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Anemia
Reviewed by Sabrina Felson, MD on August 11, 2020

What Is Anemia?

Anemia is defined as a low number of red blood cells. In a

routine blood test, anemia is reported as a low
hemoglobin or hematocrit. Hemoglobin is the main
protein in your red blood cells. It carries oxygen, and
delivers it throughout your body. If you have anemia,
your hemoglobin level will be low too. If it is low enough,
your tissues or organs may not get enough oxygen.
Symptoms of anemia -- like fatigue or shortness of
breath -- happen because your organs aren't getting what
they need to work the way they should.

Anemia is the most common blood condition in the U.S.

It a!ects almost 6% of the population. Women, young
children, and people with long-term diseases are more
likely to have anemia. Important things to remember are:

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Certain forms of anemia are passed down through

your genes, and infants may have it from birth.

Women are at risk of iron-deficiency anemia

because of blood loss from their periods and higher
blood supply demands during pregnancy.

Older adults have a greater risk of anemia

because they are more likely to have kidney disease
or other chronic medical conditions.

There are many types of anemia. All have di!erent causes

and treatments. Some forms -- like the mild anemia that
happens during pregnancy -- aren’t a major concern. But
some types of anemia maymay reflect a serious
underlying medical condition
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Anemia Symptoms
The signs of anemia can be so mild that you might not
even notice them. At a certain point, as your blood cells
decrease, symptoms o"en develop. Depending on the
cause of the anemia, symptoms may include:

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Dizziness, lightheadness, or feeling like you are

about to pass out

Fast or unusual heartbeat

Headache

Pain, including in your bones, chest, belly, and

joints

Problems with growth, for children and teens

Shortness of breath

Skin that’s pale or yellow

Cold hands and feet

Tiredness or weakness

Anemia Types and Causes

There are more than 400 types of anemia, and they’re
divided into three groups:

Anemia caused by blood loss

Anemia caused by decreased or faulty red blood

cell production

Anemia caused by destruction of red blood cells

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Anemia Caused by Blood Loss

You can lose red blood cells through bleeding. This can
happen slowly over a long period of time, and you might
not notice. Causes can include:

Gastrointestinal conditions such as ulcers,

hemorrhoids, gastritis (inflammation of your
stomach), and cancer

Non-steroidal anti-inflammatory drugs (NSAIDs)

such as aspirin or ibuprofen, which can cause ulcers
and gastritis

A woman’s period, especially if you have a heavy

menstruation (or heavy period). This can be
associated with fibroids.

Post-trauma or post-surgery as well.

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Anemia Caused by Decreased or Faulty Red Blood Cell

Production

With this type of anemia, your body may not create

enough blood cells, or they may not work the way they
should. This can happen because there’s something
wrong with your red blood cells or because you don’t
have enough minerals and vitamins for your red blood
cells to form normally. Conditions associated with these
causes of anemia include:

Bone marrow and stem cell problems

Iron-deficiency anemia

Sickle cell anemia

Vitamin-deficiency anemia, specifically b12 or

folate

Bone marrow and stem cell problems may keep your

body from producing enough red blood cells. Some of
the stem cells in the marrow that’s in the center of your
bones will develop into red blood cells. If there aren’t
enough stem cells, if they don’t work right, or if they’re
replaced by other cells such as cancer cells, you might get
anemia. Anemia caused by bone marrow or stem cell
problems includes:

Aplastic anemia happens when you don’t have

enough stem cells or have none at all. You might
get aplastic anemia because of your genes or
because your bone marrow was injured by
medications, radiation, chemotherapy, or infection.
Other malignancies that commonly e!ect the bone
marrow include multiple myeloma or leukemia.
Sometimes, there’s no clear cause of aplastic
anemia.

Lead poisoning. Lead is toxic to your bone marrow,

causing you to have fewer red blood cells. Lead
poisoning can happen when adults come into
contact with lead at work, for example, or if
children eat chips of lead paint. You can also get it if
your food comes into contact with some types of
pottery that aren’t glazed right.

Thalassemia happens with a problem with

hemoglobin formation (4 chains aren't correctly
formed). You make really small red blood cells-
though you can make enough of them to be
asymptomatic, or it can be severe.It’s passed down
in your genes and usually a!ects people of
Mediterranean, African, Middle Eastern, and
Southeast Asian descent. This condition can range
from mild to life-threatening; the most severe form
is called Cooley's anemia.

