Anemia – Causes, Symptoms, Treatments

What is Anemia?

Anemia is a medical condition characterized by a deficiency in the number or quality of red blood cells or hemoglobin in the blood. Hemoglobin is an essential protein found in red blood cells that binds to oxygen in the lungs and carries it to various tissues and organs throughout the body. When there is a shortage of red blood cells or hemoglobin, the body’s tissues and organs may not receive an adequate supply of oxygen, leading to a range of symptoms and potential complications.

Causes and Types of Anemia

There are several types of anemia, each with its own causes and characteristics. The most common type is iron deficiency anemia, which occurs when the body doesn’t have enough iron to produce an adequate amount of hemoglobin. Iron deficiency can result from insufficient dietary intake of iron, poor absorption of iron from the diet, blood loss due to menstruation or internal bleeding, or increased iron requirements during pregnancy.

Another type of anemia is vitamin deficiency anemia, which can be caused by a lack of essential vitamins such as vitamin B12 or folate. Vitamin B12 is necessary for red blood cell production. People with a restricted diet (e.g. vegans) or those with digestive issues that hinder B12 absorption can develop this deficiency. Folate, another B vitamin, is crucial for red blood cell formation. Poor dietary intake, certain medications, or digestive problems can cause folate deficiency.

Anemia can also be associated with chronic diseases such as cancer, chronic kidney disease, autoimmune disorders, or inflammatory conditions. In these cases, the underlying disease process can interfere with the body’s ability to produce red blood cells or lead to increased destruction of red blood cells, resulting in anemia. Diseases that affect the bone marrow, such as aplastic anemia or myelodysplasia, can also hinder the production of red blood cells.

Anemia can also develop due to blood loss. For example heavy menstrual bleeding is a common cause of iron deficiency anemia in women. Gastrointestinal bleeding via ulcers, stomach or intestinal cancers, and hemorrhoids can cause chronic blood loss, leading to anemia. Other forms of blood loss via acute blood loss from accidents, surgery, or frequent blood donations can also contribute to anemia.

Additionally, inherited blood disorders like sickle cell anemia can run in families.

How Age and Pregnancy Increase Susceptibility to Anemia

Age plays a significant role in susceptibility to anemia. Infants, young children, and older adults are more susceptible to anemia. Newborns are born with iron stores from their mothers, but these stores deplete within the first 6 months. Infants need iron for rapid growth and development, and if they don’t get enough iron from breastmilk or formula supplemented with iron, they can become iron deficient and develop anemia. Once infants start eating solid foods, they may not consume enough iron-rich options like fortified cereals, meat, or beans. This can contribute to iron deficiency anemia.

Young children can be picky eaters, and if they avoid iron-rich foods, they are at risk of iron deficiency anemia. Also, similar to infants, young children are going through a period of rapid growth, which also increases their iron needs.

Older adults are more likely to have chronic health conditions that can contribute to anemia. These include conditions that cause blood loss (like ulcers or hemorrhoids), nutritional deficiencies (vitamin B12 or folate), or problems with red blood cell production (bone marrow disorders).

As we age, our bodies become less efficient at absorbing iron from food. This can lead to iron deficiency anemia in older adults. Older adults may also eat less due to changes in appetite or difficulty preparing meals. This can make it harder to get the nutrients they need, including iron and vitamins B12 and folate.

Pregnant women are also more susceptible to anemia for a couple of key reasons. During pregnancy, your body’s blood volume increases by about 20-30% to support the growing baby. This rapid expansion dilutes the concentration of red blood cells, even if the total number stays the same. Since red blood cells carry oxygen, this dilution can lead to anemia if the body isn’t producing enough new red blood cells to compensate.

On top of the blood volume increase, pregnancy puts a greater demand on iron stores. Iron is a crucial mineral for producing hemoglobin, the protein in red blood cells that carries oxygen. The developing baby also needs iron for its own growth. If a pregnant woman doesn’t have sufficient iron stores or doesn’t consume enough iron-rich foods, she can become iron deficient and develop anemia.

Symptoms of Anemia

Anemia symptoms can vary depending on the cause and severity, but some common ones point towards a lack of oxygen reaching your body’s tissues. Here’s a detailed breakdown of the frequent signs to watch out for:

General Fatigue and Weakness is the most prevalent symptom of anemia. People with anemia often experience persistent tiredness and weakness, even after getting enough sleep. This fatigue can significantly impact daily activities and leave you feeling drained.

