Anemia is a medical condition caused when the body does not produce enough red blood cells (RBCs) to circulate throughout the body. RBC destruction or loss can also lead to anemia. People with anemia are often tired and suffer from fatigue, lightheadedness, shortness of breath, and weakness. If you are one of the about 3 million people in the US with anemia, you are not alone. Luckily, there is help.

Hemoglobin is a component of red blood cells consisting of the protein globin and the compound heme made up of iron and porphyrin pigment that provides the blood with its red coloring. It is hemoglobin that carries crucial oxygen from the lungs to the other organs and cells throughout the body. Because people with low RBC counts are also low in hemoglobin, their iron levels are typically low. That is why doctors often prescribe iron supplements for people who are anemic.

Various types of anemia exist, each with specific causes, symptoms, and treatments. Anemia can be acute and short-term or chronic and long-term. Symptoms can range from mild and barely noticeable to severe and potentially debilitating. Anemia can also signal other critical illnesses.

Women are often at a higher risk of anemia due to their monthly menstrual cycle when they lose blood and during pregnancy. Some medications and medical treatments can also hinder red blood cell counts.

Symptoms of Anemia

In mild cases of anemia, symptoms may be unnoticeable or mild. As anemia worsens, so do the symptoms. When anemia is present with another medical condition, the symptoms of that issue can mask those of anemia, causing it to be overlooked. Blood analysis is crucial to determine if anemia is present.

The most common symptoms of anemia, especially iron deficiency anemia, include:

• Fatigue
• Irregular heartbeat
• Chest pain
• Headaches
• Increased thirst
• Lightheadedness or dizziness
• Pale or yellowish skin
• Sweating
• Shortness of breath
• Cold feet and hands
• Lower leg cramps
• Brittle nails
• Pulsatile tinnitus

Causes

The causes of anemia can be as different as the types. Aging is a contributing factor, as is family history. We examine the most common causes below:

• Blood loss

Often the cause of iron-deficiency anemia, blood loss can be acute, such as due to trauma, childbirth, or surgery, or chronic, such as cancer, tumors, endometriosis, or stomach ulcers. Heavy menstruation, anti-inflammatory drugs such as ibuprofen and aspirin, gastritis, or hemorrhoids can also cause blood loss. When the body loses blood, water from the tissues is drawn into the blood vessels to keep them full, further diluting the blood and reducing the red blood cell count.

• Bad nutrition

A diet lacking vitamin C, B vitamins, and iron can lead to anemia.

• Bone marrow problems

Bone marrow is the source of red blood cell production, where stem cells develop into red and white blood cells and platelets. Leukemia can trigger increased white blood cell production that interferes with RBC production. Aplastic anemia and thalassemia are other conditions that impact bone marrow.

• Problems with the small intestine or stomach

Conditions such as inflammatory bowel disease (IBD) and celiac disease can inhibit the small intestine and stomach absorption of vital nutrients, including vitamin B12. When that happens, the body does not receive crucial vitamins to help with blood cell production.

• Hormonal problems

Different hormonal changes can increase the risk of anemia, for example, pregnancy and heavy menstrual periods in women. Testosterone is a hormone that stimulates red blood cell production in bone marrow in males and females. Find out if there is a connection between anemia and testosterone causing you problems.

• Chronic health conditions and autoimmune disorders

Various autoimmune conditions can cause problems for red blood cells by destroying them long before their 120-day life cycle is complete. Kidney disease, IBD, rheumatoid arthritis, cancer, systemic lupus, erythematosus, HIV/AIDS, hepatitis B or C, and celiac disease can contribute to anemia.

• Inheritance 

Inherited conditions such as sickle cell anemia, hemolytic anemia, or thalassemia can lead to anemia.

• Infections

Chronic infections such as endocarditis, lung abscess, or tuberculosis can increase anemia risk.

Types of Anemia

There are different types of anemia, some from nutritional causes, inherited issues, specific medical conditions, or abnormal red blood cell production or function. The most common are listed below:

• Iron deficiency anemia

As the most common type of anemia that occurs when the body does not produce enough iron-rich red blood cells, this form may come from various reasons, including:

• Low dietary iron consumption
• Frequent blood donation
• Heavy menstruation or internal bleeding
• Digestive conditions such as Crohn’s disease and celiac disease interfere with nutrient absorption in the stomach or small intestines
• Endurance training
• Kidney failure
• Surgery that removed part of the intestines or stomach

The symptoms of iron deficiency anemia are listed in the symptoms section above.

Treatment may include dietary changes incorporating more vitamin C (increases iron absorption) and iron-rich foods, iron supplements, and identifying if excessive bleeding is present and addressing that problem.