Iron-deficiency anemia happens because you don’t

have enough of the mineral iron in your body. Your bone
marrow needs iron to make hemoglobin, the part of the
red blood cell that takes oxygen to your organs. Iron-
deficiency anemia can be caused by:

A diet without enough iron, especially in infants,

children, teens, vegans, and vegetarians

Certain drugs, foods, and ca!einated drinks

Digestive conditions such as Crohn's disease, or if

you’ve had part of your stomach or small intestine
removed

Donating blood o"en

Endurance training

Pregnancy and breastfeeding using up iron in your

body

Your period

A common cause is chronic slow bleed, usually

from a Gastrointestinal source.

Sickle cell anemia is a disorder that, in the U.S., a!ects

mainly African Americans and Hispanic Americans. Your
red blood cells, which are usually round, become
crescent-shaped because of a problem in your genes.
Anemia results when the red blood cells break down
quickly, so oxygen doesn’t get to your organs. The
crescent-shaped red blood cells can also get stuck in tiny
blood vessels and cause pain.

Vitamin-deficiency anemia can happen when you aren’t

getting enough vitamin B12 and folate. You need these
two vitamins to make red blood cells. This kind of anemia
can be caused by:

Dietary deficiency: If you eat little or no meat, you

might not get enough vitamin B12. If you overcook
vegetables or don’t eat enough of them, you might
not get enough folate.

Megaloblastic anemia: When you don’t get enough

vitamin B12, folate, or both

Pernicious anemia: When your body doesn’t absorb

enough vitamin B12

Other causes of vitamin deficiency include medications,

alcohol abuse, and intestinal diseases such as tropical
sprue.

Anemia associated with other chronic conditions

usually happens when your body doesn’t have enough
hormones to make red blood cells. Conditions that cause
this type of anemia include:

Advanced kidney disease

Hypothyroidism

Old age

Long-term diseases, such as cancer, infection,

lupus, diabetes, and rheumatoid arthritis

Anemia Caused by Destruction of Red Blood Cells

When red blood cells are fragile and can’t handle the
stress of traveling through your body, they may burst,
causing what’s called hemolytic anemia. You might have
this condition at birth, or it could come later. Sometimes,
the causes of hemolytic anemia are unclear, but they can
include:

An attack by your immune system, as with lupus.

This can happen to anyone, even a baby still in the
womb or a newborn. That’s called hemolytic
disease of the newborn.

Conditions that can be passed down through your

genes, such as sickle cell anemia, thalassemia, and
thrombotic thrombocytopenic purpura (TTP)

Enlarged spleen. This can, in rare cases, trap red

blood cells and destroy them too early.

Something that puts strain on your body, such as

infections, drugs, snake or spider venom, or certain
foods

Toxins from advanced liver or kidney disease

Vascular gra"s, prosthetic heart valves, tumors,

severe burns, being around certain chemicals,
severe hypertension, and clotting disorders

Anemia Diagnosis
A complete blood count (CBC) test will measure your red
blood cells, hemoglobin, and other parts of your blood.
Your doctor will ask about your family history and your
medical history a"er the CBC. They’ll probably do some
tests, including:

Blood smear or di!erential to count your white

blood cells, check the shape of your red blood cells,
and look for unusual cells

Reticulocyte count to check for immature red blood

cells

Anemia Treatment
Your treatment will depend on your type of anemia.
There are lot of causes, so there are also many
treatments available.

If you have aplastic anemia, you might need

medication, blood transfusions (in which you get
blood from another person), or a bone marrow
transplant (in which you get a donor’s stem cells).

If you have hemolytic anemia, you might need

medication that will hold back your immune
system. Your primary care doctor may refer you to
a doctor who specializes in vascular problems.

If it’s caused by blood loss, you might have surgery

to find and fix the bleeding. If you have iron-
deficiency anemia, you’ll probably need to take
iron supplements and change your diet.

Sickle cell anemia treatment includes painkillers,

folic acid supplements, intermittent antibiotics or
oxygen therapy. A drug. called hydroxyurea (Droxia,
Hydrea, Siklos) is o"en prescribed to decrease
sickle cell pain crises (complicated mechanism).
The medication called voxelator (Oxbryta)
whichcan help your red blood cells keep their
proper shape. Crizanlizumab-tmca (Adakveo) can
keep the blood cells from sticking together and
blocking vessels. L-glutamine oral powder (Endari)
can cut down on your trips to the hospital for pain
and also guard against a condition called acute
chest syndrome.

If you have a vitamin B12 or folate deficiency, you

will be prescribed supplements..

Thalassemia doesn’t usually need treatment, but if

your case is severe, you might have blood
transfusions, a bone marrow transplant, or surgery.

WebMD Medical Reference

Sources 
© 2020 WebMD, LLC. All rights reserved.

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