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Anemia

 

Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues.

Different types of anemia include:

  • Anemia due to vitamin B12 deficiency
  • Anemia due to folate (folic acid) deficiency
  • Anemia due to iron deficiency
  • Anemia of chronic disease
  • Hemolytic anemia
  • Idiopathic aplastic anemia
  • Megaloblastic anemia
  • Pernicious anemia
  • Sickle cell anemia
  • Thalassemia

Iron deficiency anemia is the most common type of anemia.

Causes

Although many parts of the body help make red blood cells, most of the work is done in the bone marrow. Bone marrow is the soft tissue in the center of bones that helps form all blood cells.

Healthy red blood cells last between 90 and 120 days. Parts of your body then remove old blood cells. A hormone called erythropoietin (epo) made in your kidneys signals your bone marrow to make more red blood cells.

Hemoglobin is the oxygen-carrying protein inside red blood cells. It gives red blood cells their color. People with anemia do not have enough hemoglobin.

The body needs certain vitamins, minerals, and nutrients to make enough red blood cells. Iron, vitamin B12, and folic acid are three of the most important ones. The body may not have enough of these nutrients due to:

  • Changes in the lining of the stomach or intestines affect how well nutrients are absorbed (for example, celiac disease)
  • Poor diet
  • Surgery that removes part of the stomach or intestines

Possible causes of anemia include:

  • Iron deficiency
  • Vitamin B12 deficiency
  • Folate deficiency
  • Certain medicines
  • Destruction of red blood cells earlier than normal (which may be caused by immune system problems)
  • Long-term (chronic) diseases such as chronic kidney disease, cancer, ulcerative colitis, or rheumatoid arthritis
  • Some forms of anemia, such as thalassemia or sickle cell anemia, which can be inherited
  • Pregnancy
  • Problems with bone marrow such as lymphoma, leukemia, myelodysplasia, multiple myeloma, or aplastic anemia
  • Slow blood loss (for example, from heavy menstrual periods or stomach ulcers)
  • Sudden heavy blood loss

Symptoms

 

You may have no symptoms if the anemia is mild or if the problem develops slowly. Symptoms that may occur first include:

  • Feeling weak or tired more often than usual, or with exercise
  • Headaches
  • Problems concentrating or thinking
  • Irritability
  • Loss of appetite
  • Numbness and tingling of hands and feet

If the anemia gets worse, symptoms may include:

  • Blue color to the whites of the eyes
  • Brittle nails
  • Desire to eat ice or other non-food things (pica syndrome)
  • Lightheadedness when you stand up
  • Pale skin color
  • Shortness of breath with mild activity or even at rest
  • Sore or inflamed tongue
  • Mouth ulcers
  • Abnormal or increased menstrual bleeding in females
  • Loss of sexual desire in men

 

Exams and Tests

 

The provider will perform a physical examination, and may find:

  • A heart murmur
  • Low blood pressure, especially when you stand up
  • Slight fever
  • Pale skin
  • Rapid heart rate

Some types of anemia may cause other findings on a physical exam.

Blood tests used to diagnose some common types of anemia may include:

  • Blood levels of iron, vitamin B12, folic acid, and other vitamins and minerals
  • Complete blood count
  • Reticulocyte count

Other tests may be done to find medical problems that can cause anemia.

 

Treatment

 

Treatment should be directed at the cause of the anemia, and may include:

  • Blood transfusions
  • Corticosteroids or other medicines that suppress the immune system
  • Erythropoietin, a medicine that helps your bone marrow make more blood cells
  • Supplements of iron, vitamin B12, folic acid, or other vitamins and minerals

 

Possible Complications

 

Severe anemia can cause low oxygen levels in vital organs such as the heart, and can lead to heart failure.

 

When to Contact a Medical Professional

 

Call your provider if you have any symptoms of anemia or unusual bleeding.

 

 

References

Bunn HF. Approach to the anemias. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 158.

Elghetany MT, Schexneider KI, Banki K. Erythrocytic disorders. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 23rd ed. St Louis, MO: Elsevier; 2017:chap 32.

Lin JC. Approach to anemia in the adult and child. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 34.

Text only

 
  • Red blood cells, elliptocytosis

    Red blood cells, elliptocytosis - illustration

    Elliptocytosis is a hereditary disorder of the red blood cells (RBCs). In this condition, the RBCs assume an elliptical shape, rather than the typical round shape.