Pale Skin, mucous membranes, and nails are another visible symptom. Reduced red blood cells mean less oxygen is delivered throughout the body. This can cause a noticeable paleness in your skin, especially on the face, inner eyelids (palpebral conjunctiva), and underneath your fingernails.

Shortness of breath is another important signal. As your body struggles to deliver oxygen to your tissues, you might experience shortness of breath, particularly during physical activity. This shortness of breath can even occur at rest in severe cases.

Dizziness and lightheadedness often occur when your brain isn’t receiving enough oxygen, you might feel dizzy or lightheaded. This can be especially noticeable when standing up from a seated position (orthostatic hypotension).

Headaches are another frequent symptom of anemia. The exact reason remains unclear, but it’s likely linked to reduced oxygen flow or changes in blood vessel function.

Cold Hands and Feet are another sign often reported by individuals with anemia.Typically, in an attempt to conserve heat and maintain core body temperature, your body might constrict blood vessels in the extremities, leading to cold hands and feet.

Severe or untreated anemia may cause chest pain (angina) or discomfort, particularly during physical activity. This symptom arises because the heart may not be receiving enough oxygen to meet its needs, leading to cardiac strain.

In some cases, anemia can lead to palpitations or an irregular heartbeat. This occurs because the heart may need to work harder to compensate for the decreased oxygen-carrying capacity of the blood.

Chronic or severe anemia can lead to generalized weakness, decreased concentration, and cognitive impairment. These symptoms occur due to the reduced oxygen supply to the body’s tissues and organs, including the brain.

Other Potential Symptoms:

• Brittle Nails: Nails may become brittle, develop ridges, or even spoon-shaped (concave).
• Sore or Inflamed Tongue (Glossitis): The tongue can become smooth, inflamed, and painful.
• Mouth Ulcers: Canker sores or mouth ulcers may develop.
• Hair Loss: Hair loss can occur due to impaired hair follicle function from lack of oxygen.
• Loss of Appetite: You might experience a reduced desire to eat.
• Restless Legs Syndrome: This condition can cause an uncontrollable urge to move your legs, especially at night, disrupting sleep.
• Pica (Craving to Eat Non-Food Items): In some cases, people with anemia may develop cravings for unusual or non-food items like ice, dirt, or paper.

Additional Considerations in Women and Children:

• Heavy Menstrual Periods: For women, heavy menstrual bleeding can be a significant contributor to iron deficiency anemia.
• Developmental Delays in Children: Children with anemia might experience delays in growth and development.

Potential Long Term Complications of Anemia

Untreated anemia, especially if severe, can lead to various long-term complications. Due to insufficient oxygen reaching tissues, the heart has to work harder to pump more blood throughout the body to compensate. This can eventually lead to heart enlargement and weaken the heart muscle, causing high output heart failure. Anemia can also disrupt the electrical signals in your heart, leading to irregular heartbeats (arrhythmias).

Other organs and bodily functions may also be at risk. Chronic oxygen deprivation can affect brain function, potentially leading to problems with memory, concentration, and mood. Anemia can weaken your immune system, making you more susceptible to infections.

If anemia stems from an underlying chronic condition like kidney disease, uncontrolled anemia can worsen the existing condition and accelerate its progression. Anemia during pregnancy can increase the risk of premature birth, low birth weight, and health problems for both mother and baby.

Persons may also develop Restless legs syndrome. This condition causes an uncontrollable urge to move your legs, especially at night, disrupting sleep and overall well-being.

Persistent fatigue and weakness associated with anemia can significantly impact your daily activities, work performance, and overall quality of life. The associated shortness of breath, can make it difficult to engage in physical activities, further restricting your lifestyle.

How is Anemia Diagnosed?

Diagnosis of anemia typically involves a thorough medical history, physical examination, and blood tests to measure the levels of hemoglobin, red blood cells, and other parameters. Additional tests may be performed to determine the underlying cause of the anemia, such as tests for iron levels, vitamin B12, or folate levels, and investigations to identify any underlying chronic diseases or conditions.

Your doctor will inquire about your symptoms, including their onset, severity, and any aggravating or relieving factors. They will also ask about your diet, medications, family history of anemia or blood disorders, and potential causes of blood loss (heavy menstrual periods, recent injuries or surgeries).

The doctor will perform a physical exam to look for signs of anemia, such as: Pale skin, mucous membranes or nail beds, rapid heartbeat (tachycardia), and, while not always present not always present can still be a sign in some anemias, enlarged spleen (splenomegaly).

