Anaemia

What is anaemia?

Anaemia (also written anemia) is a condition in which the number of red blood cells (RBCs) is lowered or if there is a reduction in the level of haemoglobin in the blood.

If a person has anaemia, oxygen transportation around the body is impaired and the person becomes under-oxygenated are tires easily.

There are a few different types of anaemia:

• Aplastic anaemia – this type of anaemia is characterised by a failure of the bone marrow to produce red and white blood cells and platelets
• Haemolytic anaemia – this type of anaemia is characterised by the body destroying red blood cells faster than new ones can be produced, which can result from a range of autoimmune disorders and even from some medications
• Iron deficiency anaemia – this type of anaemia is characterised by a lack of iron, so that there is also a lack of haemoglobin – this is the most common type of anaemia
• Megaloblastic anaemia – this type of anaemia is caused by a deficiency of folic acid in the diet not enough leafy green vegetables), which makes the red blood cells become abnormally big and unable to perform their functions properly
• Pernicious anaemia – this type of anaemia is characterised by a lack of Vitamin B12 inhibiting the correct formation of red blood cells
• Sick cell anaemia – this is type of anaemia is characterised by the haemoglobin being in the abnormal shape of a sickle, instead of being healthy and round in shape

Facts about anaemia

• Severe anaemia, such as that resulting from a life-threatening injury, needs to be immediately treated by a blood transfusion
• Some types of anaemia are caused by congenital defects in the body (sickle cell and aplastic anaemia) require monitoring all through life to prevent serious ill health
• Anaemia literally means “without blood”
• While iron deficiency is the most common reason for the occurrence of anaemia, it is not the only type of anaemia

Symptoms of anaemia

General symptoms of anaemia

• Breathlessness on exertion
• Chronically tired or fatigued – this is the main symptom as there is not enough oxygen flowing to the cells of the body
• Easily bruising
• Feeling faint or dizzy
• Inability to concentrate
• Pallor (paleness of skin and looking sickly)

Further symptoms of anaemia

• Loss of sex drive
• Nervousness
• Palpitations
• Shortness of breath
• Slow healing
• Sweating
• Thirst
• Weak and fast pulse

Causes of anaemia

The most common causes of anaemia are due to:

• Deficient or abnormal haemoglobin content in the red blood cells
• Diet low in iron, folic acid or vitamin B12
• Heavy menstrual bleeding
• Lack of iron stores
• Lowered level of red blood cells

Less common reasons for anaemia are:

• Abnormally shaped red blood cells
• Blood diseases, such as leukemia
• Chronic renal (kidney) failure
• Endocrine disorders (such as low thyroid activity)
• Infections, such as from malaria

Prevention of anaemia

Some types of anaemia are unable to be prevented and should be managed with medical advice:

Non-preventable risk factors

Research shows that there are some risk factors associated with the development of anaemia that are mainly unable to be prevented:

• Age – people over 65 are more likely to have anaemia than younger people. Research shows that 40-60% of people in nursing homes who are over 85 years are more likely to have anaemia. Researchers think this is due to the gastrointestinal system not functioning as well as it did before
• Aplastic anaemia – there is no way to prevent this type of anaemia as the cause is not known. Aplastic anaemia occurs when the bone marrow fails to produce red and white blood cells and platelets
• Auto-immune problems – certain types of anaemia are thought to be caused by an auto-immune problem and current science does not know how these types of anaemia are triggered nor how to cure them (examples are, aplastic anaemia, haemolytic anaemia)
• Cancer – people with some types of cancer may becomes more at risk of developing anaemia, so blood tests should be done on a regular basis to prevent it
• Genetics – certain types of anaemia have a genetic basis, which means certain people are more liable to have this type of anaemia especially if other family members also have it too (for example, sickle cell anaemia)
• Haemolytic anaemia – this type of anaemia occurs when the red blood cells get destroyed more quickly than they can be replaced, through an autoimmune response by the body
• Heavy menstrual periods – women who have heavy blood losses each month may become more easily anaemic as their reserves of iron (and possibly haemoglobin) become quickly depleted each month and replacement may not happen rapidly enough
• Lack of folic acid – people who do not get adequate levels of folic acid in their diet (either by not eating enough foods rich in folic acid, or having a gastrointestinal disorder which prevents absorption of folic acid from food eaten), may develop anaemia
• Lack of iron – people who do not get adequate levels of iron in their diet (either by not eating enough foods rich in iron, or having a gastrointestinal disorder which prevents absorption of iron from food eaten), may develop anaemia
• Lack of vitamin B12 – people who do not get adequate levels of vitamin B12 in their diet (either by not eating enough foods rich in vitamin B12, having a gastrointestinal disorder which prevents absorption of vitamin B12 from food eaten or having a problem with intrinsic factor), may develop this type of anaemia (pernicious anaemia). Vegetarians are usually most at risk of pernicious anaemia because they may not be eating foods rich in vitamin B12
• People with stomach ulcers – these people may be at risk of anaemia if the stomach ulcer bleeds internally and this causes significant blood loss that may not be able to be replaced adequately
• Pernicious anaemia – this type of anaemia can occur when the body does not produce enough intrinsic factor in the intestines and this prevents the vitamin B12 (cyanocobalamin) from being properly absorbed. Pernicious anaemia causes the red blood cells to become large and improperly formed so that they cannot function properly. This type of anaemia can also occur when there is not enough intake of vitamin B12 (cyanocobalamin) in the diet, which can cause a deficiency
• Pregnancy – research shows that women who are pregnant have a higher risk for developing anaemia due to a nutritional deficiency. This is because the unborn child requires a lot of nutrients as does the mother to help nourish the unborn child and because the amount of blood circulating in the pregnant mother increases, which means more iron and haemoglobin are required
• Sick cell anaemia – this is a genetic disorder which causes the red blood cells to be formed in the shape of a sickle (similar to the crescent of the moon), which cannot function properly

