Anemia

Anemia is a condition in which you don't have enough healthy red blood cells to carry adequate oxygen to your tissues. If you have anemia, you probably feel tired a lot.

There are many forms of anemia, each with its own cause. Anemia can be temporary or long term, and it can range from mild to severe.

See your doctor if you suspect you have anemia, because anemia can be a sign of serious illnesses. Treatments for anemia range from taking supplements to undergoing medical procedures. You may be able to prevent some types of anemia by eating a healthy, varied diet.

Symptoms

Signs and symptoms vary depending on the cause of your anemia, but may include:

• Fatigue
• Pale skin
• A fast or irregular heartbeat
• Shortness of breath
• Chest pain
• Dizziness
• Cognitive problems
• Cold hands and feet
• Headache

Initially, anemia can be so mild it goes unnoticed. But signs and symptoms increase as anemia worsens.

When to see a doctor

See your doctor if you're feeling fatigued for unexplained reasons, especially if you're at risk of anemia. Some anemias, such as iron deficiency anemia, are common. But don't assume that if you're tired, you must be anemic. Fatigue has many causes besides anemia.

Some people learn that their hemoglobin is low, which indicates anemia, when they go to donate blood. Low hemoglobin may be a temporary problem remedied by eating more iron-rich foods or taking a multivitamin containing iron. However, it may also be a warning sign of blood loss in your body that may be causing you to be deficient in iron. If you're told that you can't donate blood because of low hemoglobin, see your doctor.

Causes

Blood consists of a liquid called plasma and cells. Floating within the plasma are three types of blood cells:

• White blood cells (leukocytes). These blood cells fight infection.
• Platelets. These blood cells help your blood clot after a cut.
• Red blood cells (erythrocytes). These blood cells carry oxygen from your lungs, via your bloodstream, to your brain and the other organs and tissues. Your body needs a supply of oxygenated blood to function. Oxygenated blood helps give your body its energy and your skin a healthy glow.

Red blood cells contain hemoglobin — a red, 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 so that it can be exhaled.

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

Causes of common types of anemial

When you're anemic, your body produces too few healthy red blood cells, loses too many of them or destroys them faster than they can be replaced. Common types of anemia and their causes include:

• Iron deficiency anemia. This common form of anemia affects about 1 to 2 percent of adults in the United States. The cause is a shortage of the element 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. The result is iron deficiency anemia.
• Vitamin deficiency anemias. In addition to iron, your body needs folate and vitamin B-12 to produce sufficient numbers of healthy red blood cells. A diet lacking in these and other key nutrients can cause decreased red blood cell production. Additionally, some people are unable to effectively absorb B-12.
• Anemia of chronic disease. Certain chronic diseases — such as cancer, HIV/AIDS, rheumatoid arthritis, Crohn's disease and other chronic inflammatory diseases — can interfere with the production of red blood cells, resulting in chronic anemia. Kidney failure also can be a cause of anemia.
• Aplastic anemia. This very rare, life-threatening anemia is caused by a decrease in the bone marrow's ability to produce all three types of blood cells — red blood cells, white blood cells and platelets. Many times, the cause of aplastic anemia is unknown, but it's believed to often be an autoimmune disease.
• Anemias associated with bone marrow disease. A variety of diseases, such as leukemia and myelodysplasia, a preleukemic condition, can cause anemia by affecting blood production in your bone marrow. The effects of these types of cancer and cancer-like disorders vary from a mild alteration in blood production to a complete, life-threatening shutdown of the blood-making process. Other cancers of the blood or bone marrow, such as multiple myeloma, myeloproliferative disorders and lymphoma, can also cause anemia.
• Hemolytic anemias. This group of anemias develops when red blood cells are destroyed faster than bone marrow can replace them. Certain blood diseases can cause increased red blood cell destruction. Autoimmune disorders can cause your body to produce antibodies to red blood cells, destroying them prematurely. Certain medications, such as some antibiotics used to treat infections, also can break down red blood cells.
• Sickle cell anemia. This inherited and sometimes serious anemia, which more commonly affects people of African, Arabic and Mediterranean descent, is caused by a defective form of hemoglobin that forces red blood cells to assume an abnormal crescent (sickle) shape. These irregular-shaped red blood cells die prematurely, resulting in a chronic shortage of red blood cells.
• Other anemias. There are several other, rarer forms of anemia, such as thalassemia and anemias caused by defective hemoglobin.

