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What causes sever anemia: Aplastic anemia – Symptoms and causes


Symptoms, Types, Causes, Risks, Treatment & Management


What is anemia?

Anemia happens when you do not have enough red blood cells. The cells travel with iron and hemoglobin, which is a protein that helps carry oxygen through the bloodstream to your organs all through the body. When someone develops anemia, they are said to be “anemic.” Being anemic might mean that you feel more tired or cold than you usually do, or if your skin seems too pale. This is due to your organs not receiving the oxygen they need to do their jobs. Some people find out they are low in iron when they go to donate blood.

Are there different kinds of anemia?

There are several different types of anemia, but each of them causes the number of red blood cells in circulation to drop. Red blood cell levels are low due to one of the following reasons:

  • Your body cannot make enough hemoglobin (low hemoglobin).
  • Your body makes hemoglobin, but the hemoglobin doesn’t work correctly.
  • Your body does not make enough red blood cells.
  • Your body breaks down red blood cells too quickly.

Some types of anemia that you may have heard of include iron-deficiency anemia and sickle cell anemia.

How common is anemia?

Anemia affects more than two billion people globally, which is more than 30% of the total population. It is especially common in countries with few resources, but it also affects many people in the industrialized world. Within the U.S., anemia is the most common blood condition. An estimated three million Americans have the disorder.

Who is most likely to develop anemia?

Anyone can develop anemia, although the following groups have a higher risk:

  • Women: Blood loss during monthly periods and childbirth can lead to anemia. This is especially true if you have heavy periods or a condition like fibroids.
  • Children, ages 1 to 2: The body needs more iron during growth spurts.
  • Infants: Infants may get less iron when they are weaned from breast milk or formula to solid food. Iron from solid food is not as easily taken up by the body.
  • People over 65: People over 65 are more likely to have iron-poor diets and certain chronic diseases.
  • People on blood thinners: These medications include drugs include aspirin, clopidogrel (Plavix®), warfarin (Coumadin®), heparin products, apixaban (Eliquis®), betrixaban (BevyxXa®), dabigatran (Pradaxa®), edoxaban (Savaysa®) and rivaroxaban (Xarelto®).

What are the signs and symptoms of anemia?

Several signs and symptoms occur in all types of anemia, such as fatigue, shortness of breath and feeling cold. Others include:

  • Dizziness or weakness.
  • Headache.
  • Sore tongue.
  • Pale skin, dry skin, or easily bruised skin.
  • Unintended movement in the lower leg (restless legs syndrome).
  • Fast heartbeat.

How does anemia affect the body?

Anemia can have other affects on your body in addition to feeling tired or cold. Other signs that you might be lacking in iron include having brittle or spoon-shaped nails and possible hair loss. You might find that your sense of taste has changed, or you might experience ringing in your ears.

Different types of anemia may lead to other serious problems. People with sickle cell anemia often have heart and lung complications.

If you have anemia that is not treated, it could lead to an arrhythmia (irregular heartbeat), an enlarged heart or heart failure. You are also at greater risk of getting infections and becoming depressed.

You might have heard that iron deficiency is linked to chewing ice, which does happen. Chewing ice is a sign of pica, a condition that includes eating things that are not really food, like chalk or dirt. So pica is also a sign of iron deficiency. It is often seen in children with anemia.

How else does anemia affect children?

It is important for children to have enough iron and other nutrients in their diets to prevent anemia and the related problems with lack of attention, delayed development of motor skills and problems with learning. In older children, you need to pay more attention to signs of anemia during growth spurts and menstrual cycles.

How does anemia affect older adults?

In older adults, anemia might have even more impact in causing confusion or depression. Weakness may make walking more difficult. Anemia may shorten your lifespan if you are older and it is not treated.

Can anemia affect my weight?

Having enough iron may also be a factor in weight issues. Studies have found overweight people might lose weight if they address low iron in the blood. You might experience unintentional weight loss along with anemia if you have other conditions, such as cancer. People who have had weight loss surgery might become anemic due to vitamin and mineral deficiencies.

How does anemia affect pregnancy?

Iron deficiency during pregnancy increases the chance of complications, such as premature birth. After the birth, studies have indicated that babies born to women with low iron levels have a higher risk of low birth weight and problems with their own iron levels.

If you are pregnant, you are more likely to develop iron-deficiency anemia. Your unborn baby relies on you for iron and other nutrients. Many women who are pregnant take iron pills to prevent anemia. To make sure that you have enough iron for you and your baby, eat well-balanced meals that include iron-rich foods and foods that provide B12 and B9 vitamins. Follow your healthcare provider’s instructions for taking vitamins and adding iron to your diet.

Finding out that you have anemia is just the beginning. Finding the cause of the anemia will lead you to the best treatment.

Symptoms and Causes

What causes anemia?

The most common cause of anemia is low levels of iron in the body. This type of anemia is called iron-deficiency anemia. Your body needs a certain amount of iron to make hemoglobin, the substance that moves oxygen throughout your body. However, iron-deficiency anemia is just one type. Other types are caused by:

  • Diets lacking in vitamin B12, or you can’t use or absorb Vitamin B12 (like pernicious anemia).
  • Diets lacking in folic acid, also called folate, or your body can’t use folic acid correctly (like folate-deficiency anemia).
  • Inherited blood disorders (like sickle cell anemia or thalassemia).
  • Conditions that cause red blood cells to break down too fast (like hemolytic anemia).
  • Chronic conditions causing your body to not have enough hormones to create red blood cells. These include hyperthyroidism, hypothyroidism, advanced kidney disease, lupus and other long-term diseases.
  • Blood loss related to other conditions such as ulcers, hemorrhoids or gastritis.

What causes iron-deficiency anemia?

You can get iron-deficiency anemia from:

  • Bleeding, either from losing a large amount of blood quickly (for instance, in a serious accident) or losing small amounts of blood over a long period of time. The body loses more iron with blood loss than it is able to replace with food. This can happen to women having heavy menstrual periods or in people who have inflammatory bowel disease.
  • Not getting enough iron in the diet.
  • Needing more iron than you did previously (for instance, during pregnancy or illness).

Some types of iron-deficiency anemia are called by other names related to the cause, such as anemia of chronic disease (also called anemia of inflammation) or acute blood loss anemia.

What causes types of anemia that aren’t iron-deficiency anemia?

Pernicious anemia

In a strict sense, pernicious anemia happens when a person lacks something called intrinsic factor, which lets them absorb vitamin B12. Without vitamin B12, the body cannot develop healthy red blood cells. Other types of anemia that involve lack of B vitamins, such as B9 (folic acid), are also often lumped in as pernicious anemia. This name may refer to other conditions, including folic acid deficiency anemia and Addison’s anemia, even though there is no intrinsic factor deficiency.

Hemolytic anemia

This type of anemia can be caused by inherited or acquired diseases that cause the body to make deformed red blood cells that die off too quickly. (An acquired disease is one that you didn’t have when you were born.) If it is not genetic, hemolytic anemia can be caused by harmful substances or reactions to certain drugs.

Sickle cell anemia

This genetic form of anemia happens because the shape of the red blood cells is faulty. They are sickle shaped, which means that they can clog the blood vessels and cause damage. The hemoglobin does not work correctly. This type of anemia is most often, but not always, found in African Americans.

Diamond-Blackfan anemia

This is a rare blood disorder that may be inherited or acquired. In this type of anemia, the bone marrow does not make enough red blood cells. Diamond-Blackfan anemia is diagnosed within the first year of life in nearly 90% of people who have it.

Aplastic anemia

This is a type of anemia in that is caused by damaged bone marrow which is unable to make enough red blood cells. It also may be congenital or acquired. Another name for aplastic anemia is bone marrow aplasia (failure). Some people might think of this condition as cancer, but it is not.

There is something referred to by some people as myelodysplastic anemia. However, myelodyplastic syndromes (MDS) refer to actual cancer and are a result of abnormal cells in the bone marrow.

Fanconi anemia

This type of anemia is also rare and it is genetic. It happens because the bone marrow does not make enough red blood cells. There are physical signs of this condition, such as abnormal bone structure and abnormal skin color. About 50% of people with this condition are diagnosed by the time that they turn 10 years old.

Mediterranean anemia

This condition is also known as Cooley’s anemia and actually refers to beta thalassemia major. Thalassemias are inherited conditions in which your body does not make the right amount of hemoglobin. In addition to not making enough of these cells, the red blood cells do not live as long as they would in someone without the condition.

Vegetarian or vegan anemia

This term refers to the idea that people who are vegetarians or vegans have a difficult time getting enough iron because they don’t eat meat, poultry or seafood. However, careful food planning makes this statement false. There are plenty of ways to get enough iron with a plant-based diet.

Your healthcare provider might also use terms for anemia that refer to the size of the red blood cells. These words include terms like macrocytic anemia (larger than normal cells) or microcytic anemia (smaller than normal cells).

Diagnosis and Tests

How is anemia diagnosed?

Your healthcare provider can perform blood tests to tell if you have anemia. The main test is a complete blood count test, also called the CBC. The CBC can tell you how many red blood cells you have, how big they are and what shape they are. Blood tests can also tell you if you are low in vitamins B12 and B9 and how much iron your body has stored.