    Red blood cells, elliptocytosis

    illustration

  • Red blood cells, spherocytosis

    Red blood cells, spherocytosis - illustration

    Spherocytosis is a hereditary disorder of the red blood cells (RBCs), which may be associated with a mild anemia. Typically, the affected RBCs are small, spherically shaped, and lack the light centers seen in normal, round RBCs.

    Red blood cells, spherocytosis

    illustration

  • Red blood cells, multiple sickle cells

    Red blood cells, multiple sickle cells - illustration

    Sickle cell anemia is an inherited disorder in which abnormal hemoglobin (the red pigment inside red blood cells) is produced. The abnormal hemoglobin causes red blood cells to assume a sickle shape, like the ones seen in this photomicrograph.

    Red blood cells, multiple sickle cells

    illustration

  • Ovalocytoses

    Ovalocytoses - illustration

    Red blood cells (RBCs) are normally round. In ovalocytosis, the cells are oval. Other conditions that produce abnormally shaped RBCs include spherocytosis and eliptocytosis.

    Ovalocytoses

    illustration

  • Red blood cells, sickle and pappenheimer

    Red blood cells, sickle and pappenheimer - illustration

    This photomicrograph of red blood cells (RBCs) shows both sickle-shaped and Pappenheimer bodies.

    Red blood cells, sickle and pappenheimer

    illustration

  • Red blood cells, target cells

    Red blood cells, target cells - illustration

    These abnormal red blood cells (RBCs) resemble targets. These cells are seen in association with some forms of anemia, and following the removal of the spleen (splenectomy).

    Red blood cells, target cells

    illustration

  • Hemoglobin

    Hemoglobin - illustration

    Hemoglobin is the most important component of red blood cells. It is composed of a protein called heme, which binds oxygen. In the lungs, oxygen is exchanged for carbon dioxide.Abnormalities of an individual's hemoglobin value can indicate defects in the normal balance between red blood cell production and destruction. Both low and high values can indicate disease states.

    Hemoglobin

    illustration

    • Red blood cells, elliptocytosis

      Red blood cells, elliptocytosis - illustration

      Elliptocytosis is a hereditary disorder of the red blood cells (RBCs). In this condition, the RBCs assume an elliptical shape, rather than the typical round shape.

      Red blood cells, elliptocytosis

      illustration

    • Red blood cells, spherocytosis

      Red blood cells, spherocytosis - illustration

      Spherocytosis is a hereditary disorder of the red blood cells (RBCs), which may be associated with a mild anemia. Typically, the affected RBCs are small, spherically shaped, and lack the light centers seen in normal, round RBCs.

      Red blood cells, spherocytosis

      illustration

    • Red blood cells, multiple sickle cells

      Red blood cells, multiple sickle cells - illustration

      Sickle cell anemia is an inherited disorder in which abnormal hemoglobin (the red pigment inside red blood cells) is produced. The abnormal hemoglobin causes red blood cells to assume a sickle shape, like the ones seen in this photomicrograph.

      Red blood cells, multiple sickle cells

      illustration

    • Ovalocytoses

      Ovalocytoses - illustration

      Red blood cells (RBCs) are normally round. In ovalocytosis, the cells are oval. Other conditions that produce abnormally shaped RBCs include spherocytosis and eliptocytosis.

      Ovalocytoses

      illustration

    • Red blood cells, sickle and pappenheimer

      Red blood cells, sickle and pappenheimer - illustration

      This photomicrograph of red blood cells (RBCs) shows both sickle-shaped and Pappenheimer bodies.

      Red blood cells, sickle and pappenheimer

      illustration

    • Red blood cells, target cells

      Red blood cells, target cells - illustration

      These abnormal red blood cells (RBCs) resemble targets. These cells are seen in association with some forms of anemia, and following the removal of the spleen (splenectomy).

      Red blood cells, target cells

      illustration

    • Hemoglobin

      Hemoglobin - illustration

      Hemoglobin is the most important component of red blood cells. It is composed of a protein called heme, which binds oxygen. In the lungs, oxygen is exchanged for carbon dioxide.Abnormalities of an individual's hemoglobin value can indicate defects in the normal balance between red blood cell production and destruction. Both low and high values can indicate disease states.

      Hemoglobin

      illustration

    A Closer Look

     

    Self Care

     

      Tests for Anemia

       
         

        Review Date: 1/19/2018

        Reviewed By: Richard LoCicero, MD, private practice specializing in hematology and medical oncology, Longstreet Cancer Center, