What Is Anemia?
Anemia (also spelled as Anaemia) is a condition in which there is a decrease in the total amount of healthy red blood cells (RBCs) or hemoglobin in the blood. RBCs (red blood cells) carry oxygen to all of your body’s tissues, so a decreased red blood count indicates a lowered ability of the blood to carry oxygen.
Most of the symptoms of anemia are due to the decreased oxygen supply to the vital tissues and organs of the body.
This condition is reported as low hemoglobin in a routine blood test. Hemoglobin is the main protein present in your RBCs that carries oxygen from the lungs to all of the body’s tissues.
In men hemoglobin level of less than 13 to 14 gram/100 ml and in women hemoglobin level of less than 12 to 13 gram/100 ml is defined as anemia.
Your hemoglobin level will be lower if you have anemia. Symptoms of anemia like feeling tired, weakness or shortness of breath, etc. occur because your organs aren’t getting enough oxygen that they need to work.
Young children, women, and people with chronic diseases are more likely to have anemia. There are several types of anemia, each with a different cause and treatment. Some types of anemia aren’t a major concern whereas some of its types may reflect a serious underlying disease.
It is generally caused by decreased production of red blood cells (RBCs), or increased destruction of red blood cells, or by blood loss. Vitamin B12 deficiency, iron deficiency, a number of neoplasms of bone marrow, and thalassemia can cause decreased production of red blood cells (RBCs). Genetic conditions like sickle cell anemia, certain autoimmune diseases, and infections like malaria can cause an increased breakdown of red blood cells. Causes of blood loss include gastrointestinal bleeding and trauma.
According to a report, this condition is affecting about one-third of the global population. It is one of the six WHO global nutrition targets for 2025.
What Are The Different Types Of Anemia?
Friends, there are more than 400 types of anemia and these are divided into three groups:
1) Anemia caused by increased destruction of red blood cells (RBCs)
2) Anemia caused by decreased or faulty production of red blood cells
3) Anemia caused by blood loss
1) Anemia caused by increased destruction of red blood cells
This condition is also called hemolytic anemia.
In this condition, your red blood cells become fragile and can’t handle the stress of traveling through your body, and they may burst.
Some of the causes of hemolytic anemia are:
a) Genetic conditions that can pass down your genes, like thrombotic thrombocytopenic purpura (TTP), thalassemia, sickle cell anemia.
b) Drugs, infections, snake venom, etc. that put strain on your body.
c) Toxins from advanced kidney or liver disease.
d) Severe burns, tumors, being around certain chemicals.
e) Autoimmune diseases like lupus.
2) Anemia caused by decreased or faulty production of red blood cells
In this type of anemia, your body may not produce enough red blood cells, or your red blood cells may not work the way they should. This can happen due to the reason that you don’t have enough vitamins and minerals to form normal red blood cells, or there’s something wrong with your RBCs.
Iron-deficiency anemia, vitamin deficiency anemia, aplastic anemia, etc. are divided into this group.
3) Anemia due to blood loss
This type of anemia can result from losing red blood cells through bleeding. This can also be happened by slow bleeding over a long time, and you may not notice. Some of its causes are:
a) Post-trauma or post-surgery
b) Gastrointestinal conditions like hemorrhoids, ulcers, and cancer.
c) The use of non-steroidal anti-inflammatory drugs (NSAIDS) like aspirin.
d) A woman’s heavy period (or heavy menstrual bleeding).
Common Types Of Anemia
Friends, now I am explaining you some common types of anemia:
1) Aplastic Anemia
It is a rare condition that occurs when your bone marrow stops producing enough new blood cells. more often your bone marrow stops producing all three cells (i.e. red blood cells, white blood cells, and platelets), but sometimes it may stop producing only one type.
Aplastic anemia can develop suddenly or can come on slowly. It can make you more prone to infections and uncontrolled bleeding.
Aplastic anemia can develop at any age, but it is more frequent in people in their late teens and twenties, and among the elderly. It can be caused by the immune system, heredity, or exposure to drugs, chemicals, or radiation. But in about half of the cases, its cause remains unknown and is known as idiopathic aplastic anemia.
There are two types of aplastic anemia:
a) Acquired Aplastic Anemia
This anemia is common in adults. According to researchers it is caused by some problem in the immune system mostly triggered by toxic chemicals, certain medications, or chemotherapy, etc.
b) Inherited Aplastic Anemia
This anemia is common in young adults and children, and is caused by gene defects.