The type and number of blood and other tests will depend on what type of anemia your provider thinks that you have.

  • Blood and urine tests can indicate if you have hemolytic anemia.
  • A colonoscopy or fecal occult blood tests of your stool may be suggested to find gastrointestinal bleeding.
  • Your provider might order a bone marrow biopsy (removal of bone marrow tissue) in certain rare cases.

The type of anemia and its cause will allow your healthcare provider to determine the right kind of treatment.

Management and Treatment

How is anemia treated?

First, your healthcare provider will find out if the anemia is being caused by a poor diet or a more serious health problem. Then, you can be treated for both the anemia and its cause. Iron-deficiency anemia is treated with:

  • Iron supplements taken by mouth.
  • Foods high in iron and foods that help your body absorb iron (like foods with Vitamin C).
  • Iron given through an intravenous (IV) infusion. (This is often a choice if you have chronic kidney disease, or CKD.)
  • Transfusions of red blood cells.

If your anemia is caused by internal bleeding, your provider may need to do surgery to stop it. Surgical repair has been used to cure anemia in people with the paraesophageal type of hiatal hernias, with or without ulcers (called Cameron’s ulcers).

Other types of anemia may require other types of treatment. For instance, genetic disorders (like beta thalassemia and sickle cell anemia) may require bone marrow transplant.

If CKD is causing your anemia, in addition to iron supplementation (through oral or IV means), treatment could also include injections of erythropoietin (EPO). EPO is a hormone that tells the bone marrow to make red blood cells.

Anemia is also linked to cancer in some cases — both in terms of anemia being a symptom and in terms of cancer treatment. Both radiation and chemotherapy can cause anemia. It might be necessary to stall further cancer treatment until the anemia is improved by iron, blood transfusions, getting necessary B vitamins and/or getting shots of drugs to stimulate your body to produce EPO.

Is anemia fatal?

Although most types of anemia can be treated, anemia can still be fatal. According to the Centers for Disease Control and Prevention, there were 1.7 deaths per 100,000 due to anemia in the U.S. in 2017.


How can I prevent anemia?

Some kinds of anemia, such as those that are inherited, cannot be prevented. However, you can prevent anemia caused by iron deficiency, vitamin B12 deficiency and vitamin B9 deficiency by eating well. This includes eating a diet with enough foods that provide iron and these vitamins, along with vitamin C food sources to help with the absorption. Make sure that you drink enough water. Some studies have indicated that this will help keep hemoglobin levels up.

How do I manage anemia?

While some types of anemia are short-term and mild, others can last throughout a lifetime. There are several ways to help manage anemia, including:

  • Following a healthy diet.
  • Drinking enough water to stay hydrated.
  • Exercising regularly. However, if you have been weak, you should begin exercising cautiously. Check with your healthcare provider about ways to exercise safely.
  • Avoiding exposure to chemicals that set off anemia.
  • Washing your hands often to avoid infection.
  • Taking good care of your teeth and going to the dentist regularly.
  • Talking to your doctor about any changing symptoms.
  • Keeping track of your symptoms by writing them down.

Which foods should I eat, and which foods should I avoid, if I have anemia?

With anemia, making good food choices is important. Eating junk food means you are getting calories without nutrients. You also have to consider other medical conditions that you have when you make your food choices.

Some things have been shown to impair iron absorption. You should not take calcium and iron supplements at the same time. In addition, you may want to avoid or limit these items:

  • Tannin-containing items like coffee, tea and some spices.
  • Milk.
  • Egg whites.
  • Fiber. (You will not want to eliminate all fiber, though, because taking iron supplements could cause constipation.)
  • Soy protein.

In general, you should eat iron-rich foods and foods that provide vitamins B12, B9 and C. This means that you can enjoy plenty of good food that is for you, whether you eat meat or not. You can get iron from plant sources like lentils, spinach and pistachios. You can get iron from protein sources like lean beef and turkey. Whole grains and dark leafy vegetables are good sources of B vitamins. Some foods are even fortified with iron.

Citrus fruits, berries and other vitamin C-containing foods like peppers and tomatoes improve iron consumption. It is a good idea to get advice from your healthcare provider or perhaps from a registered dietitian about the best ways to eat when you have anemia. Also, make sure that grapefruit does not interfere with any of your medications.

It’s important to be educated on what you can do to take the best care of yourself that you can. It is also important that you and your healthcare provider make decisions together about what works best for you. Take the opportunity to ask for a referral to a registered dietitian if you want help setting a diet to help with iron intake. Make sure you ask all the questions that you have so you can be confident in moving forward.


Are there resources for people with anemia?

Depending on what kind of anemia you have or are interested in learning more about, you might find the following resources to be helpful.

How Is Anemia Treated? | Hematology-Oncology Associates of CNY

Treatment for anemia depends on the type, cause, and severity of the condition. Treatments may include dietary changes or supplements, medicines, procedures, or surgery to treat blood loss.

Goals of Treatment

The goal of treatment is to increase the amount of oxygen that your blood can carry. This is done by raising the red blood cell count and/or hemoglobin level. (Hemoglobin is the iron-rich protein in red blood cells that carries oxygen to the body.)

Another goal is to treat the underlying cause of the anemia.

Dietary Changes and Supplements

Low levels of vitamins or iron in the body can cause some types of anemia. These low levels might be the result of a poor diet or certain diseases or conditions.

To raise your vitamin or iron level, your doctor may ask you to change your diet or take vitamin or iron supplements. Common vitamin supplements are vitamin B12 and folic acid (folate). Vitamin C sometimes is given to help the body absorb iron.


Your body needs iron to make hemoglobin. Your body can more easily absorb iron from meats than from vegetables or other foods. To treat your anemia, your doctor may suggest eating more meat—especially red meat (such as beef or liver), as well as chicken, turkey, pork, fish, and shellfish.

Nonmeat foods that are good sources of iron include:

  • Spinach and other dark green leafy vegetables
  • Tofu 
  • Peas; lentils; white, red, and baked beans; soybeans; and chickpeas
  • Dried fruits, such as prunes, raisins, and apricots
  • Prune juice
  • Iron-fortified cereals and breads

You can look at the Nutrition Facts label on packaged foods to find out how much iron the items contain. The amount is given as a percentage of the total amount of iron you need every day.

Iron also is available as a supplement. It’s usually combined with multivitamins and other minerals that help your body absorb iron.

Doctors may recommend iron supplements for premature infants, infants and young children who drink a lot of cow’s milk, and infants who are fed breast milk only or formula that isn’t fortified with iron.

Large amounts of iron can be harmful, so take iron supplements only as your doctor prescribes.

Vitamin B12

Low levels of vitamin B12 can lead to pernicious anemia. This type of anemia often is treated with vitamin B12 supplements.

Good food sources of vitamin B12 include:

  • Breakfast cereals with added vitamin B12
  • Meats such as beef, liver, poultry, and fish
  • Eggs and dairy products (such as milk, yogurt, and cheese)
  • Foods fortified with vitamin B12, such as soy-based beverages and vegetarian burgers

Folic Acid

Folic acid (folate) is a form of vitamin B that’s found in foods. Your body needs folic acid to make and maintain new cells. Folic acid also is very important for pregnant women. It helps them avoid anemia and promotes healthy growth of the fetus.

Good sources of folic acid include:

  • Bread, pasta, and rice with added folic acid
  • Spinach and other dark green leafy vegetables
  • Black-eyed peas and dried beans
  • Beef liver
  • Eggs
  • Bananas, oranges, orange juice, and some other fruits and juices

Vitamin C

Vitamin C helps the body absorb iron. Good sources of vitamin C are vegetables and fruits, especially citrus fruits. Citrus fruits include oranges, grapefruits, tangerines, and similar fruits. Fresh and frozen fruits, vegetables, and juices usually have more vitamin C than canned ones.

If you’re taking medicines, ask your doctor or pharmacist whether you can eat grapefruit or drink grapefruit juice. This fruit can affect the strength of a few medicines and how well they work.

Other fruits rich in vitamin C include kiwi fruit, strawberries, and cantaloupes.

Vegetables rich in vitamin C include broccoli, peppers, Brussels sprouts, tomatoes, cabbage, potatoes, and leafy green vegetables like turnip greens and spinach.


Your doctor may prescribe medicines to help your body make more red blood cells or to treat an underlying cause of anemia. Some of these medicines include:

  • Antibiotics to treat infections.
  • Hormones to treat heavy menstrual bleeding in teenaged and adult women.
  • A man-made version of erythropoietin to stimulate your body to make more red blood cells. This hormone has some risks. You and your doctor will decide whether the benefits of this treatment outweigh the risks.
  • Medicines to prevent the body’s immune system from destroying its own red blood cells.
  • Chelation (ke-LAY-shun) therapy for lead poisoning. Chelation therapy is used mainly in children. This is because children who have iron-deficiency anemia are at increased risk of lead poisoning.


If your anemia is severe, your doctor may recommend a medical procedure. Procedures include blood transfusions and blood and marrow stem cell transplants.

