The Facts about Anemia

Anemia is the most common disorder of the blood. It occurs when the amount of red blood cells or hemoglobin (oxygen-carrying protein) in the blood becomes low. Hemoglobin helps red blood cells carry oxygen from the lungs to all parts of the body. When it is low, the tissues of the body don't receive enough oxygen-rich blood and can't produce the energy they need to function properly.

There are many types of anemia, all with different causes.

Iron Deficiency Anemia
Iron deficiency anemia (IDA) is the most common type of anemia. IDA occurs when you don't have enough iron in your body. You need iron to make hemoglobin. This can happen when you lose blood from problems like heavy periods, ulcers, colon polyps, or colon cancer. A diet that doesn't have enough iron in it can also cause IDA. Pregnancy can cause IDA if there's not enough iron for the mother and fetus. You can get iron from foods like ground beef, clams, spinach, lentils, baked potato with skin, sunflower seeds, and cashews.

Megaloblastic Anemia
Megaloblastic (or vitamin deficiency) anemia most often occurs when the body doesn't get enough folic acid or vitamin B-12. These vitamins help the body maintain healthy blood and a healthy nervous system. With this type of anemia, the body makes red blood cells that can't deliver oxygen properly. Folic acid supplement pills can treat this type of anemia. You can also get folic acid in beans and legumes; citrus fruits and juices; wheat bran and other whole grains; dark green leafy vegetables; and poultry, pork, shellfish, and liver. Sometimes, with this disease, your health care provider may not realize you're not getting enough B-12. This usually happens to someone with pernicious anemia, a type of autoimmune disease. B-12 deficiency may also be more common in people with other autoimmune diseases, like Crohn's disease. Not getting enough B-12 can cause numbness in the legs and feet, problems walking, memory loss, and problems seeing. The treatment depends on the cause, but you may need to get B-12 shots or take special B-12 pills.

Anemia from Underlying Diseases
Certain diseases can hurt the body's ability to make red blood cells. For example, people with kidney disease, especially those getting dialysis (which takes out wastes from the blood if the kidneys can't), are at higher risk for developing anemia. Their kidneys can't create enough hormones to make blood cells, and iron is lost in dialysis.

Anemia from Inherited Blood Diseases
If you have a blood disease in your family, there is a higher risk that you will also have this disease. One type of inherited blood disease is sickle cell anemia. Instead of having normal red blood cells that move through blood vessels easily, sickle cells are hard and have a curved edge. These cells cannot squeeze through small blood vessels and block the organs from getting blood. Your body destroys sickle red cells quickly, but it can't make new red blood cells fast enough. This causes anemia. Another inherited blood disease is thalassemia. It happens when the body is missing certain genes or when variant (different from normal) genes are passed down from parents that affect how the body makes hemoglobin.

Aplastic Anemia
Aplastic anemia is a rare problem that happens when the body doesn't make enough red blood cells. Since this affects the white blood cells too, there is a higher risk for infections and bleeding that can't be stopped. This can be caused by many things:

• cancer treatments (radiation or chemotherapy)
• exposure to toxic chemicals (like those used in some insecticides, paint, and household cleaners)
• some drugs (like those that treat rheumatoid arthritis)
• autoimmune diseases (like lupus)
• viral infection that affects bone marrow
• bone marrow diseases

The treatment depends on how serious the anemia is. It can be treated with blood transfusions, medicines, or a bone marrow transplant.

Signs and Symptoms of Anemia
Anemia takes some time to develop. In the beginning, you may not have any signs or they may be mild. But as it gets worse, you may have these symptoms:

• fatigue
• weakness
• not doing well in work or school
• low body temperature
• pale skin
• rapid heartbeat
• shortness of breath
• chest pain
• dizziness
• irritability
• numbness or coldness in your hands and feet
• headache

Diagnosis and Treatment
Anemia is diagnosed by a blood test. If you have anemia, your health care provider may want to do other tests to find out what's causing it, like stomach ulcers or polyps.

Treatment depends on the cause of the anemia. For example, treatment for sickle cell anemia is different than treatment for a diet low in iron or folic acid. Talk to your health care provider about the best treatment for the cause of your anemia.

Prevention
These steps can help prevent some types of anemia:

• Eat foods high in iron: red meat, fish, chicken, liver, eggs, dried fruits like apricots, prunes, and raisins; lentils and beans; green, leafy vegetables like spinach and broccoli; tofu; cereal with iron in it (iron-fortified).
• Eat/drink foods that help your body absorb iron, like orange juice, strawberries, broccoli, or other fruits and vegetables with vitamin C.
• Don't drink coffee or tea with meals. These drinks make it harder for your body to absorb iron.
• Calcium can hurt your absorption of iron. If you have a hard time getting enough iron, talk to your health care provider about the best way to get enough calcium too.
• Make sure you get enough folic acid and vitamin B-12 in your diet.
• Talk to your health care provider about taking iron supplement pills. Do not take these pills without talking to your health care provider first. These pills come in two forms: ferrous and ferric. The ferrous form is better absorbed by your body. But taking iron pills can cause side effects like nausea, vomiting, constipation, and diarrhea. Reduce these side effects by taking these steps:
  • Start with half of the recommended dose. Gradually increase to the full dose.
  • Take the pill in divided doses.
  • Take the pill with food.
  • If one type of iron pill is causing problems, ask your health care provider for another brand.
• If you are a non-pregnant woman of childbearing age, get tested for anemia every 5 to 10 years. This can be done during a regular health exam. Testing should start in adolescence.
• If you are a non-pregnant woman of childbearing age with these risk factors for iron deficiency, get tested every year:
  • heavy periods
  • low iron intake
  • previous diagnosis of anemia

How Much Iron?
Most people get enough iron through a regular healthy diet that has iron-rich foods. But some groups of people often don't get enough iron:

• Teenage girls/women of childbearing age (especially those who have heavy menstrual losses, who have had more than one child, or use an intrauterine device [IUD])
• Older infants and toddlers
• Pregnant women: Many pregnant women have a hard time getting enough iron. During pregnancy, your body demands more iron because of the growing needs from the fetus, the higher volume of blood, and blood loss during delivery. Not getting enough iron can cause preterm labor and delivering a low-birthweight baby. If you're pregnant, make sure you get 27 mg of iron every day. Take an iron supplement pill to be sure. This dosage might be part of your prenatal vitamin. Get tested for anemia at your first prenatal visit.

These groups of people should be screened periodically for iron deficiency. If the tests show that the body isn't getting enough iron, iron supplements may be prescribed. Many health care providers prescribe iron supplements during pregnancy because many pregnant women don't get enough. They can help when diet alone can't restore the iron level back to normal. Talk with your healthcare provider to find out if you are getting enough iron through your diet or if you or your child needs to be taking iron supplements.

Milligrams (mg) of iron per day for special groups:

Infants and Children
7 to 12 months: 11 mg
1 to 3 years: 7 mg
4 to 8 years: 10 mg

Females
9 to 13 years: 8 mg
14 to 18 years: 15 mg
19 to 50 years: 18 mg
51+ years: 8 mg

Pregnant
9 to 50 years: 27 mg

Breastfeeding
9 to 18 years: 10 mg
19 to 50 years: 9 mg

This article includes information from The National Women's Health Information Center and the Office of Dietary Supplements.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.