Anemia and iron deficiency
Anemia means there are too few healthy red blood cells. The cause is sometimes simple, such as low iron, and sometimes needs a closer look. Here you can read about symptoms, finding the cause and the usual path of treatment.
What is anemia?
Red blood cells carry oxygen from the lungs to the rest of the body. They do this with hemoglobin, a protein that contains iron. Anemia means there are not enough red cells. The reason can be that the cells are not made in the amounts needed, do not work properly, or break down sooner than usual.
Common types:
- Iron deficiency. The most common type. Bleeding is its most important cause.
- Vitamin deficiency (such as vitamin B12 and folate), because of diet or poor absorption.
- Anemia caused by other conditions, such as kidney disease, long-term inflammation or cancer treatments.
- Less common types: sickle cell anemia, hemolytic anemia (red cells destroyed too early) and aplastic anemia (the bone marrow makes too few cells).
What are the symptoms?
Weakness and tiredness, shortness of breath, dizziness, a racing or irregular heartbeat, headache, cold hands and feet, pale or yellow skin, and sometimes ringing or buzzing in the ears. In iron deficiency there may also be a change in taste, a sore tongue, hair loss, nail changes, or a craving to eat things that are not food.
The symptoms of anemia are easy to overlook. Many people only find out from a blood test.
How is it diagnosed?
- Complete blood count (CBC). It shows hemoglobin, the red cells and their size. It needs no special preparation.
- Iron and ferritin tests. Ferritin shows how much iron the body has stored.
- Finding the cause. This is the most important part of the work. The doctor asks about periods, diet, pregnancy, medicines (for example anti-inflammatory painkillers that irritate the stomach) and digestive symptoms. If the cause is not clear, a test for blood in the stool, an endoscopy or colonoscopy, or a referral to another specialist may be needed. In men and in women who no longer have periods, iron deficiency usually calls for a digestive check to rule out bleeding or cancer of the digestive tract. This does not mean cancer is present; it means the doctor is following the cause seriously.
- In some cases, further blood tests or a bone marrow biopsy are needed for less common types.
The normal hemoglobin level differs between laboratories and between people (women and men, children, pregnancy). Look at the number and the range printed on your own laboratory’s sheet and leave the interpretation to the doctor. One reference (ASH), for example, gives anemia as hemoglobin below 13.5 in men and below 12 g/dL in women who are not pregnant.
How is it treated?
Treatment starts with the cause:
- Iron deficiency. First the cause (for example bleeding) is found and treated. Then the doctor decides whether you should get iron from food or tablets. Iron tablets can cause constipation, diarrhea, stomach pain, heartburn and dark stools. The doctor sets the amount and how long to take it.
- Vitamin deficiency. Treatment depends on the vitamin involved and the reason for the shortage.
- Other conditions. Treating that condition often improves the anemia.
- Blood transfusion in some cases, when a lot of blood has been lost or the anemia is severe. A transfusion is given in a treatment center, with vital signs monitored.
Follow-up and care at home
- The doctor may repeat the tests a few months later to see whether iron and hemoglobin have risen.
- Diet: meat, leafy green vegetables, legumes, dried fruits and nuts, fortified grains. Large amounts of tea, coffee and dairy reduce iron absorption. Start or stop iron tablets or supplements only on the doctor’s advice, and keep them away from children, because too much iron is dangerous for them.
- If you are tired, spread your energy across the most important tasks and ask others for help.
When to call
- Weakness and paleness that continue, or tiredness that makes daily tasks hard: see a doctor at the first opportunity.
- Black or bloody stools, or vomiting blood: go to a doctor or the emergency department right away.
- Emergency (115, Iran’s emergency number): sudden shortness of breath, chest pain, a very fast heartbeat, or fainting.
Every patient’s treatment plan is different; ask your doctor about your own situation.
Frequently asked questions
Does a low hemoglobin mean I have cancer?
No. The most common cause of anemia is iron deficiency, and most of the time the reason is blood loss, for example heavy periods or slow bleeding in the digestive tract, or not getting enough iron. Because another cause is still possible, the doctor looks for the reason.
Can I take iron tablets on my own?
It is better not to, unless a doctor has told you to. First the cause of the anemia has to be found, because if it is bleeding, iron alone does not solve the problem. Too much iron is also harmful and is dangerous for children. Keep every tablet out of children's reach.
Why can't I raise my iron with diet alone?
Diet can help, but if the cause is blood loss or poor absorption, food alone is not enough. Large amounts of tea, coffee, milk and dairy reduce iron absorption. What plan you need is for your doctor or a dietitian to say.
When would I need a blood transfusion?
A transfusion is for when a lot of blood has been lost or healthy red cells are very low, for example after heavy bleeding, with some blood diseases, or with cancer treatments. Other methods may be tried before a transfusion. The doctor makes the decision.
Should anemia be taken seriously?
It should be looked into properly, but it should not frighten you. If untreated it can raise the risk of infection and of heart and lung problems, and finding the cause matters. Finding the cause and following up the tests is where the care counts.