Blood Transfusion

A blood transfusion is a safe, common procedure in which blood is given to you through an intravenous (IV) line in one of your blood vessels. Transfusions require careful matching of donated blood with the recipient’s blood.

For more information, go to the Health Topics Blood Transfusion article.

Blood and Marrow Stem Cell Transplant

A blood and marrow stem cell transplant replaces your faulty stem cells with healthy ones from another person (a donor). Stem cells are made in the bone marrow. They develop into red and white blood cells and platelets.

During the transplant, which is like a blood transfusion, you get donated stem cells through a tube placed in a vein in your chest. Once the stem cells are in your body, they travel to your bone marrow and begin making new blood cells.

For more information, go to the Health Topics Blood and Marrow Stem Cell Transplant article.


If you have serious or life-threatening bleeding that’s causing anemia, you may need surgery. For example, you may need surgery to control ongoing bleeding due to a stomach ulcer or colon cancer.

If your body is destroying red blood cells at a high rate, you may need to have your spleen removed. The spleen is an organ that removes wornout red blood cells from the body. An enlarged or diseased spleen may remove more red blood cells than normal, causing anemia.


Source: National Heart, Lung, and Blood Institute, National Institutes of Health

Defining and recognizing different types of anemia common to the oncology practice

August 03, 2011

6 min read


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Throughout their careers, hematologists and oncologists will likely be
exposed to many patients with anemia, the most commonly occurring blood
disorder associated with systemic diseases.1 Although there are many
forms of anemia, defined as a decrease in circulating red blood
cells,2,3 the pathophysiologic origins of the condition are grouped
into only three categories.2 First, anemia can be caused by a
decrease in the production of normal and functioning red blood cells. Second,
anemia can be caused by the destruction of red blood cells and, finally, anemia
can be the result of blood loss.2

Hematologists and oncologists are exposed to patients with anemia from
all of these pathophysiologic origins. Therefore, the ability to recognize the
signs and symptoms of the condition and understand the etiology and
pathophysiology behind it are important for the recommendation of appropriate
management.2 Additionally, critical to recognizing signs and
symptoms is informing patients early on about anemia so that patients are
empowered to take an active role in their care and inform the physician of
their status.

Etiology of anemia in cancer patients

Recognizing and treating anemia in cancer patients can be challenging
because the origin of the condition may be multifactorial.2

Anemia in a patient with cancer may be the result of the malignancy
itself, the treatment prescribed for the malignancy, or an unassociated
underlying condition. Suppression of the production of red blood cells can be
caused by cancer cells infiltrating bone marrow or by myelotoxic
chemotherapeutic agents. Anemia due to the destruction of red blood cells can
occur due to inflammatory cytokines produced by the tumor, or
hemolysis2 from chemotherapeutic agents such as oxaliplatin,
fludarabine and interferon. 4

Anemia can also occur as a result of acute or chronic blood loss,
nutritional deficiencies—not uncommon in cancer patients—and
hemolysis or inflammatory cytokines associated with chronic
disease.5 In addition, a poor functional status,6 low
hemoglobin (Hb) at baseline, history of radiation to more than 20% of the body,
history of transfusion,7 older age,8 weight
loss,9 metastatic disease, prior myelosuppressive therapy, pulmonary
disease6 and comorbid cardiac disease2 are all risk
factors that increase the likelihood of a patient developing anemia during
cancer treatment.

Finally, anemia can also be related to patient characteristics that are
not necessarily connected to the cancer or cancer treatment at all.2
Sickle cell anemia and thalassemia are two types of inherent anemia present
since birth. In some cases where an individual already has anemia, a cancer
diagnosis can compound the severity of the anemia. 2,9,10

Signs and symptoms

Although a low Hb level may be the first indication of anemia, it should
prompt physicians to conduct a thorough patient history and physical
examination. On a broader level, the health care provider should ask the
patient about the onset and duration of symptoms, family medical history,
comorbidities and any medications he or she is currently

An examination for more specific symptoms is also necessary as a
decrease in red blood cell levels, which diminishes the oxygen-carrying
capacity of the blood, can ultimately lead to hypoxia and hypoxemia, eventually
having an effect on multiple biological and organ systems.9,11,12
These effects will manifest as certain recognizable signs and symptoms of
anemia including fatigue, lethargy, shortness of breath, pallor of the skin,
heart palpitations, and soft systolic murmurs.13

However, symptoms can vary greatly because anemia can affect so many
different organ systems, including the neurological system (eg, fatigue, sleep
disorders, impaired cognitive function, depression), immune system (eg,
impaired T-cell and macrophage function), cardiorespiratory function (eg,
tachycardia, palpitations, dyspnea) and more (eg, pallor of the skin, fluid
retention). Patients may exhibit genitourinary symptoms that include a loss of
libido or menstrual problems, or they could exhibit gastrointestinal symptoms
such as anorexia, nausea, or irregular bowel movements.11,12


Anemia is commonly a manifestation of another underlying
problem.2,14 The National Comprehensive Cancer Network anemia
guideline panelists agreed in their recommendations that a drop in Hb to below
11 g/dL should prompt further evaluation;2 however, the ability of
the patient to tolerate a decline in Hb level is relative to each
patient’s “normal” Hb levels.2,7

According to the National Cancer Institute and the National Institutes
of Health, anemia can be classified into five grades. Grade 1, considered mild
anemia, is Hb from 10 g/dL to the lower limit of normal; grade 2 anemia, or
moderate anemia, is Hb from 8 to less than 10 g/dL; grade 3, or severe anemia,
is below 8 g/dL; grade 4, is life-threatening anemia; grade 5 is death
(Table).13 In addition, Hb levels can vary according to a
patient’s gender and race/ethnicity, with Hb levels 1 to 2 g/dL lower in

When a hematologist or oncologist is confronted with a patient that may
have anemia, a good history, physical exam and laboratory workup are important
to not only confirm anemia but also to identify the type of

Laboratory testing

To help define the type of anemia, there are multiple laboratory tests
that can be used. Hb and hematocrit (Hct) levels can be checked by conducting
frequent complete blood counts, which also test mean corpuscular volume

The MCV measures the average volume of a red blood cell. The measurement
of MCV is classified into three categories: microcytic (< 80 fL), normocytic
(80-100 fL) and macrocytic (> 100 fL).2

Microcytic anemia is commonly the result of iron deficiency but could
also be due to thalassemia. A normocytic MCV measurement may indicate anemia
due to hemorrhage, bone marrow failure, anemia of chronic inflammation or renal
insufficiency.2 Finally, macrocytic MCV usually indicates anemia due
to a vitamin B12 or folate deficiency,2 but can also
indicate a primary marrow synthetic abnormality as would occur in

In addition, the cause of anemia can be narrowed by examining a
patient’s peripheral blood smear. Learning and gaining familiarity with
different types and morphologies of damaged red blood cells may aid in the
diagnosis of anemia.2 For example, if the smear shows the presence
of spherocytes and an increased reticulocyte count, the patient may have
hemolytic anemia.16

Finally, the underlying cause of anemia can be narrowed further by
ordering a stool guaiac test, which helps rule out blood loss, or a bone marrow
biopsy, which helps to identify metastatic disease and hematologic


  1. Spivak JL. The blood in systemic disorders. Lancet.
  2. he NCCN Clinical Practice Guidelines in Oncology. Cancer- and
    Chemotherapy-Induced Anemia. Version 2.2012. National Comprehensive Cancer
    Network website.
    Accessed August 5, 2012.
  3. National Cancer Institute. Dictionary of cancer terms. National
    Cancer Institute website.
    http://www.cancer.gov/dictionary. Accessed June 20, 2011.
  4. Klap PC, Hemphill RR. Acquired hemolytic anemia. In: Tintinalli JE,
    Stapczynski JS, Cline DM, Ma OJ, Cydulka RK, Meckler GD, eds.
    Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th
    ed. New York, NY: McGraw-Hill; 2011.
    http://accessmedicine.com/content.aspx?aid=6386652. Accessed
    February 21, 2011.
  5. Schwartz RN. Anemia in patients with cancer: incidence, causes,
    impact, management, and use of treatment guidelines and protocols. Am J
    Health Syst Pharm
    . 2007;64(suppl 2):S5-S13.
  6. Shelton BK. Therapeutic options for patients with cancer and
    treatment-related anemia. Adv Stud Nurs. 2006;4:109-114.
  7. Hurter B, Bush NJ. Cancer-related anemia: clinical review and
    management update. Clin J Oncol Nurs. 2007;11:349-359.
  8. Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC.
    Prevalence of anemia in persons 65 years and older in the United States:
    evidence for a high rate of unexplained anemia. Blood.
  9. Adamson JW, Longo DL. Anemia and polycythemia. In: Fauci AS,
    Braunwald E, Kasper DL, et al, eds. Harrison’s Principles of Internal
    . 17th ed. New York, NY: McGraw Hill; 2008:353-363.
  10. Guyton AC, Hall JE. Red blood cells, anemia, and polycythemia. In:
    Guyton AC, Hall JE, eds. Textbook of Medical Physiology. 11th ed.
    Philadelphia, PA: Elsevier Saunders; 2006:419-428.
  11. Ludwig H, Fritz E. Anemia in cancer patients. Semin Oncol.
    1998;25(suppl 7):2-6.
  12. Ludwig H, Strasser K. Symptomatology of anemia. Semin Oncol.
    2001;28(suppl 8):7-14.
  13. US Department of Health and Human Services. National Institutes of
    Health. National Cancer Institute. Common terminology criteria for adverse
    events (CTCAE). Version 4.0. National Cancer Institute website.
    Published May 28, 2009. Accessed June 9, 2011.
  14. Hinkel JM, Li EC, Sherman SL. Insights and perspectives in the
    clinical and operational management of cancer-related anemia. J Natl Compr
    Canc Netw
    . 2010;8(suppl 7):S38-S55.
  15. Tefferi A, Hanson CA, Inwards DJ. How to interpret and pursue an
    abnormal complete blood cell count in adults. Mayo Clin Proc.
  16. Marks PW, Rosenthal DS. Hematologic manifestations of systemic
    disease: infection, chronic inflammation, and cancer. In: Hoffman R, Benz EJ,
    Shattil SJ, et al, eds. Hematology: Basic Principles and Practice. 5th
    ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2009; 2309-2319.