Preventable risk factors

Some types of anaemia are generally easier to prevent through proper intake of certain foods rich in these nutrients in the diet:

• Folic acid deficiency anaemia – this type of anaemia can generally occur when there is too little folic acid in the diet which causes a deficiency and ultimately causes the red blood cells to become abnormally large and unable to function properly
• Iron deficiency anaemia – this type of anaemia can occur when there is not enough iron intake in the diet, which can cause a deficiency and ultimately causes a lack of haemoglobin, the molecule responsible for oxygen transportation throughout the blood

Complications of anaemia

There are a number of complications of anaemia, which if can cause health problems if the anaemia is left undiagnosed and is severe:

• Infections – people with the anaemia are more susceptible to getting infections from viruses and bacteria and have a harder time fighting them off
• Severe bleeding – if bleeding is severe, internal and excessive (from an accident) then death can ensue if a blood transfusion is not given and the cause of the bleeding is not treated
• Stroke – if haemoglobin is defective, it can damage the walls of the red blood vessels and this can result in narrowing or even blockages in the brain, which can lead to serious, life threatening strokes (especially in children)

Untreated anaemia can cause a number of symptoms, which while not generally life threatening, can disrupt the quality of life.

People with any of the symptoms for anaemia should make an appointment to see their doctor to be diagnosed and promptly treated.

When to see a doctor about anaemia

A doctor should be consulted if symptoms of anaemia start to occur. It is much more preferable to see a doctor as soon as symptoms start to reduce discomfort and to prevent symptoms from getting worse.

The information on the alternative-complementary treatment of anaemia should be looked at to determine if any of the simple suggestions there provide a resolution for for symptoms, especially if the anaemia has already been diagnosed as a nutrient deficiency.

A doctor will usually suggest the simple options first for anaemia.

Diagnosis of anaemia

Anaemia is normally diagnosed (confirmed) by the following:

• Medical history of symptoms – your doctor will take a complete history of duration, severity and onset of symptoms
• Blood test – a blood test will confirm if anaemia is present and can usually detect the type of anaemia too. The blood test normally includes a full blood count (of both red and white blood cells and platelets), levels of iron and haemoglobin

Further blood tests

If the first blood test cannot confirm anaemia, further blood tests may be ordered to test for other types of anaemia caused by lack of certain nutrients, such as vitamin B12 and folic acid in general.

Once anaemia is diagnosed and confirmed, then your doctor will advise on treatment options.

Conventional treatment of anaemia

Conventional treatment that is recommended for anaemia depends on the cause and the severity of the anaemia.

Blood transfusion

If the anaemia is really bad due to severe blood loss (injury, accident) and blood levels are too low, then a blood transfusion will be given to prevent death.

Oxygen therapy

Some people with severe anaemia (usually due to injury, illness or accident ) may require an oxygen mask to help them breath, if their oxygen levels are too low. This is due to a lack of of haemoglobin in the blood, which carries around the oxygen to the cells. Oxygen therapy is usually given in hospital and only used for patients with very severe anaemia.

Supplements

If the anaemia is due to a deficiency of particular nutrients, then the most common form of treatment are supplement (given in a variety of formats, depending on the type of anaemia):

• Iron injections – the mineral iron can be given by injection for people who have very low blood levels of this mineral, but in general an iron supplement is recommended for most people with low iron levels
• Vitamin B12 injections – people who cannot make enough intrinsic factor in their stomach or have very low levels of vitamin B12 will be given regular vitamin B12 injections to treat their pernicious anaemia
• Vitamin and mineral supplements – these are given when there is a general deficiency of a number of nutrients to top them up and avoid worsening of symptoms

Surgery

Some people may need surgery to stop the cause of their anaemia:

• Hysterectomy – this surgery involves partial or full removal of the uterus and ovaries and is often performed on women who are past their child bearing years and who have excessive bleeding
• Spleenectomy – this surgery involves removal of the spleen in cases of severe haemolytic anaemia

Alternative / complementary treatment of anaemia

Anyone who thinks they may have anaemia needs to have a proper diagnosis by their doctor to ensure they are getting proper treatment and use this information in conjunction and with approval of medical advice.

The following are the treatments advocated by alternative therapists:

Herbs

There are no herbs which are recommended to help treat anaemia.

Vitamins

There are a number of vitamins which are beneficial in preventing nutritional-deficiency anaemia and others which support blood function:

• B vitamin complex – a B vitamin complex is necessary to help ensure the proper function of the blood vessels and haemoglobin
• Folic acid – if a blood test confirms that folic acid levels are low, supplementation will be required to bring folic acid levels back to normal and treat the anaemia
• Vitamin B12 – pernicious anaemia is due to a deficiency of vitamin B12, so this may require injections of vitamin B12 to avoid the stomach (as intrinsic factor may also not be functioning properly)
• Vitamin C – the antioxidant vitamin C is useful to help the body absorb more of the iron and vitamin B12 in food, it also helps to enhance haemoglobin function and it also ensures folic acid is used more effectively by the body
• Vitamin E – the antioxidant vitamin E is beneficial in conjunction with vitamin C to help the body use the haemoglobin more effectively and prevent it from becoming unhealthy. Vitamin E also helps the blood becomes less sticky and may prevent stroke (which is a complication of sickle cell anaemia)

Minerals

There are a number of minerals which are beneficial in preventing nutritional-deficiency anaemia and others which support blood function:

• Iron – when blood iron levels are low, this can cause iron-deficiency anaemia, so supplementation will be required. The best forms of absorbable iron are: iron chelate, ferrous gluconate, fumarate or phosphate. Iron supplementation should not self-prescribed, but only taken when iron-deficiency anaemia has been diagnosed, as too high levels of iron can cause toxicity

Other nutrients

There are some other nutrients which are recommended to help with certain types of anaemia:

• Probiotics – such as acidophilus can help the intestinal flora become more balanced with “good” bacteria and assist with absorption of vitamin B12

Dietary modifications

For people who have been diagnosed with nutritional deficiencies, the following are recommended:

• Increase foods rich in folic acid – people who are low in this important vitamin need to increase their intake of foods rich in folic acid, such as spinach, kale, collard greens (any dark green, leafy vegetables)
• Increase foods rich in iron – people who have been diagnosed with iron deficiency anaemia need to increase their intake of foods rich in iron, such as kidneys, liver, egg yolk
• Increase foods rich in vitamin B12 – people who have been diagnosed with vitamin B12 deficiency anaemia need to increase their intake of foods rich in vitamin B12, such as mollusks, beef liver, trout, salmon
• Increase foods rich in vitamin C – people with any type of nutritional deficiency anaemia should include foods rich in vitamin C, to help their body better absorb those nutrients and reduce anaemia symptoms

Lifestyle modifications

There are no lifestyle modifications which are recommend for people with anaemia.

Alternative treatments

There are no other alternative treatments which are recommended for people with anaemia.

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with anaemia

Management of people with anaemia requires the following:

• Medication – take the medications that have been prescribed to prevent worsening of symptoms or any complications that may arise
• Reduce nutritional deficiencies – people need to eat a varied diet to ensure they have enough of all the vitamins and minerals especially and avoid anaemia due to a deficiency of nutrients
• Regular blood tests – people who have already been diagnosed with anaemia and feel the symptoms returning again, should have regular blood tests to ensure their anaemia is not longer affecting them
• Reduce doctor visits – people who have anaemia that is due to a genetic problem or auto-immune dysfunction need to see their doctor regularly to manage their condition, which while not curable, can often be managed successfully to try to ensure some good quality of life

Caring for someone with anaemia

Partner

People with a partner who has any type of anaemia can help to support their partner with the following strategies:

• Injections – a partner is often called upon to give any vitamin B12 injections that the person with anaemia may need

Friends

People with a friend who has any type of anaemia can help to support their friend with the following strategies:

• Support – just providing a good level of support and understanding for a friend with anaemia is helpful. If your friend is not always be available for social outings due to ill health, it is always good to be understanding

Parents

Parents who have a child that has any type of anaemia can help to support their child with the following strategies:

• Good diet – growing children require a varied diet with enough fresh food to help them grow healthy and strong, so ensure they have plenty of vegetables, fruit, grains, legumes and protein foods
• Regular doctor visits – children with any type of anaemia need to visit their doctor regularly to monitor their condition, especially if the anaemia is due to a genetic disorder or auto-immune problem
• Supplementation – a doctor will recommend supplementation if it is required and parents can try to monitor it so that supplements are taken regularly

References

Last reviewed and updated: 14 May 2024