Understanding Anemia. Types, Symptoms, Causes, and Treatment

Anemia occurs when the number of healthy red blood cells is low. Without enough red blood cells, there is not enough hemoglobin; an iron protein in the blood that carries oxygen throughout the body. There are several types of anemia, so it can require some investigation to determine which one is present.

What causes anemia?

Anemia has several causes. Some people are born with anemia, and others develop it at another point in their life. Anemia occurs if the body does not make enough red blood cells, loses red blood cells (usually through bleeding), or destroys red blood cells. Different types of anemia have different causes, but many are related to illness, blood loss, or diet.

Types of anemia

There are several different types of anemia, each one with its own origin:

Iron deficiency anemia - the most common type resulting from low iron. If the body does not get enough or incorrectly uses iron, it cannot make enough hemoglobin for the red blood cells.

Vitamin deficiency anemia - occurs when vitamins B12 and folate are too low to produce enough red blood cells. This may happen because some people do not absorb B12 sufficiently, or it is severely lacking in their diet. It may also be due to pernicious anemia.

Pernicious anemia - a condition that occurs due to an autoimmune response. The body's immune system attacks the stomach cells responsible for producing a substance called intrinsic factor. Without this substance, it’s impossible for the intestines to absorb vitamin B12.

Aplastic anemia - a rare, life-threatening anemia in which the body does not make enough red blood cells. There are several reasons for this, including infections, autoimmune diseases, and toxic chemical exposure among others.

Anemia of chronic disease (or anemia of inflammation) - develops due to ongoing inflammation related to a disease lasting more than three months. The inflammation decreases the body’s ability to use iron and make new red blood cells. This can happen in diseases like cancer, HIV, kidney disease, and other inflammatory conditions.

Hemolytic anemia is inherited or acquired (developed later in life) - red blood cells are destroyed faster than the body can make them. The red blood cells may develop deformed, not function properly, and die off quicker than normal.

Sickle cell anemia is genetic. Red blood cells are misshapen and can cause blockages in the blood vessels. This type is most typically found in African Americans. It is painful and requires treatment.

Who is at risk of having anemia?

Anyone can have anemia. Some people are more likely to develop it due to the increased risk factors outlined below:

  • Women have increased risk during monthly periods especially with heavy bleeding and childbirth.
  • Infants who do not receive enough iron via breastmilk or transition to solid foods.
  • People with poor dietary intake that lack iron, vitamin B12, and folate.
  • Those who suffer from ongoing illnesses that can affect red blood cells.
  • Family history of anemia may increase the risk.
  • Other issues like alcoholism, certain medications, or illness.
  • People over age 65 due to health history or diets lacking in sufficient nutrients.

Symptoms of anemia

When anemia is mild, there may not be any symptoms. Symptoms may come on gradually or suddenly depending on the cause and type of anemia and may include:

  • Weakness
  • Pale skin
  • Dizziness
  • Fainting
  • Shortness of breath
  • Tiredness or fatigue
  • Headache
  • Sore tongue
  • Irritability
  • Brittle nails
  • Abnormal cravings
  • Pagophagia - desire to eat ice
  • Pica - eating nonfood items like dirt, paper, or clay

How is anemia diagnosed?

Anemia may be diagnosed because your healthcare provider actively tests for it, or found by coincidence. Due to the gradual onset or lack of symptoms, anemia is often determined during other routine tests.

Your healthcare provider will take a complete medical history; asking questions about your family history, medical problems, and symptoms. This will also include questions about your diet and nutrition. Your provider will complete a physical exam, specifically checking your skin for color or paleness, fingernails, tongue, and other areas that show signs and causes of anemia.

Your provider will order blood tests to confirm if the symptoms you are having are from anemia. Blood tests can include:

  • Complete blood count (CBC) that shows the number, shape, and size of red blood cells, hemoglobin, and hematocrit. Normal levels vary based on age, gender, and location.
  • Serum Iron level - which is the amount of iron in the blood and the total iron binding capacity (TIBC or transferrin), a protein in the blood that moves it through the body.
  • Other tests for vitamin levels may be included such as vitamin B12 and folate.
  • Tests to determine what is causing anemia may also be considered if the cause is unknown.

Treating anemia

Treatment depends on the type of anemia, how severe it is, and the reason behind it. Mild anemia may not require treatment; it may just be necessary to manage the source. Treating the medical problems or adjusting medications that lead to it may solve the problem.

Your healthcare provider may instruct you to take dietary supplements if the blood tests show that your levels are below adequate. Adding iron when levels are low can improve iron deficiency anemia. However, this should not be taken without direction from a healthcare provider, as too much can be harmful and taking it when not needed will not fix the problem.

You may be directed to take vitamin B12 supplements or shots if B12 deficiency is the explanation for your anemia. Again, your healthcare provider will advise whether this is necessary. The same is true for folic acid and vitamin C deficiencies if diet options are inadequate.

In more severe cases, blood transfusions may be needed to replace the low red blood cells until the body can create enough. In other situations, bone marrow testing or transplants may be necessary to determine more in-depth treatments.

Can I prevent anemia?

Anemia due to inadequate nutrients can be prevented by eating foods high in iron, vitamins C, D, and B12 such as red meat, seafood, dark leafy vegetables, iron-fortified cereals, broccoli, oranges, tomatoes, and eggs. Limit the amount of cow’s milk children drink to 20 ounces daily after one year of age, as it results in decreased iron intake and absorption.

Stay well hydrated by drinking plenty of water. Exercise regularly.

Anemias that are hereditary cannot be prevented. Those that result from other diseases are hard to prevent.

Complications of anemia

If anemia is not adequately treated, it can pose a risk to your health. Additional health problems can arise including:

  • Heart problems such as irregular heartbeats, enlarged heart, or heart failure
  • Risks during pregnancy
  • Death

Contact your healthcare provider if you are concerned about symptoms of anemia. Delaying treatment could make symptoms worse or harder to diagnose and treat.

References

Medscape. Anemia

Mayo Clinic. Anemia

UpToDate. Anemia caused by low iron in adults (Beyond the Basics)

National Heart, Lung, and Blood Institute. Anemia

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