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Anemia | Beacon Health System


Anemia is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body’s tissues. Having anemia, also referred to as low hemoglobin, can make you feel tired and weak.

There are many forms of anemia, each with its own cause. Anemia can be temporary or long term and can range from mild to severe. In most cases, anemia has more than one cause. See your doctor if you suspect that you have anemia. It can be a warning sign of serious illness.

Treatments for anemia, which depend on the cause, range from taking supplements to having medical procedures. You might be able to prevent some types of anemia by eating a healthy, varied diet.


Anemia signs and symptoms vary depending on the cause and severity of anemia. Depending on the causes of your anemia, you might have no symptoms.

Signs and symptoms, if they do occur, might include:

  • Fatigue
  • Weakness
  • Pale or yellowish skin
  • Irregular heartbeats
  • Shortness of breath
  • Dizziness or lightheadedness
  • Chest pain
  • Cold hands and feet
  • Headaches

At first, anemia can be so mild that you don’t notice it. But symptoms worsen as anemia worsens.

When to see a doctor

Make an appointment with your doctor if you feel fatigued and you don’t know why.

Fatigue has many causes besides anemia, so don’t assume that if you’re tired you must be anemic. Some people learn that their hemoglobin is low, which indicates anemia, when they donate blood. If you’re told that you can’t donate because of low hemoglobin, make an appointment with your doctor.


Anemia can be due to a condition present at birth (congenital) or to a condition you develop (acquired). Anemia occurs when your blood doesn’t have enough red blood cells.

This can happen if:

  • Your body doesn’t make enough red blood cells
  • Bleeding causes you to lose red blood cells more quickly than they can be replaced
  • Your body destroys red blood cells

What red blood cells do

Your body makes three types of blood cells — white blood cells to fight infection, platelets to help your blood clot, and red blood cells to carry oxygen from your lungs to the rest of your body and carbon dioxide from the body back to the lungs.

Red blood cells contain hemoglobin — an iron-rich protein that gives blood its red color. Hemoglobin enables red blood cells to carry oxygen from your lungs to all parts of your body and to carry carbon dioxide from other parts of the body to your lungs to be exhaled.

Most blood cells, including red blood cells, are produced regularly in your bone marrow — a spongy material found within the cavities of many of your large bones. To produce hemoglobin and red blood cells, your body needs iron, vitamin B-12, folate and other nutrients from the foods you eat.

Causes of anemia

Different types of anemia have different causes. They include:

  • Iron deficiency anemia. This most common type of anemia is caused by a shortage of iron in your body. Your bone marrow needs iron to make hemoglobin. Without adequate iron, your body can’t produce enough hemoglobin for red blood cells.

    Without iron supplementation, this type of anemia occurs in many pregnant women. It’s also caused by blood loss, such as from heavy menstrual bleeding; an ulcer in the stomach or small bowel; cancer of the large bowel; and regular use of some pain relievers that are available without a prescription, especially aspirin, which can cause inflammation of the stomach lining resulting in blood loss. It’s important to determine the source of iron deficiency to prevent recurrence of the anemia.

  • Vitamin deficiency anemia. Besides iron, your body needs folate and vitamin B-12 to produce enough healthy red blood cells. A diet lacking in these and other key nutrients can cause decreased red blood cell production. Some people who consume enough B-12 aren’t able to absorb the vitamin. This can lead to vitamin deficiency anemia, also known as pernicious anemia.
  • Anemia of inflammation. Certain diseases — such as cancer, HIV/AIDS, rheumatoid arthritis, kidney disease, Crohn’s disease and other acute or chronic inflammatory diseases — can interfere with the production of red blood cells.
  • Aplastic anemia. This rare, life-threatening anemia occurs when your body doesn’t produce enough red blood cells. Causes of aplastic anemia include infections, certain medicines, autoimmune diseases and exposure to toxic chemicals.
  • Anemias associated with bone marrow disease. A variety of diseases, such as leukemia and myelofibrosis, can cause anemia by affecting blood production in your bone marrow. The effects of these types of cancer and cancer-like disorders vary from mild to life-threatening.
  • Hemolytic anemias. This group of anemias develops when red blood cells are destroyed faster than bone marrow can replace them. Certain blood diseases increase red blood cell destruction. You can inherit a hemolytic anemia, or you can develop it later in life.
  • Sickle cell anemia. This inherited and sometimes serious condition is a hemolytic anemia. It’s caused by a defective form of hemoglobin that forces red blood cells to assume an abnormal crescent (sickle) shape. These irregular blood cells die prematurely, resulting in a chronic shortage of red blood cells.

Risk factors

These factors place you at increased risk of anemia:

  • A diet lacking in certain vitamins and minerals. A diet consistently low in iron, vitamin B-12, folate and copper increases your risk of anemia.
  • Intestinal disorders. Having an intestinal disorder that affects the absorption of nutrients in your small intestine — such as Crohn’s disease and celiac disease — puts you at risk of anemia.
  • Menstruation. In general, women who haven’t had menopause have a greater risk of iron deficiency anemia than do men and postmenopausal women. Menstruation causes the loss of red blood cells.
  • Pregnancy. Being pregnant and not taking a multivitamin with folic acid and iron, increases your risk of anemia.
  • Chronic conditions. If you have cancer, kidney failure or another chronic condition, you could be at risk of anemia of chronic disease. These conditions can lead to a shortage of red blood cells.

    Slow, chronic blood loss from an ulcer or other source within your body can deplete your body’s store of iron, leading to iron deficiency anemia.

  • Family history. If your family has a history of an inherited anemia, such as sickle cell anemia, you also might be at increased risk of the condition.
  • Other factors. A history of certain infections, blood diseases and autoimmune disorders increases your risk of anemia. Alcoholism, exposure to toxic chemicals and the use of some medications can affect red blood cell production and lead to anemia.
  • Age. People over age 65 are at increased risk of anemia.


Left untreated, anemia can cause many health problems, such as:

  • Extreme fatigue. Severe anemia can make you so tired that you can’t complete everyday tasks.
  • Pregnancy complications. Pregnant women with folate deficiency anemia can be more likely to have complications, such as premature birth.
  • Heart problems. Anemia can lead to a rapid or irregular heartbeat (arrhythmia). When you’re anemic your heart pumps more blood to make up for the lack of oxygen in the blood. This can lead to an enlarged heart or heart failure.
  • Death. Some inherited anemias, such as sickle cell anemia, can lead to life-threatening complications. Losing a lot of blood quickly results in acute, severe anemia and can be fatal. Among older people, anemia is associated with an increased risk of death.


Many types of anemia can’t be prevented. But you can avoid iron deficiency anemia and vitamin deficiency anemias by eating a diet that includes a variety of vitamins and minerals, including:

  • Iron. Iron-rich foods include beef and other meats, beans, lentils, iron-fortified cereals, dark green leafy vegetables and dried fruit.
  • Folate. This nutrient, and its synthetic form folic acid, can be found in fruits and fruit juices, dark green leafy vegetables, green peas, kidney beans, peanuts, and enriched grain products, such as bread, cereal, pasta and rice.
  • Vitamin B-12. Foods rich in vitamin B-12 include meat, dairy products, and fortified cereal and soy products.
  • Vitamin C. Foods rich in vitamin C include citrus fruits and juices, peppers, broccoli, tomatoes, melons and strawberries. These also help increase iron absorption.

If you’re concerned about getting enough vitamins and minerals from food, ask your doctor whether a multivitamin might help.


To diagnose anemia, your doctor is likely to ask you about your medical and family history, perform a physical exam, and run the following tests:

  • Complete blood count (CBC). A CBC is used to count the number of blood cells in a sample of your blood. For anemia, your doctor will likely be interested in the levels of the red blood cells contained in your blood (hematocrit) and the hemoglobin in your blood.

    Normal adult hematocrit values vary among medical practices but are generally between 40% and 50% for men and 35% and 43% for women. Normal adult hemoglobin values are generally 13.6 to 16.9 grams per deciliter for men and 11.9 to 14.8 grams per deciliter for women.

    Numbers might be lower for people who engage in intense physical activity, are pregnant or of older age. Smoking and being at high altitude might increase numbers.

  • A test to determine the size and shape of your red blood cells. Some of your red blood cells might also be examined for unusual size, shape and color.

Additional diagnostic tests

If you receive a diagnosis of anemia, your doctor might order other tests to determine the cause. Occasionally, it can be necessary to study a sample of your bone marrow to diagnose anemia.


Anemia treatment depends on the cause.

  • Iron deficiency anemia. Treatment for this form of anemia usually involves taking iron supplements and changing your diet. For some people, this might involve receiving iron through a vein.

    If the cause of iron deficiency is loss of blood — other than from menstruation — the source of the bleeding must be located and the bleeding stopped. This might involve surgery.

  • Vitamin deficiency anemias. Treatment for folic acid and vitamin C deficiency involves dietary supplements and increasing these nutrients in your diet.

    If your digestive system has trouble absorbing vitamin B-12 from the food you eat, you might need vitamin B-12 shots. At first, you might have the shots every other day. Eventually, you’ll need shots just once a month, possibly for life, depending on your situation.

  • Anemia of chronic disease. There’s no specific treatment for this type of anemia. Doctors focus on treating the underlying disease. If symptoms become severe, a blood transfusion or injections of a synthetic hormone normally produced by your kidneys (erythropoietin) might help stimulate red blood cell production and ease fatigue.
  • Aplastic anemia. Treatment for this anemia can include blood transfusions to boost levels of red blood cells. You might need a bone marrow transplant if your bone marrow can’t make healthy blood cells.
  • Anemias associated with bone marrow disease. Treatment of these various diseases can include medication, chemotherapy or bone marrow transplantation.
  • Hemolytic anemias. Managing hemolytic anemias includes avoiding suspect medications, treating infections and taking drugs that suppress your immune system, which could be attacking your red blood cells. Severe hemolytic anemia generally needs ongoing treatment.
  • Sickle cell anemia. Treatment might include oxygen, pain relievers, and oral and intravenous fluids to reduce pain and prevent complications. Doctors might also recommend blood transfusions, folic acid supplements and antibiotics. A cancer drug called hydroxyurea (Droxia, Hydrea, Siklos) also is used to treat sickle cell anemia.
  • Thalassemia. Most forms of thalassemia are mild and require no treatment. More-severe forms of thalassemia generally require blood transfusions, folic acid supplements, medication, removal of the spleen, or a blood and bone marrow stem cell transplant.

Preparing for an appointment

Make an appointment with your primary care doctor if you have prolonged fatigue or other signs or symptoms that worry you. He or she may refer you to a doctor who specializes in treating blood disorders (hematologist), the heart (cardiologist) or the digestive system (gastroenterologist).

Here’s some information to help you get ready for your appointment.

What you can do

Before your appointment, make a list of:

  • Your symptoms and when they began
  • Key personal information, including major stresses, implanted medical devices, exposure to toxins or chemicals, and recent life changes
  • All medications, vitamins and other supplements you take, including the doses
  • Questions to ask your doctor

For anemia, basic questions to ask your doctor include:

  • What’s the most likely cause of my symptoms?
  • Are there other possible causes?
  • Do I need tests?
  • Is my anemia likely temporary or long lasting?
  • What treatments are available, and which do you recommend?
  • What side effects can I expect from treatment?
  • I have other health conditions. How can I best manage them together?
  • Do I need to restrict my diet?
  • Do I need to add foods to my diet? How often do I need to eat these foods?
  • Do you have brochures or other printed materials I can take? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

  • Do your symptoms come and go or are they constant?
  • How severe are your symptoms?
  • Does anything seem to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Are you a vegetarian?
  • How many servings of fruits and vegetables do you usually eat in a day?
  • Do you drink alcohol? If so, how often, and how many drinks do you usually have?
  • Are you a smoker?
  • Have you recently donated blood more than once?

Last Updated: September 8th, 2021

Recognize symptoms of anemia | Ada

What is anemia?

Anemia is the general name for a condition where the body either cannot make enough healthy red blood cells and/or has too little hemoglobin, the substance that enables red blood cells to transport oxygen around the body.

There are many different types of anemia. These include, but are not limited to:

Medically speaking, anemia is broadly classified as macrocytic, microcytic or normocytic, depending on the size and volume of the red blood cells (erythrocytes):

  • Macrocytic anemia. In this category of anemia, the red blood cells are larger than normal. This includes anemia caused by vitamin B12 deficiency or folate deficiency.
  • Microcytic anemia. In this category of anemia, the red blood cells are smaller than normal. This includes anemia caused by iron deficiency, thalassemia or sickle cell disease.
  • Normocytic anemia. In this category of anemia, the red blood cells are normal in size, but fewer than normal in number. This includes anemia caused by chronic conditions, e.g. kidney disease.

Regardless of the type or cause, common symptoms of anemia include:

  • Tiredness and lethargy
  • Breathlessness
  • Faintness
  • Headaches

There may also be other symptoms specific to the type of anemia being experienced.

The treatment recommended for anemia depends on the underlying cause. In cases of iron or vitamin deficiency, treatment will typically involve dietary changes and sometimes the use of supplements or medications. In less common types of anemia, as well as severe cases, more complex approaches, such as blood transfusions, may be needed.

The outlook depends on the type, cause and severity of anemia, as well as the age and overall health of the person; but with appropriate and timely treatment, recovery or effective management can be expected in many cases.

If left untreated, anemia can lead to complications, including reduced ability to function, lower quality of life, lung problems and even heart failure. It is important to consult a medical practitioner without delay, should the condition be suspected.

Types of anemia

There are a number of different types of anemia. These include the following:

Iron deficiency anemia

Iron deficiency anemia is caused by a lack of iron in the body, leading to reduced levels of sufficiently functioning red blood cells. Iron deficiency can be caused by a variety of factors and conditions, including internal bleeding, pregnancy, heavy menstruation, inflammatory bowel disease (IBD) and a lack of iron in one’s diet.

Megaloblastic anemia

Megaloblastic anemia is a type of macrocytic anemia that can be caused by a lack of vitamin B12 or lack of folic acid (folate). This is most often due to a dietary deficiency or malabsorption, e.g. as in pernicious anemia, where the body cannot absorb sufficient amounts of vitamin B12.

Aplastic anemia

Aplastic anemia is a consequence of damage or dysfunction in the bone marrow cells, causing them to produce fewer red blood cells than needed. This may be the result of a number of conditions, including infectious diseases and autoimmune disorders, as well as certain substances and cancer treatments. Rarely, aplastic anemia may run in families. Examples of hereditary conditions that can lead to aplastic anemia include Fanconi anemia and Diamond-Blackfan anemia.

Hemolytic anemia

Hemolytic anemia occurs as a result of red blood cells being destroyed more quickly than usual. This can be caused by a number of different conditions, some of which may run in families. There are many types of hemolytic anemia. Two examples include thalassemia and sickle cell anemia, both of which are hereditary.


Thalassemia is a genetic disorder that affects the production and function of hemoglobin, causing red blood cells to break down more easily than normal. The condition may be mild or severe.

Read more about Thalassemia »

Sickle cell anemia

This is a common, severe, form of sickle cell disease – a group of conditions that cause hemoglobin to be abnormally shaped and red blood cells to break down more easily than normal. Sickle cell disease is acquired genetically.

Read more about Sickle Cell Disease »

Concerned you or a loved one may have anemia? Start your free symptom assessment in the Ada app

Anemia symptoms

Common symptoms of anemia, regardless of the cause, include:

  • Fatigue (tiredness)
  • Lethargy (lack of energy)
  • Breathlessness
  • Faintness
  • Headaches

Less common symptoms of anemia may include:

  • Paleness
  • Palpitations (the feeling that the heart is skipping a beat or pounding)
  • Tinnitus (ringing in the ears)
  • Muscle cramps
  • Loss of appetite
  • Altered sense of taste

There may also be other symptoms, depending on the type of anemia. For example, iron deficiency anemia may cause wounds to heal slowly and brittle nails. VItamin B12 deficiency anemia may cause pins and needles, confusion and depression.

Good to know: In the early stages of anemia, some people may not experience symptoms.

People experiencing possible symptoms of anemia can use the free Ada app to carry out a symptom assessment.

Anemia causes

There are many possible causes of anemia. These include:

  • Dietary deficiencies of essential vitamins and minerals, such as vitamin B12, folic acid and iron
  • Malabsorption of nutrients, e.g. in celiac disease, Crohn’s disease
  • Substantial blood loss, e.g. from heavy menstruation or inflammatory bowel disease
  • Bone marrow problems and leukemia
  • Certain chronic conditions, e.g. rheumatoid arthritis, kidney disease (anemia of chronic disease)
  • Certain genetic disorders, e.g. thalassemia and sickle cell disease
  • Certain infections, e.g. malaria
  • Certain medications and therapies, e.g. some types of painkillers, antibiotics, drugs for hyperthyroidism and cancer treatments
  • Periods where the body needs more energy than usual, such as puberty and pregnancy

Diagnosis of anemia

As the first step, a doctor will typically take the person’s medical history and perform a physical examination. They may then order blood tests to check:

The doctor may also ask for the following tests to be done:

  • Urine tests
  • Stool (feces) tests
  • A bone marrow biopsy, removing a small sample for examination
  • A gastroscopy or colonoscopy to examine the digestive tract

As effective treatment of anemia depends on identifying the cause, the doctor will attempt to establish what this is. Further tests may be required if the cause is not clear.

Anemia treatment

The treatment recommended will depend on the underlying cause, as well as the severity of the anemia. Treatment may include:

  • Dietary changes to include more iron or vitamin-rich foods
  • Vitamin or iron supplements
  • Antibiotics, in the case of certain infections
  • Hormonal medication, in some cases of heavy menstruation
  • Adjusting any medications or therapies that may be causing anemia

In severe or persistent cases of anemia, the following may be recommended:

  • Medication to stimulate the production of red blood cells or to slow down their destruction
  • Medication to suppress the immune system, where this is involved
  • Blood transfusions
  • Bone marrow transplants
  • Surgery to stop internal bleeding
  • Surgery to remove the spleen, where it is rapidly destroying red blood cells

Complications of anemia

If severe or left untreated, anemia can cause a number of complications, including the following:

  • Lasting fatigue leading to diminished productivity
  • Weakened immune system
  • Fast or irregular heartbeat
  • Heart failure
  • Problems during pregnancy, including fatigue, premature labor and problems with fetal development
  • Increased risk of postpartum depression

Good to know: Specific types of anemia may cause other serious complications. If any kind of anemia is suspected, it is very important to consult a medical practitioner without delay.

Prevention of anemia

While it may not be possible to prevent all types of anemia, steps can be taken to reduce the risk of developing anemia related to nutritional deficiencies. These include:

  • Eating a well-balanced diet
  • Eating fortified foods and/or taking vitamin and mineral supplements where one’s diet is restrictive, e.g. vegetarians and vegans
  • Avoiding regular consumption of tannin-containing tea or coffee with meatless meals, as this may interfere with absorption of iron from plant sources

People experiencing symptoms that may be linked to anemia or a related condition can use the Ada app to carry out a free symptom assessment.

Anemia FAQs

Q: Is anemia during pregnancy common?
A: Yes. Mild anemia is quite common during pregnancy, as a pregnant person needs more iron than usual. It is recommended that a pregnant person eat foods that are rich in iron, such as dark green leafy vegetables, fortified cereals, eggs, nuts and lean meats to help prevent iron deficiency anemia. A doctor may also recommend a vitamin and mineral supplement. They may order blood tests to check the person’s iron levels during pregnancy. If any symptoms of anemia are present, a pregnant person should consult a doctor without delay.

For more information about achieving a balanced diet during pregnancy, see these resources on foods to eat during pregnancy and foods to avoid during pregnancy.

Q: What are the best foods for anemia?
A: It depends on the type of anemia and what is causing it. In the case of iron deficiency anemia, iron-rich foods such as dark green leafy vegetables, fortified cereals, eggs, nuts and lean meats may be recommended to help treat the condition. In the case of anemia caused by a deficiency of vitamin B12 or folic acid, other types of food may be recommended. In many cases, a well-balanced diet should provide sufficient nutrients to prevent anemia. If anemia is suspected, it is important to consult a medical practitioner, as self-diagnosis may be inaccurate.

Other names for anemia

  • Anaemia (UK spelling)
  • Lack of blood
  • Tired blood
  • Iron deficiency

Coping with Anemia (Low Red Blood Cells)

What is anemia?

Anemia means you have fewer red blood cells than normal, or you do not have enough iron in your blood. When this happens, your red blood cells cannot carry enough oxygen to the rest of your body.

Symptoms include:

  • Feeling very weak, tired or short of breath

  • Feeling dizzy or light-headed

  • Skin, gums, nail beds or lower eyelids that are pale.

How is it treated?

Anemia can be treated with:

These medicines may increase your iron, help your body make red blood cells, or treat the cause of your anemia.

Severe anemia requires a blood transfusion. In this case you would receive donated blood through an IV line (a small tube in your vein). This usually takes four to five hours. You can receive blood at one of Fairview’s outpatient infusion centers.

You will need a number of blood tests to see if your treatment is working.

What else can I do to treat or prevent anemia?

  • Eat a healthy diet with lots of iron-rich foods (like beef, liver, canned salmon, dried fruits and fortified cereals). Drink lots of fluids.

  • Sleep more at night and take naps during the day.

  • Plan your day to include rest periods. Don’t try to over-schedule yourself. Save your energy for the things that are most important to you.

  • Try to do light exercise every day. Avoid heavy exercise or activity.

  • Don’t be afraid to ask for help when you need it. Family and friends can help with child care, shopping, housework or driving.

  • Don’t get up too quickly when lying or sitting. This may make you dizzy. Change positions slowly.

  • Avoid injuries that might cause bleeding or bruising. Keep your home as safe as possible. Do not use razors or sharp knives.

  • Make time for activities that help you relax (meditation, reading, talking with friends, listening to music).

When should I call my care team?

Call your care team if:

  • You feel very weak and tired all the time.

  • You have trouble breathing or feel short of breath.

  • You are dizzy or light-headed.

  • Your heart rate is faster than normal.

  • You have headaches often.

  • You have heavy vaginal bleeding (soaking one pad an hour) or a change in your periods. This includes increased bleeding or bleeding between cycles.












For informational purposes only. Not to replace the advice of your health care provider. Copyright © 2006 Fairview Health Services. All rights reserved. Clinically reviewed by Fairview Oncology. SMARTworks 520523 – REV 04/19.

Anemia | MUSC Health | Charleston SC

What is anemia?

Anemia is a condition defined by deficiency of hemoglobin in the blood. Hemoglobin is a protein molecule contained in red blood cells and is responsible for carrying oxygen. The normal level of hemoglobin in the blood is approximately 12-14 grams per deciliter in men and 11-13 gm/dl in women, although normal value ranges may vary slightly among different laboratories.

Anemia can occur rapidly when there is a sudden loss of blood. Often, the source of this blood loss can be from the esophagus, stomach, or small intestines. This is often seen as vomiting blood (hematemesis) or rectal bleeding. Patients usually feel dizzy because their blood pressure drops, especially when standing up.

Anemia occurs more chronically when the body does not produce enough hemoglobin or red blood cells to maintain its normal level.

What causes anemia?

By far, the most common cause of anemia is shortage of iron. Iron is essential to make new red blood cells. In women, this is usually due to menstrual loss of blood.

Other possible causes of anemia could include:

a slow loss of blood in the GI tract that cannot be seen in a person’s stool
deficiencies of vitamin B12 for which a special substance in the stomach is needed in order for the vitamin to be absorbed from food
major stomach surgery that may cause an inability to absorb proper nutrients, such as B-vitamins
folic acid deficiency (also referred to as folate deficiency), which is when a person’s body does not get enough folic acid
There are other less common causes of anemia. It can be seen in patients with a chronic disease (such as severe arthritis, inflammation, etc.), in which the red blood-forming tissues (blood marrow) become sluggish. There are specific diseases of the bone marrow in which all of the main blood cells are not made efficiently or adequately.


Mild chronic anemia does not usually cause significant symptoms. More severe anemia, however, will result in:

  • an unhealthy, pale appearance of the skin (pallor)
  • a lack of energy
  • shortness of breath

Other symptoms, based on the cause of the anemia, may also be present. Patients with bone marrow problems may have inadequate white blood cells and platelets, whereas patients with hemolysis may develop yellow jaundice of the skin and eyes.


Tests for anemia are simple and logical. Blood levels of hemoglobin are measured and the red blood cells are observed under a microscope to assess the likely cause of the condition.

Red blood cells have characteristic appearances according to the specific deficiency. It is possible to recognize very “young” red blood cells, called reticulocytes. More than the usual number of these in the blood indicates a rapid turnover of red blood cells in response to hemolysis or blood loss.

Assessment of the other blood constituents (white cells and platelets) will demonstrate whether the problem is solely due to hemoglobin development, or a more diffuse bone marrow disease. The lack of iron can be recognized easily on a blood smear, and the levels can be measured. Blood levels of iron, folate, and B12 are measured when appropriate. When discovered, further investigations can determine the precise cause of any deficiency.

The finding of iron deficiency anemia, particularly in women who are not menstruating and men, should prompt the investigation for chronic bleeding into the bowel. This bleeding may not be obvious to the patient, but can be detected by tests on the stool.

These then lead logically to examination of the lining of the intestine to seek a source for the bleeding. These are most commonly found in the stomach and colon using standard endoscopic techniques such as:

These investigations are particularly important in older patients since this bleeding is an important early sign of possible gastrointestinal cancer.

Capsule Endoscopy

In some people, a source of bleeding can not be found in the esophagus, stomach or colon. These people may need further evaluation of their small intestines for bleeding. This can now be accomplished vis the swallowing of a small capsule with a camera in it that can take pictures from within the small intestines and transmit them to a recorder that the patient wears on a belt. These pictures can then be reviewed by a physician for areas of bleeding that can not be reached by standard endoscopes.