Blood tests also play a crucial role in diagnosing anemia and determining its cause. 

• Complete Blood Count (CBC): This basic blood test measures various components of your blood, including red blood cell count, size, and hemoglobin concentration. Low red blood cell count or hemoglobin levels are key indicators of anemia.
• Reticulocyte Count: Reticulocytes are young red blood cells. This test helps assess your bone marrow’s red blood cell production rate. A high reticulocyte count suggests your body is trying to compensate for anemia, while a low count might indicate impaired production.
• Iron Studies: These tests measure iron levels in your blood (serum iron) and stores (ferritin). Low iron levels suggest iron deficiency anemia.
• Vitamin B12 and Folate Levels: These tests assess levels of these essential vitamins for red blood cell production. Deficiencies can contribute to anemia.

Additional Tests (Depending on the Doctor’s Suspicion):

• Hemoglobin Electrophoresis: This test identifies abnormal types of hemoglobin, which can be present in conditions like sickle cell disease or thalassemia.
• Bone Marrow Aspiration and Biopsy: In rare cases, a doctor might recommend examining a bone marrow sample to directly assess red blood cell production and identify underlying causes like aplastic anemia.

Preventative Measures for Anemia

• Consume a balanced diet rich in iron: Include iron-rich foods in your diet like red meat, poultry, fish, beans, lentils, fortified cereals, and dark green leafy vegetables. Vitamin C aids iron absorption, so pair iron-rich foods with citrus fruits or tomatoes.
• Ensure adequate intake of Vitamin B12 and folate: Focus on incorporating foods rich in vitamin B12 like dairy products, eggs, meat, poultry, and fortified cereals. Leafy green vegetables, fruits, nuts, beans, and fortified grains are good sources of folate.

Manage chronic health conditions:

• Effectively manage existing chronic conditions: If you have a chronic illness like kidney disease or rheumatoid arthritis that can contribute to anemia, work with your doctor to manage it effectively. Good control of the underlying condition can help prevent anemia development.

Other preventive measures:

• Seek medical attention if experiencing symptoms: If you experience persistent fatigue, weakness, paleness, shortness of breath, dizziness, or other symptoms suggestive of anemia, consult a doctor for prompt diagnosis and treatment. Early intervention can prevent complications.
• Consider iron supplements (if recommended by a doctor): For individuals at high risk of iron deficiency, such as pregnant women or those with low iron stores, a doctor might recommend iron supplements. However, it’s important to avoid taking iron supplements without consulting a doctor, as excessive iron intake can be harmful.

Here are some additional tips:

• Iron-absorption inhibitors: Be mindful of certain substances that can hinder iron absorption. Coffee, tea, and calcium-rich foods can interfere with iron absorption. If you consume these, space them out from iron-rich meals.
• Regular blood tests: If you have a history of anemia or are at high risk, regular blood tests recommended by your doctor can help monitor your iron levels and identify potential problems early on.
• Maintain a healthy weight: Obesity can be a risk factor for certain types of anemia. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce the risk.

How is Anemia Treated?

There are many different types of anemia, and the treatment will depend on the underlying cause. If you have iron-deficiency anemia, your doctor may recommend eating more iron-rich foods, such as red meat, beans, lentils, and dark leafy greens. You may also need to take iron supplements, vitamin B12 supplements, or folic acid supplements.

In some cases, you may need medication to treat the underlying cause of your anemia. For example, if you have sickle cell anemia, you may need to take medication to help prevent painful episodes.

In severe cases of anemia, you may need a blood transfusion. This is a procedure in which healthy red blood cells are transfused into your bloodstream.

Most Commonly Prescribed Medications for Anemia

The most commonly prescribed medication depends on the underlying cause of the anemia. 

Iron deficiency anemia is the most common type of anemia. Iron supplements are the most common medication prescribed to treat this condition. Iron is necessary for the production of red blood cells. There are many different types of iron supplements available, and your doctor will recommend the best one for you.

Vitamin B12 and folate deficiencies can also cause anemia. Vitamin B12 and folate supplements are commonly prescribed to treat these types of anemia. Vitamin B12 and folate are necessary for the production of healthy red blood cells.

Erythropoiesis-stimulating agents (ESAs) are a group of medications that stimulate the bone marrow to produce more red blood cells. ESAs are typically used to treat anemia in people with chronic kidney disease.