• Vitamin deficiency anemia (pernicious anemia or megaloblastic anemia)

A shortage of vitamin B12 and folate necessary for RBC production can lead to this type of anemia. With pernicious anemia, the body cannot absorb vitamin B12, and with megaloblastic anemia, the body does not get enough of these two vitamins. The symptoms associated with vitamin deficiency anemia are slightly different than iron deficiency anemia and include the following:

• Vision problems
• Trouble walking
• Diarrhea
• Forgetfulness
• Confusion
• Smooth, red tongue (glossitis)

Treatment may include vitamin B12 injections or supplements and consuming vitamin B12 foods, such as fish, meat, dairy, eggs, and items fortified with vitamin B12.

• Sickle cell anemia

With this inherited condition, red blood cells take on a crescent moon or sickle shape, becoming sticky and rigid and unable to move through the bloodstream. Symptoms typically appear around six months of age and may include:

• Fatigue
• Pain
• Frequent infections
• Vision problems
• Swelling in the feet and hands
• Delayed growth or puberty

Treatment cannot cure the condition but can help reduce complications and relieve pain, and may include intravenous fluids, oxygen therapy, antibiotics, pain relief medications, blood transfusions, folic acid supplements, or the cancer drug hydroxyurea.

• Thalassemia

With this condition, the body has less hemoglobin due to DNA cell mutations, and thalassemia is often detected at birth or during the first two years of life. Thalassemia can increase infection risk and cause too much iron in the body. Symptoms include:

• Weakness
• Fatigue
• Facial bone deformities
• Yellow or pale skin
• Abdominal swelling
• Dark urine
• Slow growth

Treatment options include iron chelation, folic acid supplements, and possible bone marrow transplants or blood transfusions.

• Aplastic anemia

A rare acquired or inherited blood condition that occurs when bone marrow cannot meet the body’s demand for red blood cells, aplastic anemia often results from a stem cell-damaging autoimmune disease. Chemotherapy, radiation, toxin exposure, and certain medicines can contribute to this risk. Because this type of anemia begins in the bone marrow, the body also does not produce enough platelets (blood-clotting cells) and white blood cells (which fight off infections). Symptoms include:

• Fatigue
• Skin rashes
• More frequent infections
• Increased bruising

Treatment may include bone marrow transplants, medicines, lifestyle changes, or blood transfusions.

• Hemolytic anemia

In this type of anemia, the RBCs break down or die faster than the body can produce new cells. Hemolytic anemia can stem from problems with bone marrow, infections, autoimmune diseases, and inherited conditions such as thalassemia and sickle cell disease. Another form, autoimmune hemolytic anemia, occurs when the immune system attacks the red blood cells. Symptoms include:

• Jaundice
• Dizziness
• Dark urine
• Weakness
• Abdominal pain
• Fever

Treatment may include drugs that suppress the immune system, infection treatments, blood filtering (plasmapheresis), lifestyle changes, surgery, or blood transfusions.

Some anemias are specifically linked to certain other conditions, such as:

• Macrocytic anemia

In this type of anemia, the bone marrow produces abnormally large RBCs that do not contain the necessary nutrients for their functions. Megaloblastic macrocytic anemia can come from vitamin B12 and folate deficiency, and non-megaloblastic macrocytic anemia may come from medical conditions such as hypothyroidism, myelodysplastic syndrome, or alcohol use disorder that can affect nutrient absorption.

• Microcytic anemia

The opposite of macrocytic anemia’s large RBCs is microcytic anemia’s small red blood cells that lack adequate hemoglobin. Along with other types of anemia leading to this one, lead poisoning can also cause smaller RBCs.

Treatment of microcytic anemia focuses on identifying the cause and proceeding with that treatment.

• Anemias linked to bone marrow disease

These anemias, linked to conditions such as myelofibrosis or leukemia, influence bone marrow production of red blood cells.

• Anemia of inflammation 

Conditions such as kidney disease, rheumatoid arthritis, Crohn’s disease, cancer, and HIV/AIDS can increase inflammation in the body and inhibit red blood cell production.

Conclusion

Anemia can stem from many causes, and the treatment depends on the type and severity of the anemia. Vitamins and iron supplements may help, but should only be used under doctor supervision, especially if you are taking any prescription medications, have health issues, or are under treatment for other conditions.

Dietary changes that incorporate more iron-rich foods into your life may help. Get input from your doctor before adjusting what you usually eat. Foods high in iron include meat, dark leafy greens, nuts, seeds, fish, eggs, tofu, dried fruits, brown rice, and iron-fortified bread and cereal.

A thorough physical examination can help determine if other health issues are contributing to anemia, and if so, undergoing the necessary treatment can help improve red blood cell production. Contact a doctor if you frequently feel tired or weak or have any of the other symptoms mentioned.