Some treatment options include:

  • iron supplements, usually given by mouth, for iron deficiency anemia
  • iron infusions, given by injection, for more severe cases of iron deficiency anemia
  • vitamin B12 infusions
  • stricter diet and nutrition management for cases of folic acid deficiency

90,000 Anemia of chronic diseases

Anemia of chronic diseases (anemia of inflammation) – anemia that occurs in patients with infection, inflammation, neoplasia and lasts more than 1-2 months.

It should be noted that the anemia of chronic diseases is usually not severe. Its degree correlates with the severity of the chronic disease causing it. A characteristic feature of this type of anemia is the combination of a reduced level of serum iron (hypoferremia) with sufficient reserves in the reticuloendothelial system.

Etiology of anemia of chronic diseases:

(1) infections (acute and chronic), viruses, including HIV, bacterial, parasitic, fungal;

(2) tumors – hemoblastosis, solid tumors;

(3) autoimmune diseases – rheumatoid arthritis, systemic lupus erythematosus and other connective tissue diseases, vasculitis, sarcoidosis, chronic inflammatory bowel disease;

(4) chronic graft rejection;

(5) chronic kidney disease.

In the pathogenesis of anemia of chronic diseases, there is most often a combination of several factors leading to anemia:

(1) erythrocyte lifespan slightly reduced;

(2) the transfer of iron from reticuloendothelial cells to bone marrow erythroblasts can be blocked;

(3) insufficiently high level of erythropoietin (inhibition of erythropoiesis) relative to the degree of anemia.

Clinical manifestations of anemia:

1) General symptoms.Due to the developing hypoxia. These are pallor of the skin and mucous membranes, weakness, headaches, dizziness, palpitations, shortness of breath.

2) Symptoms characteristic of certain groups of anemias according to their pathogenesis. With iron deficiency anemia, sideropenic syndrome develops due to tissue iron deficiency – dry mouth, hair loss, brittle nails. With B12 – deficiency anemias – lesions of the gastrointestinal tract, lesions of the nervous system in the form of funicular myelosis (numbness, tingling sensation, crawling creeps in the fingertips).

Patients with suspected anemia undergo laboratory tests:

1) General blood test with determination of reticulocytes, counting siderocytes.

2) Examination of bone marrow punctate with sideroblast count.

3) Biochemical studies: determination of total protein and protein fractions, urea, creatinine, serum iron, total iron-binding capacity of serum, ferritin, transferrin.

Peripheral blood.

More often, anemia of chronic diseases is normochromic normocytic, less often moderately hypochromic. The reticulocyte count is normal or decreased. The hematocrit ranges from 25 to 40%. Bleeding episodes, vitamin deficiencies (cyanocobalamin and folic acid), autoimmune hemolysis, radiation and chemotherapy can serve as additional factors contributing to the increase in anemia.

Changes in iron metabolism are characterized by a redistributive iron deficiency (a decrease in serum iron, total serum iron-binding capacity, transferrin, and an increase in serum ferritin).Ferritin belongs to acute phase proteins, therefore, an increased level of serum ferritin in ACD may reflect not only the body’s iron store, but also be a manifestation of an acute phase response, which limits its use as an indicator for determining iron stores.

In case of anemia, consult your doctor or hematologist.

Laboratory tests can be carried out in the clinical diagnostic laboratory of the Minsk Clinical Consultative and Diagnostic Center on the referral of the center’s specialists and attached healthcare institutions free of charge.Without referral – on a paid basis.

Doctor of laboratory diagnostics Bogacheva E.I.

90,000 Complications of coronavirus are caused by ferritin, according to Israeli scientist

Photo: AGN Moscow

Scientists have figured out which biomarker can indicate a severe form of coronavirus disease.It is ferritin, a blood protein that plays an important role in the transport of iron. This, as stated at the St. Petersburg State University on April 14, said a professor at St. Petersburg State University, professor emeritus of Tel Aviv University, researcher at the Israeli Sheba Medical Center Yehuda Shenfeld at an online conference.

We must defeat the storm

Ferritin stores iron stores in the human body. He very quickly delivers this element to the organ that needs it. As a rule, this is due to the regulation of oxygen metabolism in cells.But, as it turned out, if there is a lot of this protein, it becomes deadly in some diseases, including coronavirus. This means that people who have high ferritin levels are at increased risk: most likely, their disease will be severe. This is especially true for the elderly.

“Ferritin activates macrophages – the cells that protect us by embracing bacteria and viruses,” said Yehuda Schoenfeld . “But when they are activated, they release cytokines – in small amounts they help us resist infection, but if there are a lot of them, it leads to collapse.”

In medicine, this collapse is called “cytokine storm” – it is he who leads to the death of half of older patients: in the case of coronavirus, the immune system mistakenly attacks lung cells and very quickly destroys them completely. Now it became clear that this “storm” is rising precisely because of the high content of ferritins.

“So we have a diagnostic parameter,” Schönfeld said. “And therefore, we understand that in order to reduce mortality, we must somehow deal with high levels of ferritin.”

The virus will help you overcome yourself

They have been able to take a blood test for ferritin content in clinics for a long time – this is a fairly quick and affordable study, which can immediately show how great the risk for a patient is to face serious complications from coronavirus. True, it is useless to take blood in the admission department of the hospital: it must be done on an empty stomach. And if the patient takes preparations containing iron, then not earlier than three days after their last intake.

Another marker suggesting a high likelihood of complications, according to Schoenfeld, may be the cytokine CD-143, which also indicates too high activity of macrophages.

“Thus, our main task is to block cytokines,” the professor concluded.

Yehudi Schoenfeld. Photo: spbu.ru

Now all over the world, scientists are looking for antibodies that can effectively overcome the “cytokine storm”, and it is desirable that they hit specific cytokines, without completely suppressing the immune system. St. Petersburg State University reported that such work is being carried out at the university’s Center for Autoimmune Diseases, which is headed by Yehudi Schoenfeld.

“In addition, we intend to create a vaccine against coronavirus,” said an Israeli professor. “We intend to base it on parts of the virus – viral proteins that are not found in the human body and therefore are not able to create an unwanted immune response.”

But, according to Schoenfeld, such a vaccine will be able to prevent the development of processes in which immune bodies attack healthy cells. From the point of view of the scientist, it is this path that will lead to the creation of an effective remedy for coronavirus as quickly as possible.

Read also:

• TOP-10 products for cleansing the lungs according to doctors
• Who should not be vaccinated against COVID-19

Who is at risk

A short-term rise in ferritin levels occurs as the body’s response to infection. And its constantly high level, as a rule, is observed:

  • for hemochromatosis;
  • for various endocrine diseases such as hyperthyroidism;
  • for hemolytic anemias;
  • for inflammation of the upper respiratory and urinary tract;
  • for acute and chronic liver diseases;
  • for certain cancers – bone marrow cancer, breast cancer, Hodgkin’s disease;
  • when taking iron-containing drugs;
  • in those who have undergone multiple blood transfusions;
  • for alcoholism.

People suffering from these diseases should protect themselves from contact as much as possible in order to reduce the likelihood of contracting coronavirus.

Low hemoglobin – symptoms and causes

Hemoglobin is an element in the blood that carries out the function of transporting oxygen to tissues and cells, taking carbon dioxide back into the lungs. This protein is contained in erythrocytes – red blood cells, but erythrocytes act only as a “transport”, while hemoglobin is a container with oxygen.Any changes in hemoglobin values ​​are not the cause of the disease, but its consequence. But the reasons can be many, ranging from malnutrition to really serious diseases. And the result is anemia, low hemoglobin levels.

Causes of low hemoglobin

The development of anemia is caused by the following reasons:

  • Too rapid destruction of red blood cells.
  • Serious blood loss.
  • Disturbances in the work of the hematopoietic organs.Anemia can occur due to unfavorable environmental conditions, trauma, infections, genetic causes and pathologies, insufficient amounts of nutrients.
  • Deficiency of vitamins and minerals, especially iron. The development of this type of anemia can be affected by an unbalanced diet, disturbances in the functioning of the digestive system, an insufficient amount of iron that enters the body through food, or an increased need for iron, chronic blood loss, prolonged use of drugs, alcohol dependence.

Degrees of low hemoglobin and their signs

  • Mild degree . The hemoglobin level drops to 90 g / l. Usually, during mild anemia, a person does not feel any changes in the body, therefore, it is diagnosed by chance – after taking a blood test. However, nevertheless, sometimes patients complain of rapid fatigue and weakness.
  • Medium . The hemoglobin level ranges from 70 g / l to 90 g / l. The patient observes signs of mild anemia, as well as dizziness.In addition, there are problems with the skin (it becomes rough and dry), cracks on the lips, digestive problems – constipation, diarrhea, flatulence may appear.
  • Severe . The hemoglobin level falls below 70 g / l. A person observes signs of mild to moderate anemia, to which are added loss of consciousness, flies before the eyes, and stopping menstruation. The skin becomes pale and the hair and nails become brittle. Fatigue is felt even after light physical exertion, and hands and feet are constantly freezing.