The diagnosis of aplastic anemia can only be confirmed by bone marrow biopsy. But before this procedure, other blood tests of the patient are generally done to get diagnostic clues.
These tests include complete blood count, liver enzymes, thyroid function tests, renal function tests, and folic acid and vitamin B-12 levels.
In bone marrow biopsy, a doctor removes a small sample of bone marrow from a large bone, such as hip bone in your body. That sample is then examined under a microscope. There are about 30-70% blood stem cells in normal bone marrow, but in aplastic anemia, most of these cells are gone and are replaced by fat.
Treatments for aplastic anemia depend on your age and the severity of your condition. It includes medications, blood transfusions, or bone marrow transplantation. Medications like immunosuppressive drugs, corticosteroids, cyclosporine, and chemotherapy drugs, are used in its treatment and regarded as first-line treatment for aplastic anemia.
2) Iron Deficiency Anemia
Iron deficiency anemia is the most common type of anemia. It is a condition when your body doesn’t have enough iron. As iron is required to make hemoglobin, so, with insufficient iron, your body can’t produce enough hemoglobin (an oxygen-carrying protein in red blood cells).
Due to this, your blood lacks sufficient healthy red blood cells and you may feel short of breath, weak, and tired.
There may be growth and development problems in children with iron deficiency anemia.
It is generally caused by insufficient dietary intake, poor absorption of iron from food, parasitic worms, or blood loss.
This anemia can be corrected by consuming a diet rich in iron, or by iron supplementation. Iron injections, or blood transfusions are needed in severe cases.
3) Thalassemia
Thalassemia is an inherited blood disorder that causes your body to have less oxygen-carrying protein called hemoglobin than normal.
It is an inherited disorder, which means that at least one of your parents is a carrier of this disorder. It causes anemia and thus leaves you fatigued.
You may not need any treatment, if you have mild thalassemia. But there might be requirement of regular blood transfusions in more severe forms.
Thalassemia is of three types:
a) Alpha thalassemia: it includes the subtypes hemoglobin H and hydrops fetalis.
b) Beta thalassemia: it includes the subtypes major and intermedia
c) Thalassemia minor
The signs and symptoms you have depend on the type of thalassemia. The onset and the severity of the disease also vary with the type and the subtype of thalassemia.
Signs and symptoms of the thalassemia are:
- Facial bone deformities
- Fatigue
- Slow growth
- Pale or yellowish skin
- Dark urine
- Abdominal swelling
- Weakness
Diagnosis of thalassemia can be done by a blood sample which should be tested for anemia and abnormal hemoglobin. Your blood sample under the microscope will show abnormally shaped red blood cells (a sign of thalassemia).
To confirm the diagnosis a test called hemoglobin electrophoresis is performed. Hemoglobin electrophoresis is used to identify normal and abnormal hemoglobins and to assess their quantity.
Treatment for thalassemia depends on its type and severity. Mild forms of thalassemia don’t need any treatment.
Moderate to severe forms are treated by frequent blood transfusions, medications, a bone marrow transplant, and sometimes surgery may be required to remove the spleen or gallbladder.
4) Sickle Cell Anemia
Sickle cell anemia (SCA) is an inherited red blood cell disorder, which is one of a group of disorders known as sickle cell disease (SCD).
Normal RBCs are disc-shaped and have the flexibility to travel through even the smallest blood vessels. But due to this disease, RBCs become rigid and sickle-like (or crescent moons) in shape. These sticky and rigid red blood cells get stuck in small vessels and thus blocks blood flow to different parts of the body. This can lead to pain and tissue damage.
Signs and symptoms of sickle cell anemia generally appear around 5 to 6 months of age. Its symptoms vary from person to person and change over time.
Signs and symptoms of sickle cell anemia are:
- Periodic episodes of pain, also known as pain crisis or sickle cell crisis.
- Frequent infections
- Swelling and pain in the hands and feet
- Delayed growth or puberty
- Excessive fatigue
- Vision problems
Diagnosis of sickle cell anemia can be done by sickle cell solubility test, hemoglobin electrophoresis, and high-performance liquid chromatography. Genetic testing is also performed in rare cases.
Treatment of sickle cell anemia is usually aimed at relieving symptoms and preventing complications. Its treatment might include blood transfusions and medications. A stem cell transplant may cure the disease in some children and teenagers.
Medications like hydroxyurea, L-glutamine oral powder, voxelotor, crizanlizumab, are used in its treatment.
5) Vitamin Deficiency Anemia
Vitamin deficiency anemia is caused by a deficiency of cobalamin (vitamin B-12), folate (vitamin B-9), or vitamin C. It is a condition in which there is a lack of healthy red blood cells.
It can occur if you don’t get enough of these vitamins from your diet. Or it can occur if your body cannot properly absorb or process these vitamins.
Signs and symptoms of vitamin deficiency anemia are:
- Dizziness
- Fatigue
- Pale or yellowish skin
- Mental confusion or forgetfulness
- Irregular heartbeats
- Numbness or tingling in your hands and feet
- Weight loss
- Muscle weakness
- Unsteady movements
- Shortness of breath
a) Folate Deficiency Anemia
Folate is also known as vitamin B-9, and it helps your body to make red blood cells. Folate is present in green leafy vegetables, and citrus fruits. If your diet is consistently lacking in folate, you may end up with a folate deficiency. Its deficiency can also occur if you have a disease that prevents your body from absorbing or processing folate.
Folate deficiency can cause anemia, known as folate deficiency anemia.
Pregnant women, women who are breast-feeding, or people undergoing dialysis for kidney disease have an increased demand for folate. Failure to meet this increased demand can also result in folate deficiency.
Diagnosis of folate deficiency anemia is done by blood tests.
Treatment of folate deficiency anemia is done by increasing its dietary intake or taking folate or folic acid supplements.
b) Vitamin B-12 Deficiency Anemia
A diet consistently lacking in vitamin B-12 can cause vitamin B-12 deficiency. Vitamin B-12 is mainly present in milk, eggs, and meat.
Vitamin B-12 deficiency can cause vitamin B-12 deficiency anemia, in which your body doesn’t have enough healthy red blood cells because of a deficiency of vitamin B-12.
Sometimes your body is lacking a substance called intrinsic factor. It is a protein made by your stomach which helps your body to absorb vitamin B-12.
Intrinsic factor deficiency can be caused when your immune system mistakenly attacks your stomach cells which are responsible for its production. This type of vitamin B-12 deficiency anemia is known as pernicious anemia.
Apart from lack of intrinsic factor, vitamin B-12 deficiency anemia can also occur if your small intestine is unable to absorb vitamin B-12. This may be due to the reason:
- You are having abnormal bacterial growth in the small intestine
- You have surgery to remove part of your stomach, where intrinsic factor is made
- You have surgery to remove part of your intestine
- You have been infected with a tapeworm
- You are taking some medicines, such as anti-seizure drugs, or antibiotics.
- You have a disease that interferes with absorption of the nutrients in your small intestines, such as Celiac disease, or Crohn’s disease.
Signs and symptoms of vitamin B-12 deficiency anemia are:
- Fatigue
- Dizziness
- Pale or yellow skin
- Feeling irritable
- Shortness of breath
- Loss of appetite
- Swollen, red tongue or bleeding gums
- Numbness and tingling of hands and feet
Diagnosis of vitamin B-12 deficiency can be done by the tests like :
- Complete blood count (CBC)
- Vitamin B-12 level
- Methylmalonic acid (MMA) test
- Intrinsic factor antibodies test
- Schilling test
Treatment of vitamin B-12 deficiency anemia depends on the cause of vitamin B-12 deficiency. The goal of the treatment is to increase its levels.
It usually treated with diet and vitamin B -12 supplements. Most people respond very well to the oral vitamin B-12 supplements, but shots of vitamin B-12 are given to people who don’t respond well to oral supplements or have a very low level of vitamin B-12.
c) Vitamin C Deficiency Anemia
If you don’t get enough vitamin C from your diet you can develop vitamin C deficiency. Its deficiency can also occur if something impairs your body’s ability to absorb vitamin c from food.
Vitamin C deficiency can also occur due to the following causes which impair the body’s ability to absorb vitamin C:
- Certain chronic diseases, such as chronic kidney disease or cancer.
- Excessive consumption of alcohol or use of illegal drugs
- Smoking
Diagnosis of vitamin C deficiency anemia can be done by blood tests like complete blood count, vitamin C levels tests.
Treatment of vitamin C deficiency anemia can be done by administering vitamin C supplements by mouth or by injection.
What Are The Causes Of Anemia?
Anemia happens when your blood doesn’t have enough red blood cells.
Anemia can occur if:
- Your body destroys red blood cells
- There is bleeding in your body which causes you to lose red blood cells more rapidly than they can be replaced
- Your body doesn’t make sufficient red blood cells
Different types of anemia and their causes
Different types of anemia are caused by different causes. Friends, below I am explaining to you some common types of anemia and their causes:
Iron deficiency anemia
This is the most common type of anemia and is caused by the deficiency of iron in your body. your bone marrow needs a certain amount of iron to make hemoglobin. Thus without iron, your body isn’t able to produce sufficient hemoglobin for red blood cells.
Aplastic anemia
It is rare and life-threatening anemia that can be caused by gene defects (inherited aplastic anemia), or by some problem in your immune system mostly triggered by toxic chemicals, certain medications, etc. (acquired aplastic anemia).
Vitamin deficiency anemia
To produce sufficient healthy red blood cells, your body also requires folate, vitamin B-12, and vitamin C apart from iron.
If your diet is consistently lacking in folate, or if you have a disease that prevents your body from absorbing or processing folate, then you may end up with a folate deficiency anemia.
If your diet is consistently lacking in vitamin B-12, or if your small intestine is unable to absorb vitamin B-12, then this can cause vitamin B-12 deficiency anemia.
Vitamin C deficiency anemia is caused if you don’t get enough vitamin C from your diet, or if something impairs your body’s ability to absorb vitamin C.
Sickle cell anemia
it is an inherited red blood disorder, in which red blood cells become rigid and sickle-like (crescent moons) in shape.
These irregular RBCs die prematurely and thus results in a chronic shortage of red blood cells.
Thalassemia
It is an inherited blood disorder that causes your body to have less hemoglobin than normal. This disorder causes excessive destruction of red blood cells which results in anemia.
What Are The Signs And Symptoms Of Anemia?
Signs and symptoms of anemia depend on the cause of the anemia. Like, if the anemia is caused due to a chronic disease, then the disease can mask its symptoms and the anemia may be noticed by tests for another disease.
Depending on the underlying cause of your anemia, you may not have any signs and symptoms or maybe so mild that you can’t even notice them. But as your blood cells decrease signs and symptoms often develop.
Signs and symptoms of anemia, if they occur, are:
- Pale or yellow skin
- Weakness
- Fatigue
- Irregular heartbeats
- Headaches
- Chest pain
- Dizziness or lightheadedness
- Shortness of breath
- Cold hands and feet
- Joint pain
- Unusual cravings, such as wanting to eat clay, dirt, or ice
- Trouble concentrating
As anemia worsens, these symptoms also worsen.
Some types of anemia can also cause swelling of the tongue, resulting in a red, smooth, glossy, and sometimes painful tongue.
If anemia is severe, then fainting (a sudden temporary loss of consciousness) may also occur.
What Are The Risk Factors For Anemia?
Anemia can occur in people of any age, sex, and ethnicity. But the following factors increase your risk of anemia:
A diet deficient in certain vitamins and minerals
A diet consistently lacking in vitamin B-12, folate, or iron increases your risk of iron deficiency anemia or vitamin deficiency anemia.
Chronic conditions
Chronic conditions such as diabetes, kidney failure, cancer, increase your risk of anemia of chronic disease.
Menstruation
Menstruation causes loss of red blood cells in women, thus women of childbearing age have a greater risk of iron deficiency anemia than men and postmenopausal women.
Intestinal disorders
Having an intestinal disorder such as Celiac disease or Crohn’s disease, that impairs the absorption of nutrients in your small intestine, increases your risk of anemia.
Pregnancy
During pregnancy, there is a greater requirement of folic acid and iron in the body due to developing fetus. So, if you are pregnant and not taking supplements of these nutrients, then you are at an increased risk of anemia.
Family history
If you have a family history of inherited anemia, like sickle cell anemia, then you are also at increased risk of the condition.
Age
If your age is over 65 years, then you are at increased risk of anemia.
Blood loss
Blood loss due to gastrointestinal conditions like hemorrhoids, ulcers, or cancer; or blood loss due to trauma or surgery increases your risk of anemia.
Other factors
Alcoholism, use of certain medications, exposure to toxic chemicals, or autoimmune disorder increases your risk of anemia.
How Is Anemia Diagnosed?
To diagnose anemia, your doctor is likely to ask you about your health history and your family health history, perform a physical exam, and advise blood tests.
Your detailed answers about your health history, family health history, symptoms, diet, alcohol intake, smoking habits, medications you take, can help the doctor in the diagnosis of anemia.
Your doctor can advise following blood tests, these will confirm the diagnosis and will also help to find the underlying disease. These tests include:
Complete blood count (CBC)
This test determines the number, volume, size, and hemoglobin content of red blood cells in a sample of your blood. To diagnose anemia, your doctor will be interested in your hematocrit (levels of red blood cells contained in your blood) and the hemoglobin results of this test.
A blood test to determine the shape and size of your red blood cells
In this test your red blood cells might be examined for unusual shape and size.
Serum iron test
This test is done to find whether iron deficiency is the cause of anemia.
Ferritin test
Serum ferritin level is the indicator of your body’s iron stores.
Vitamin B-12 test
This test indicates your vitamin B-12 levels and helps your doctor to decide if they’re too low.
Folic acid test
This test is done to determine the levels of serum folate in your body.
Stool examination for the occult blood
This test is done to see if blood is present in your stool. If blood is present in your stool then it means that blood is being lost somewhere in your gastrointestinal tract. Ulcerative colitis, colon cancer, or stomach ulcers can cause blood in the stool.
Additional diagnostic tests
If you receive a diagnosis of anemia, then your doctor may order you some additional diagnostic tests to determine the cause of anemia.
Your doctor may order additional tests such as:
- A CT scan of your abdomen
- A barium enema
- Chest X-rays
Sometimes your doctor may order a study of a sample of your bone marrow to diagnose the cause of your anemia.
What Is The Treatment Of Anemia?
Your anemia’s treatment will depend upon the cause of your anemia.
Treatment of anemia aims to increase the number of red blood cells, which results in increased oxygen amount in the blood.
Friends, below I am outlining treatments for some common types of anemia:
Anemia caused by the deficiency of dietary iron, folate, or vitamin B-12, is treated with nutritional supplements of these nutrients. In some cases, injections of vitamin B-12 are required if your small intestine is unable to absorb vitamin B-12. Injections of iron (parenteral iron) are also used in cases where oral iron is has proven ineffective, or where iron absorption is impeded.
Your doctor can also prescribe a diet that contains all these nutrients to prevent this kind of anemia from recurring.
If you have aplastic anemia, you may need medications (like immunosuppressive drugs, corticosteroids), blood transfusions, or a bone marrow transplant.
If your anemia is caused by blood loss, you may have surgery to find and fix the bleeding.
You may need medications that will hold back your immune system if you have hemolytic anemia.
If you have sickle cell anemia, you may need medications that relieve pain, intermittent antibiotics, or blood transfusions. Medications like hydroxyurea, L-glutamine oral powder, voxelotor, crizanlizumab, are also used in the treatment of sickle cell anemia.
Mild forms of thalassemia don’t need any treatment. But if your case is severe, you might be treated by frequent blood transfusions, medications, and a bone marrow transplant; and sometimes surgery may be required to remove the spleen or gallbladder.
Sometimes, if your anemia is severe, your doctor can use erythropoietin injections to increase red blood cell production in the bone marrow.
In some cases, where hemoglobin is very low a blood transfusion may be required.
What Is The Prognosis For A Person With Anemia?
Anemia usually has a very good prognosis and is treatable in many instances. Sometimes, people with anemia can be cured just by making dietary changes alone. And some types of anemia can be life-threatening without treatment.
But the overall prognosis depends on the underlying cause of the anemia, severity of anemia, and the overall health of the person.
Summary
Anemia occurs when there is a decrease in the total amount of healthy red blood cells (RBCs) or hemoglobin in the blood. This causes decreased oxygen supply to the vital tissues and organs of the body and leads to symptoms such as pale skin, fatigue, breathlessness, and chest pain.
There are more than 400 types of anemia. It can be caused by increased destruction of red blood cells, decreased or faulty production of red blood cells or blood loss.
A doctor can use CBC, serum iron test, ferritin test, vitamin B-12 test, folic acid test, stool examination for the occult test, or study of a sample of bone marrow, to confirm the diagnosis and to find the underlying cause of anemia.
Treatment of anemia depends upon the cause of anemia. Its treatment may include vitamin or iron supplements, medications, blood transfusions, and a bone marrow transplant.
However, in some people anemia can be cured by dietary changes.
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Disclaimer
This article is intended for informational purpose only. Any information associated with this article should not be considered as a substitute for prescription suggested by local health care professionals.
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