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Apr 10, 2024

What Is Anemia?

SDI Productions / Getty Images Medically reviewed by Kashif J. Piracha, MD Anemia is a condition that occurs when your blood has a reduced number of red blood cells or hemoglobin, the protein that

SDI Productions / Getty Images

Medically reviewed by Kashif J. Piracha, MD

Anemia is a condition that occurs when your blood has a reduced number of red blood cells or hemoglobin, the protein that helps your red blood cells transport oxygen from your lungs to the rest of your body. When you have anemia, your blood has less oxygen than normal. This can cause symptoms like fatigue and weakness, shortness of breath, dizziness, headaches, and an irregular heartbeat.

Anemia can develop in anyone regardless of age, race, or ethnicity. However, some people are more at risk for developing the condition, including people who have cancer, an autoimmune disorder, or heavy periods.

Treatment for mild to moderate anemia usually involves supplements or medications that help your blood develop more red blood cells. In more severe cases, a blood transfusion or surgery may be necessary.

There are many types of anemia. Some types are more common and easier to treat than others, but they can all lead to complications if left untreated.

When you don't have enough iron, you are at risk of developing iron deficiency anemia. This common type of anemia usually occurs when you don't consume adequate iron in your diet. It impacts 30% of women and children. Low iron levels can also develop due to blood loss or medical conditions that make it difficult for your body to absorb iron.

While this type of anemia rarely causes death, it can lead to significant complications. Symptoms and possible complications include:

Fatigue

Headaches

Restless legs syndrome, a condition that causes your legs to move uncontrollably

Heart problems

Pregnancy complications like early labor (before 36 weeks) and low infant birth weight

Iron deficiency anemia can cause other medical conditions to worsen or cause treatments to be ineffective.

Pernicious anemia is an autoimmune disorder, meaning your body mistakenly attacks healthy cells. This type of anemia is relatively rare. It affects less than 2% of people over age 60 worldwide.

People with pernicious anemia have low levels of vitamin B12. Your body needs vitamin B12 to make healthy red blood cells and keep your nervous system working properly. Pernicious anemia causes larger-than-normal red blood cells that do not divide effectively. These blood cells have difficulty moving out of bone marrow (where they're made) and so cannot carry oxygen throughout your body.

If left untreated, pernicious anemia can cause serious complications. You might experience bleeding and infections, as well as irreversible brain or nerve damage. Infants of people who have a vitamin B12 deficiency are more likely to experience developmental delays and birth defects, particularly in the brain and spinal cord.

Aplastic anemia is a rare but serious blood condition. It occurs when your bone marrow cannot make enough new blood cells for your body to function properly. This type of anemia, which impacts about two out of every one million people in the United States, usually results from damage to stem cells inside your bone marrow. This causes your bone marrow to make fewer red blood cells, white blood cells, and platelets. Aplastic anemia often occurs because your immune system attacks and destroys the stem cells.

Untreated aplastic anemia can lead to serious complications like an irregular heartbeat and heart failure. It also increases your risk of developing bleeding issues, leukemia (a type of cancer that begins in the blood cells), and other serious blood conditions.

Aplastic anemia is a life-threatening condition with very high death rates. About 70% of people die within one year if the disease is left untreated. The five-year survival rate is about 80% for people under age 20.

With hemolytic anemia, your red blood cells are destroyed faster than they can be replaced. There are multiple types of hemolytic anemia. It can be acquired or inherited, and the cause is not always known. This type of anemia is rare and impacts approximately 1-3 per 100,000 people every year. It can occur at any age.

People with mild hemolytic anemia may not need treatment, but those with more serious cases could be at risk for serious complications if the condition is left untreated. Possible complications include an irregular heartbeat, a larger-than-normal heart, and heart failure.

Related: Iron Deficiency Signs and Symptoms

Anemia symptoms can vary depending on the severity of the condition and how quickly it develops. People with mild anemia may not experience any symptoms at all. Symptoms typically worsen as the condition progresses.

Initial symptoms of anemia include abnormally pale skin and feeling weak or fatigued. As anemia progresses, you may experience symptoms like:

Dizziness

Increased thirst

Sweating

Rapid pulse

Fast breathing

Mouth symptoms like tongue swelling, dry mouth, and ulcers (small sores)

Koilonychia (brittle, spoon-shaped nails)

Hair loss

Symptoms of more severe anemia include:

Lower leg cramps

Shortness of breath

Brain damage

It's common to experience heart-related symptoms with anemia—primarily because your heart must work harder to deliver oxygen-rich blood to your body. These symptoms can include everything from arrhythmias (abnormal heart rhythms) and heart murmurs to an enlarged heart and heart failure.

