Anemia: Symptoms, Causes, Treatment

Anemia affects 1.62 billion people or 24.8% of the world’s population. 

Even though it is a common term and most people know it’s a blood-related problem, there’s a lot we still need to learn about it. 

Throughout this post, you’re going to learn about everything anemia entails, why it happens, its symptoms, treatment, and more. 

What is anemia?

Anemia is a blood disorder indicated by reduced red blood cell mass or decreased concentration of hemoglobin. An insufficient amount of healthy red blood cells decreases oxygen levels in the blood and their supply to tissues throughout the body.

Although we tend to think anemia is a single disease, the truth is there are several types of this condition. And each type has its specific causes. You will learn more about different types of anemia further in the post where we discuss the causes of this condition.

Anemia is related to increased mortality and morbidity in women and children, poor birth outcomes, reduced work productivity, and problems with behavioral and cognitive development in children. This condition can be temporary or chronic (long-term). Additionally, symptoms of anemia may range from mild to severe.

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Symptoms

Not every person with anemia has the same symptoms. The signs and symptoms depend on the type, cause, overall health, and severity. In many cases, symptoms go unnoticed due to the underlying health problem. 

While symptoms may vary from one type to another, those common to all forms of anemia include:

  • Leg cramps

  • Dizziness

  • Pale or yellowish skin

  • Difficulty concentrating 

  • Headache or shortness of breath, particularly after exercise

  • Rapid heart rate, especially after exercise 

  • Chest pain

  • Cold hands and feet

In some cases, anemia symptoms are mild and unnoticeable, but the symptoms become more pronounced as the condition worsens. 

Causes

Anemia occurs when the body has insufficient amounts of red blood cells. We need red blood cells to survive. These tiny cells transport hemoglobin, a type of protein that binds to molecules of iron. 

Moreover, the importance of these molecules is immense as they carry oxygen from the lungs to all other parts of your body. The reasons for the reduced presence of red blood cells are numerous, so we have several types of anemia. 

Below, you can take a look at different types and the causes behind them:

Iron deficiency anemia 

This occurs when the body doesn’t have enough iron levels to make hemoglobin. Low iron in the body can occur due to insufficient consumption through diet, blood loss, pregnancy, and inability to absorb iron due to intestinal disorders such as celiac disease. This type of anemia is associated with chronic kidney disease too.

Vitamin deficiency anemia 

This develops due to a shortage of vitamins the body needs to produce red blood cells. These vitamins are vitamin B12, folate (a form of vitamin B), and vitamin C. Vitamin B12 deficiency anemia is pernicious anemia. 

Factors that exacerbate the development of these types of anemia, besides inadequate diet, include alcoholism, pregnancy, prescription medications such as anti-seizure drugs and antacids, and intestinal problems.

Aplastic anemia 

This results from damage to stem cells in the bone marrow. The stem cells produce blood cells, including red and white blood cells. The most common culprit for aplastic anemia is that the immune system starts attacking stem cells. 

This type of anemia can also occur due to radiation and chemotherapy, pregnancy, viral infection such as hepatitis, parvovirus B19, HIV, Epstein-Barr, and cytomegalovirus. Autoimmune disorders, certain medications, exposure to toxic chemicals can also cause aplastic anemia.

Macrocytic anemia 

This happens due to abnormally large red blood cells that outnumber healthy red blood cells. A common form of anemia is megaloblastic anemia, where the bone marrow produces unusually massive and structurally abnormal red blood cells or megaloblasts.

Sickle cell anemia 

This occurs due to a mutation in the gene that instructs the body to produce hemoglobin. Abnormal hemoglobin in sickle cell anemia affects the function and appearance of red blood cells. They become rigid, misshapen, and sticky.

Thalassemia 

This happens due to mutation in the DNA of hemoglobin-producing cells. These mutations are passed to children from parents.

Hemolytic anemia 

This occurs when red blood cells are destroyed at a faster rate than they are made. Destruction of these cells is called hemolysis. This type of anemia can be inherited (hereditary spherocytosis) or acquired. 

