may also be used to treat sickle cell anemia.

Prevention & Prophylaxis

In infants and preschool children, anemia can be prevented by exclusive breast feeding for four to six months after birth. When the child is weaned, an additional source of iron needs to be added. Cow's milk hampers the absorption of iron from the stomach. Therefore, it's recommended that children one to five years old should have limited intake of milk.Foods that are rich in vitamin C are recommended for children beyond six months to help them increase iron absorption.

Adolescent girls and women need a healthy iron rich diet to prevent iron deficiency. They also need to be screened for anemia every five to 10 years until menopause. For pregnant women, supplements of iron may be started to prevent anemia. Also, they should eat iron-rich foods and foods that increase iron absorption.

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