In addition, the signs of low hemoglobin include:

  • shortness of breath;
  • Hair loss, dullness and fragility;
  • muscle weakness;
  • frequent infectious diseases;
  • Memory impairment.

Low hemoglobin levels are dangerous if left untreated – this will lead to disruptions in the work of all organs.

Diagnosis and treatment of low hemoglobin

First of all, if symptoms of anemia are observed or you want to undergo a routine examination, you should contact a therapist or hematologist.The doctor will conduct an examination and prescribe the necessary tests – most often it is a blood test. After receiving the results and collecting an anamnesis, the doctor will be able to prescribe the correct treatment, refer to the necessary narrowly focused specialist or for additional studies if necessary.

Treatment for low hemoglobin depends on the type of anemia and the underlying causes. This can be a diet, taking vitamins, supplements, medications, and the like. Only a doctor can determine the cause and prescribe the necessary treatment.

Call (067) 127-03-03, (044) 490-25-03 or fill out the form on the website to make an appointment with a physician or hematologist.

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90,000 The cause of death is anemia. How does it threaten our health? | Healthy life | Health

Anemia is an unpleasant phenomenon. It is recognized mainly through blood tests.But at the same time, she is capable of giving negative manifestations in the form of certain symptoms. In fact, doctors say, anemia can kill a person, although it is often underestimated.

Anemia is understood as a decrease in hemoglobin in the blood, which is conventionally divided into several degrees, the last of which is severe and life-threatening. There may be many reasons for this condition, but the result for the body is not the best in any case. Often, parents are concerned about the level of iron in the blood, who are monitoring the condition of their children.And in adulthood, many people forget about this parameter. And completely in vain.

About why anemia is deadly and how exactly it kills, as well as how to recognize it in time, AiF.ru was told therapist, professor, head of the Outpatient Doctor and the Institute of Outpatient Therapy, Honored Scientist of the Russian Federation Arkady Vertkin .

Attention to hemoglobin

Low hemoglobin is a phenomenon that is not always given due attention. Few doctors make a diagnosis of “anemia” on a separate line.It is generally accepted in our country that there is nothing terrible here, “all my life such hemoglobin – and nothing, alive.” At the same time, due to a decrease in hemoglobin, all organs, systems, tissues of the body regularly experience a lack of oxygen and receive less nutrition.

What hemoglobin is considered reduced? Here it is worth referring to the average WHO data, which are also used for laboratory testing. So, the standards are as follows:

Men – below 130 g / l;

Women – below 120 g / l.

It is important to remember that anemia is not an independent disease, but a manifestation and / or complication of another serious disease. It is unacceptable to ignore it, and in any case, the prognosis of life is unfavorable. I am not exaggerating. When a person has a heart attack or stroke (and these diseases are not uncommon in our country), anemia greatly aggravates the course of the disease, causes additional difficulties in treatment and worsens the prognosis. After all, how to save a person whose blood does not carry oxygen to the organs?

What other consequences does anemia have?

Other negative consequences of this condition should not be underestimated.These usually include the following factors:

– cardiovascular diseases;

– cognitive impairment;

– high risk of falls and fractures;

– low productivity, efficiency, weakness.

The complexity of anemia is that it has a lot of causes. Consequently, there are also many varieties.

Causes of pathology

We can distinguish 3 main reasons:

– Increased consumption of red blood cells.Red blood cells are cells that carry hemoglobin. In some situations, the body needs too many red blood cells, such as bleeding, donation, dialysis, pregnancy. In fact, it is often possible to suspect internal bleeding by the reduced hemoglobin, which has not yet manifested itself in any way.

– The body produces few red blood cells. This happens with a deficiency of iron, vitamin B12, folic acid, leukemia, blood diseases.

– Internal hematomas.

If you see a reduced hemoglobin in the blood test, then do not rush to eat apples and drink pomegranate juice in liters. An urgent need to contact a therapist. His task is to find the cause of anemia in order to correct the situation in time. Many patients become hostages of a “long search” and undergo many different studies: FGDS, colonoscopy, ultrasound, blood tests, consultations with a gynecologist, urologist, and so on.

In fact, the first thing a therapist should do is order a complete blood count and determine your average red blood cell volume (MCV).Today it is determined by the analyzer, which is available everywhere. The MCV indicator determines in which direction to look for the cause of the decrease in hemoglobin.

Let me give you an example. If MCV <80, then such anemia is called microcytic anemia and most often indicates iron deficiency, and it is necessary to look for the cause in this direction. Do not forget to ask girls and women about unusual taste preferences (chalk, for example) and clarify what unusual smells give pleasure (for example, fresh lime, gasoline).If the MCV is> 100, this may indicate a lack of vitamin B12, liver disease, or banal helminthiasis.

Some people mistakenly think that hematologists should treat anemia. In fact, they are connected only when there is a suspicion of a blood disease, or in case of microcytic anemia with an excess of iron in the blood.

How do you suspect you have anemia?

Everyone can be guided by their own condition, because anemia makes itself felt by a number of signs and symptoms.Among them, there may be problems such as dizziness when you get out of bed or a chair, chair, etc., tachycardia due to increased work of the heart muscle, weakness, shortness of breath, manifested with various physical exertion, the appearance or exacerbation , if any, angina pectoris, brittle nails, spoon-shaped nails, active hair loss and pallor of the skin, jaundice.

In the event of disturbing signals, it is worth contacting a specialist as soon as possible to undergo research.This will allow not to let the situation take its course, and in some cases will even save a person’s life.

Iron deficiency anemia – causes, symptoms and treatment – Medcompass

Iron deficiency anemia is a syndrome characterized by a decrease in the amount of hemoglobin and / or red blood cells in the blood due to a lack of a trace element in the body – iron. This type of anemia is the most common among all, and according to statistics, it accounts for about 78% in the structure of such diseases.

Symptoms of the disease

Symptoms of the disease depend on the severity of the anemic syndrome. There are three degrees:

  • Light (hemoglobin within 90-110 g / l)
  • Medium (hemoglobin within 70-90 g / l)
  • Heavy (hemoglobin below 70 g / l).

The clinic of anemia consists of two syndromes: anemic and sideropenic.

With anemic syndrome, patients complain of increased heart rate, feeling of lack of air, general weakness, dizziness, drowsiness, headache, loss of working capacity, difficulty concentrating, tinnitus, irritability, muscle weakness.These symptoms are not specific, they can be present in many diseases. Attention is drawn to the pallor of the skin and mucous membranes, arterial hypotension.

Sideropenic syndrome is caused by a decrease in the amount of substances that, like hemoglobin, have iron in their structure. Skin changes are characteristic. It becomes dry and flaky. Nails begin to exfoliate, become brittle. Cracks appear in the corners of the mouth. Patients complain of changes in their sense of smell and taste preferences (some begin to eat chalk, coal, dry cereals, inhale the smells of gasoline, acetone, etc.)). In some cases, cracks appear in the tongue, ulceration.

Causes of the disease

Deficiency of iron in the body can be observed when it is insufficiently obtained from food, at increased costs, in violation of its assimilation in the body. The main causes of anemia are:

  • Chronic blood loss (heavy periods in women, gastrointestinal, nosebleeds, uncontrolled donation, blood loss in urine with hematuria)
  • Lack of iron in food (fasting, vegetarianism, strict fasting, malnutrition)
  • Violation of the processes of absorption of a trace element in the gastrointestinal tract (surgical removal of part of the stomach and intestines, chronic gastritis, enteritis, Crohn’s disease)
  • Violation of the processes of iron transport in the body (birth defects of various enzymatic systems that take part in the transport of iron)
  • Increased consumption microelement (pregnancy, lactation, the period of active growth of the child, the use of iron by parasites).


The main thing in the diagnosis of iron deficiency anemia is a clinical blood test. Of the doctor’s indicators, the following are of particular interest:

  • The amount of hemoglobin (will be reduced)
  • The number of erythrocytes (will be reduced)
  • Color indicator (below the norm – hypochromic anemia)
  • When studying the morphology (shape and structure of erythrocytes), the following features are noted, which indicate IDA – anisocytosis (different sizes of erythrocytes in one person, microcytes are more characteristic of the gastrointestinal tract – less than usual), poikilocytosis (various forms of blood cells).

Biochemical analysis for IDA indicates:

  • Decrease in the amount of serum iron
  • Decrease in iron saturation of transferrin (transport protein for iron)
  • Decrease in the amount of ferritin in serum (depot form of iron)
  • Increase in the total iron-binding function of blood serum …

The above criteria are sufficient to diagnose IDA. But the diagnostic search does not end there. Further, hematologists prescribe a whole range of examinations and consultations in order to establish the cause of anemia.


The prognosis with timely diagnosis and adequate therapy is very favorable. If the process has gone far, then against the background of anemia, various chronic diseases develop. Most often, patients observe heart failure, chronic hypoxia, diseases of the heart, blood vessels, liver, and brain.

With a critical decrease in hemoglobin in the blood, the development of hypoxic coma, acute cardiovascular failure and death is possible.