Factors that contribute to acquired hemolytic anemia include viral or bacterial infections include some medications, blood cancer, certain tumors, mechanical heart valves, or severe reaction to blood transfusion. Autoimmune hemolytic anemia is also possible due to autoimmune conditions such as lupus, ulcerative colitis, and rheumatoid arthritis.

Risk Factors

Even though everyone is at risk, some people are more likely to develop this condition than others. Factors that make you more likely to develop anemia or fewer red blood cells include:

Age 

Like many other health problems, the risk of anemia increases with age. People older than 65 are generally more likely to have anemia.

Family history 

Persons with a family history of inherited anemia like sickle cell anemia are more likely to develop this health problem.

Insufficient intake of certain nutrients

Low consumption of vitamin B12 and iron puts you at a greater risk of anemia.

Menstruation 

Since menstruation leads to the loss of red blood cells, it may contribute to the development of anemia.

Intestinal problems 

Celiac disease, Crohn’s disease, and other intestinal disorders that impair absorption of nutrients in the small intestine can make a person anemic.

Chronic health problems 

Diabetes, kidney disease or failure, cancer, and other chronic health problems increase anemia risk because they may deplete the concentration of red blood cells.

Pregnancy 

Pregnant women who aren’t taking their multivitamins, including iron and folic acid, are more likely to become anemic. Besides the abovementioned, other risk factors make you more likely to develop anemia. For instance, you have a higher chance of becoming anemic if you have a history of some infections, autoimmune disorders, and blood diseases. 

Additionally, people who take medications that affect the production of red blood cells are at a higher risk of anemia as well. Other factors include exposure to toxic chemicals. Alcoholism can also affect red blood cells and contribute to anemia. 

When to see a doctor

Most people often don’t realize they have anemia. That’s why you should schedule an appointment to see the doctor if you have unexplained fatigue that isn’t going away. Keep in mind fatigue doesn’t necessarily mean you have anemia. Multiple causes lead to fatigue. 

But the doctor will carry out necessary tests to diagnose the culprit behind fatigue, and one of those culprits is anemia. You should also consult your doctor if you don’t obtain enough iron or vitamin B12 through diet or your menstruation is very heavy. You may also want to see a doctor if you are concerned about exposure to chemicals, have family members with hereditary anemia, or have symptoms of an ulcer, hemorrhoids, gastritis, colorectal cancer, and tarry or bloody stools. 

Diagnosis

Once you see the doctor, you should describe all symptoms you’re experiencing, even if you think they are insignificant. The doctor will ask questions about family and medical history. 

Since symptoms of anemia aren’t specific to this condition only, the doctor will order some tests to rule out other conditions. 

Diagnostic tests include:

Complete blood count (CBC) 

This test counts the number of blood cells in a blood sample. The doctor will put a strong emphasis on hematocrit or red blood cells and hemoglobin levels. 

Healthy hematocrit values range between 35% and 47% for women and 40% and 52% for men. Normal values of hemoglobin are between 12 and 16 for women and 14-18g for men.

Size and shape of red blood cells 

The doctor may order a test to examine the size and shape of red blood cells to detect irregularities and inconsistencies. The abovementioned tests are standard for the diagnosis of anemia. 

But your doctor may order other tests, including iron profile and serum ferritin level, reticulocyte count, thyroid function tests, abdominal sonogram, bone marrow aspiration, or sample.

Treatment

Treatment of anemia depends on the underlying cause. So, the doctor will recommend the most suitable treatment approach once they establish the cause behind it. That means not all cases of anemia have the same course of management.

Treatment of iron deficiency anemia revolves around taking iron supplements or modifying your diet. If a patient has iron deficiency anemia due to blood loss that isn’t related to menstruation, it is necessary to uncover the cause of bleeding and manage it. Management often involves surgery.

On the other hand, treatment of anemia linked to vitamin deficiency requires taking supplements to compensate for the missing vitamins. However, people with intestinal disorders that impair absorption of certain nutrients may need injections.