Related: Vitamin B12 Deficiency

There are three main causes of anemia:

Lack of red blood cell production: Nutritional deficiencies or inadequate nutrient absorption can lower your body's ability to produce red blood cells.

High rates of red blood cell destruction: Chronic conditions can affect your body’s ability to make enough red blood cells or even lead to red blood cell destruction.

Blood loss: Blood loss through menstruation or internal bleeding (for example, in the stomach or colon) can also lead to anemia.

A variety of different conditions and genetic factors can increase your risk of developing anemia. Risk factors include:

A diet low in iron, vitamin B12, or folic acid

Frequent blood donation

Heavy periods

Pregnancy

Cancer

Ulcers

Colon polyps

Colon cancer

Autoimmune disorders

Inherited conditions

Blood conditions like sickle cell disease (SCD), a condition in which abnormal hemoglobin causes red blood cells to become rigid and crescent-shaped

Metabolic conditions like glucose-6-phosphate dehydrogenase deficiency, a genetic condition that causes red blood cells to break down

Frequent exposure to toxins like pesticides

Radiation and chemotherapy treatments

Viral infections like Epstein-Barr virus (EBV), a common and highly contagious herpes virus that spreads through bodily fluids like saliva

Diagnosis of anemia usually begins with a physical exam to look for a pale tongue and brittle nails. Your healthcare provider will ask about your medical history, diet, and whether other family members have ever been diagnosed with anemia.

They will also order blood tests and consider other testing options.

Blood tests might include:

Complete blood count (CBC): A blood test that provides information on a variety of markers including your red blood cells, white blood cells, and platelets. It's one of the most common ways to check for anemia.

Mean corpuscular hemoglobin concentration (MCHC): A blood test that measures the amount of hemoglobin a red blood cell has relative to the cell's volume.

Mean corpuscular hemoglobin (MCH): A blood test that measures the average amount of hemoglobin within your red blood cells.

Hematocrit levels: A blood test that measures the percentage of red blood cells in your blood.

Mean corpuscular volume (MCV): A blood test that measures the average size of your red blood cells.

Other possible tests and diagnostic tools include:

Bone marrow tests: Two bone marrow tests—aspiration and biopsy—can detect anemia, and they're often performed together. Aspiration is a procedure to collect a small amount of fluid from your bone marrow. Your healthcare provider will then perform a biopsy, which involves removing a small amount of bone marrow tissue. The goal of a bone marrow test is to determine if your bone marrow is healthy and if it makes normal amounts of blood cells.

Urine tests: Urine tests help determine if your kidneys are working properly. They may also detect bleeding in your urinary tract.

Genetic tests: Genetic tests detect the presence of genes that affect how your body makes red blood cells.

Other diagnostic tests: A colonoscopy can detect bleeding in your colon. Your healthcare provider may also consider an endoscopy to look for bleeding in the esophagus, stomach, and small intestine. For an endoscopy, a doctor or surgeon inserts a flexible tube with a camera, called an endoscope, into your body.

Treatments for anemia depend on the cause and severity of your condition. Some forms of anemia can be treated with dietary changes and supplements. More severe anemia might require blood transfusions, blood or bone marrow transplants, or surgery.

The primary goal of treatment is to increase your red blood cell count or hemoglobin and improve oxygen levels in your blood, as well as relieve your symptoms and improve your quality of life. Other treatment goals include treating the underlying condition causing your anemia as well as preventing complications such as heart or nerve damage.

Including more iron-rich foods in the diet is one of the main treatment strategies for early or mild iron deficiency anemia. Iron is naturally present in a variety of animal and plant-based foods. Heme iron is the type of iron found in animal foods like meat, poultry, seafood, and eggs. Non-heme iron is found in plant foods. Your body absorbs about 25% of dietary heme iron and about 17% of dietary non-heme iron.

Heme iron also enhances the absorption of non-heme iron. Therefore, people who don’t eat animal sources of iron often need to eat more sources of plant-based iron or take an iron supplement to meet their daily needs. Daily iron recommendations are about 1.8 times higher for vegetarians and vegans.

Foods rich in iron include:

Beef

Poultry

Eggs

White beans

Dark leafy greens

You can combine these with foods high in vitamin C like broccoli, oranges, and strawberries. Vitamin C helps your body absorb iron.