Risk factors

These factors place you at increased risk of anemia:

• Poor diet. Anyone — young or old — whose diet is consistently low in iron and vitamins, especially folate, is at risk of anemia. Your body needs iron, protein and vitamins to produce sufficient numbers of red blood cells.
• 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. Surgical removal of or surgery to the parts of your small intestine where nutrients are absorbed can lead to nutrient deficiencies and anemia.
• Menstruation. In general, women are at greater risk of iron deficiency anemia than are men. That's because women lose blood — and with it, iron — each month during menstruation.
• Pregnancy. If you're pregnant, you're at an increased risk of iron deficiency anemia because your iron stores have to serve your increased blood volume as well as be a source of hemoglobin for your growing fetus.
• Chronic conditions. For example, if you have cancer, kidney or liver failure, or another chronic condition, you may be at risk of what's called 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 may be at increased risk of the condition.

Other factors
Certain infections, blood diseases and autoimmune disorders, exposure to toxic chemicals, and the use of some medications can affect red blood cell production and lead to anemia.

Other people at risk of anemia are people with diabetes, people who are dependent on alcohol (alcohol interferes with the absorption of nutrients) and people who adhere to a strict vegetarian diet, who may not get enough iron or vitamin B-12 in their diet.

Complications

Left untreated, anemia can cause numerous complications, such as:

• Severe fatigue. When anemia is severe enough, you may be so tired that you can't complete everyday tasks. You may be too exhausted to work or play.
• Heart problems. Anemia can lead to a rapid or irregular heartbeat — an arrhythmia. Your heart must pump more blood to compensate for the lack of oxygen in the blood when you're anemic. This can even lead to congestive heart failure.
• Nerve damage. Vitamin B-12 is essential not only for healthy red blood cell production, but also for healthy nerve function.
• Impaired mental function. A shortage of vitamin B-12 can also affect your mental abilities.
• Death. Some inherited anemias, such as sickle cell anemia, can be serious and lead to life-threatening complications. Losing a lot of blood quickly results in acute, severe anemia and can be fatal.

Preparing for your appointment

You're likely to start by first seeing your family doctor or a general practitioner. However, if you have a type of anemia that requires more complex treatment, such as aplastic anemia or anemia caused by other diseases, you may be referred to a doctor who specializes in blood disorders (hematologist).

Because appointments can be brief and there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements that you're taking to show your doctor.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your appointment. List your questions from most important to least important in case time runs out. For anemia, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Are there other possible causes for my symptoms?
• What kinds of tests do I need?
• Is my anemia likely temporary or chronic?
• What treatments are available? What are the possible side effects of each?
• What treatment do you recommend?
• I have these other health conditions. How can I best manage them together?
• Are there any dietary restrictions that I need to follow?
• Are there foods I need to add to my diet? How often do I need to eat these foods?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous, or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

What you can do in the meantime If you're not already doing so, start eating a balanced diet that contains a variety of nutrients, especially iron, folate and vitamin B-12.

Tests and diagnosis

Doctors diagnose anemia with the help of a medical history, a physical exam and blood tests, including a complete blood count (CBC). This blood test measures levels of the red blood cells contained in the blood (hematocrit) and the hemoglobin in your blood. Normal adult hematocrit values are between 32 and 43 percent. Normal adult hemoglobin values are generally in the 11 to 15 grams per deciliter range.

Some of your red blood cells may also be examined under a microscope for:

• Size
• Shape
• Color

Doing so can help pinpoint a diagnosis. For example, in iron deficiency anemia, red blood cells are smaller and paler in color than normal. In vitamin deficiency anemias, red blood cells are enlarged and fewer in number.

Additional tests
If you receive a diagnosis of anemia, your doctor may order additional tests to determine the underlying cause. For example, iron deficiency anemia can result from chronic bleeding of known or unknown ulcers, benign polyps in the colon, colon cancer, tumors, or kidney failure. Your doctor may test for these and other conditions that may underlie the anemia.

Occasionally, it may be necessary to study a sample of your bone marrow to diagnose anemia.

Treatments and drugs

Anemia treatment depends on the cause:

• Iron deficiency anemia. This form of anemia is treated with iron supplements, which you may need to take for several months or longer. If the underlying cause of iron deficiency is loss of blood — other than from menstruation — the source of the bleeding must be located and stopped. This may involve surgery.
• Vitamin deficiency anemias. Pernicious anemia is treated with injections — often lifetime injections — of vitamin B-12. Folic acid deficiency anemia is treated with folic acid supplements.
• Anemia of chronic disease. There's no specific treatment for this type of anemia. Doctors focus on treating the underlying disease. Iron supplements and vitamins generally don't help this type of anemia. However, if symptoms become severe, a blood transfusion or injections of synthetic erythropoietin, a hormone normally produced by your kidneys, may help stimulate red blood cell production and ease fatigue.
• Aplastic anemia. Treatment for this anemia may include blood transfusions to boost levels of red blood cells. You may need a bone marrow transplant if your bone marrow is diseased and can't make healthy blood cells. You may need immune-suppressing medications to lessen your immune system's response and give the transplanted bone marrow a chance to start functioning again.
• Anemias associated with bone marrow disease. Treatment of these various diseases can range from simple medication to chemotherapy to bone marrow transplantation.

• Hemolytic anemias. Managing hemolytic anemias includes avoiding suspect medications, treating related infections and taking drugs that suppress your immune system, which may be attacking your red blood cells. Short courses of treatment with steroids, immune suppressant medications or gamma globulin can help suppress your immune system's attack on your red blood cells.

  If the condition has caused an enlarged spleen, you may need to have your spleen removed. Your spleen — a relatively small organ below your rib cage on the left side — filters out and stores defective red blood cells. Certain hemolytic anemias can cause your spleen to become enlarged with damaged red blood cells. Sometimes, the spleen contributes to hemolytic anemia by removing too many red blood cells. Depending on the severity of your anemia, a blood transfusion or plasmapheresis may be necessary. Plasmapheresis is a type of blood-filtering procedure.

• Sickle cell anemia. Treatment for this anemia may include the administration of oxygen, pain-relieving drugs, and oral and intravenous fluids to reduce pain and prevent complications. Doctors also commonly use blood transfusions, folic acid supplements and antibiotics. A bone marrow transplant may be an effective treatment in some circumstances. A cancer drug called hydroxyurea (Droxia, Hydrea) also is used to treat sickle cell anemia in adults.

Prevention

Many types of anemia can't be prevented. However, you can help avoid iron deficiency anemia and vitamin deficiency anemias by eating a healthy, varied diet, including:

• Iron. The best sources of iron are beef and other meats. Other foods rich in iron include beans, lentils, iron-fortified cereals, dark green leafy vegetables, dried fruit, peanut butter and nuts.
• Folate. This nutrient, and its synthetic form, folic acid, can be found in citrus juices and fruits, bananas, dark green leafy vegetables, legumes and fortified breads, cereals and pasta.
• Vitamin B-12. This vitamin is plentiful in meat and dairy products.
• Vitamin C. Foods containing vitamin C, such as citrus fruits, melons and berries, help increase iron absorption.

Eating plenty of iron-containing foods is particularly important for people who have high iron requirements, such as children — iron is needed during growth spurts — and pregnant and menstruating women. Adequate iron intake is also crucial for infants, strict vegetarians and long-distance runners.

Caution about iron supplements
Doctors may prescribe iron supplements or multivitamins containing iron for people with high iron requirements. But iron supplements are appropriate only when you need more iron than a balanced diet can provide. Don't assume that if you're tired, you simply need to take iron supplements. Overloading your body with iron can be dangerous.

Genetic counseling
If you have a family history of an inherited anemia, such as sickle cell anemia, talk to your doctor and possibly a genetic counselor about your risk and what risks you may pass on to your children.