Treatment for sickle cell anemia may include pain relievers, oxygen, and administration of oral and intravenous fluids to prevent complications and alleviate pain. Folic acid supplements, blood transfusion, and antibiotics may also be necessary. 

Other causes of anemia and treatments include:

Chronic disease-related anemia 

Treatment of the underlying cause is the best approach to address anemia caused by a specific chronic health problem. 

In case of severe symptoms, a patient may need a blood transfusion or erythropoietin injections to reduce fatigue and promote the production of red blood cells.

Bone marrow-related anemia 

Treatment revolves around medications, bone marrow transplant, and chemotherapy.

Aplastic anemia 

Treating this involves blood transfusion or, in some cases, bone marrow transplant.

Hemolytic anemia 

Treatment includes managing infections and taking medications that suppress the immune system, thereby preventing it from attacking red blood cells. Patients may also need to change medications and take the alternatives that don’t contribute to this condition.

Thalassemia 

This usually doesn’t require treatment in mild anemia forms. More severe cases call for blood transfusion, medications, folic acid supplements. Some patients may need bone marrow stem cell transplant and removal of the spleen.

Since iron supplement pills are an important aspect of treating nutritional anemias, it is important to mention time-release products are not a good choice. Keep in mind that iron is primarily absorbed in the upper digestive tract, so time-release iron pills can’t do much. During the treatment, you will have to go to checkups regularly so the doctor can order blood tests and analyze the progress.

Lifestyle Modifcations

Besides the doctor-recommended treatment approaches, lifestyle modifications are also necessary. 

These include:

  • Eat a well-balanced diet

  • Write down all symptoms you have to keep track 

  • Stay hydrated by drinking enough water

  • Wash hands often to avoid infection

  • Exercise regularly, but if you are weak, do so with caution

  • Avoid or reduce exposure to chemicals that may worsen your anemia

  • Take good care of your teeth and gums

Complications

Anemia is a health problem that leads to serious complications if left untreated or unmanaged properly. Potential complications include heart problems, severe fatigue, pregnancy complications, and even death. According to the CDC, there were 1.6 deaths per 100.000 people due to anemia in 2019.

Complications are down to your heart’s need to pump more blood to compensate for the lack of oxygen. A chain of reactions occurs that starts with a weakened heart and other functions. Fortunately, anemia is a largely treatable and manageable condition. That’s why it’s so important to see the doctor and start with the treatment. 

Prevention

Not all types of anemia are preventable. Most of them are, though. 

These tips can help you lower the odds of developing anemia:

  • Make sure your diet delivers enough vitamin B12 and folic acid.

  • Consume plenty of iron-rich foods such as lean red meat, beans, green and leafy vegetables.

  • Try not to drink coffee or tea with your meals. They can affect the absorption of iron.

  • Get enough vitamin C.

  • Consult a doctor about taking dietary supplements if you are vegan or vegetarian.

  • Make sure to follow all safety guidelines and regulations if you are exposed to toxic chemicals in the workplace.

  • Consult public health authorities or your doctor regarding getting eating utensils and dishes tested for lead.

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Conclusion

Anemia is a condition where the body doesn’t have enough hemoglobin or red blood cells. When left untreated, it can have serious consequences, including death. Fortunately, many cases of anemia are preventable and treatable. 

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Sources

  1. Coyer SM. Anemia: diagnosis and management. J Pediatr Health Care. 2005. https://pubmed.ncbi.nlm.nih.gov/16286225/ 
  2. Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Ann N Y Acad Sci. 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697587/ 
  3. Freeman AM, Rai M, Morando DW. Anemia Screening. [Updated 2021 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. https://www.ncbi.nlm.nih.gov/books/NBK499905/
Alternative Text

Dr. Ahmed Zayed

Dr. Ahmed Zayed holds a baccalaureate of Medicine and Surgery. He has completed his degree at the University of Alexandria, Egypt. Founder of ZayedMD, Dr. Ahmed believes in making the knowledge as accessible as possible to patients. He had his work featured in reputable publications such as The Huffington Post. Other than his passion for writing, Dr. Ahmed spends​ his time outside the hospital at the gym or with a good book.

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