The most common approach to treating iron deficiency anemia is through oral supplementation (a pill taken by mouth) of iron. The dose depends on factors like your age and iron deficit, as well as your ability to tolerate potential side effects. For more severe cases, iron therapy (iron given through an intravenous line, or IV, into your vein) is used. One benefit of this approach is that it only takes one or two sessions to replenish the iron in your body.

For people with pernicious anemia, healthcare providers may use B12 supplements or shots to restore vitamin B12 levels. Nose gels and sprays can be valuable options for people who have difficulty swallowing pills.

Dietary supplements are minimally regulated by the FDA and may or may not be suitable for you. The effects of supplements vary from person to person and depend on many variables, including type, dosage, frequency of use, and interactions with current medications. Please speak with your healthcare provider or pharmacist before starting any supplements.

Medications that treat the underlying condition causing anemia can also treat the anemia itself. If your current medication is causing anemia, your healthcare provider may make adjustments or change your medication to reduce your symptoms.

If you have aplastic anemia or hemolytic anemia, you may be prescribed medications to suppress your immune system, known as immunosuppressants. For aplastic anemia, they also may prescribe medications that stimulate your bone marrow to make red blood cells, such as erythropoietin therapy (injections of a hormone called erythropoietin, which helps with red blood cell production).

If you have severe iron deficiency anemia, your healthcare provider may recommend a blood transfusion to quickly increase your iron and red blood cell levels. This procedure usually takes one to four hours and includes monitoring before and after the procedure. Blood transfusions also help treat aplastic anemia.

For people with severe aplastic anemia, a healthcare provider may recommend replacing damaged stem cells in your bone marrow with healthy cells. During this procedure, high doses of chemotherapy (medications used to treat cancer)—and possibly radiation—destroy ineffective stem cells before donor stem cells are put into your body. This type of transplant works best in people who have donors with closely matching cell types. It's typically used for children and young adults.

Surgery is sometimes required for internal bleeding that causes anemia. People with hemolytic anemia might also have surgery to remove the spleen because the spleen removes abnormal cells from the blood. This approach is rarely used.

Some types of anemia can be prevented, particularly those caused by vitamin or mineral deficiencies. Other types of anemia are long-lasting conditions that require ongoing management and treatment.

Including iron-rich foods in your diet can also help prevent iron deficiency anemia, especially if you combine them with foods high in vitamin C.

You can also try to avoid potential triggers that can increase your risk of anemia. For example, some types of anemia are triggered by things like particular foods or cold temperatures. If you have hemolytic anemia, washing your hands often and maintaining distance from people who might be sick can reduce your risk of infection.

If you have heavy periods, talk to an OB-GYN about how to address this condition before anemia develops.

Related: Vitamin B12 Foods

There are a number of conditions related to anemia, many of which involve the heart. For example, anemia commonly occurs with acute coronary syndromes (ACS), a group of conditions caused by sudden or severely limited blood flow to the heart.

Other common related conditions include:

Heart failure: Anemia frequently occurs with heart failure. Research suggests this is due to the complex relationship between iron deficiency, kidney disease, and cytokine production. Cytokines are proteins that help fight infections.

Hypertension: Anemia is common among people with hypertension (high blood pressure). People with anemia also tend to have higher blood pressure readings.

Chronic pulmonary obstructive disease (COPD): Anemia is common in people with COPD, a chronic lung disease that damages the lungs and makes breathing difficult. Up to 33% of people with COPD have anemia.

Hypothyroidism: People with thyroid diseases like hypothyroidism (underactive thyroid gland) often have anemia. The reasons for this connection remain unclear.

Chronic kidney disease (CKD): Certain factors can increase the likelihood that you have anemia with chronic kidney disease. For instance, one 2020 meta-analysis of 28 studies found that female patients with kidney disease were 36% more likely to develop anemia.

Rheumatoid arthritis: Anemia is common in people with rheumatoid arthritis (RA), an autoimmune disease that causes joint inflammation. Estimates of how many people have both conditions vary widely, but falls within 30-60%.

Anemia can often be treated and managed with supplements, lifestyle interventions, and medications. Treating it early can also improve energy levels, allow you to be more active, and improve your overall quality of life—especially if you have mild or moderate anemia.

However, some types of anemia can be severe, long-lasting, and even fatal. If left untreated, some types of anemia can cause multi-organ failure and eventually lead to death.

Talk to your healthcare provider if you think you may have anemia. People who receive prompt and appropriate treatment can often live long and healthy lives.

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Read the original article on Health.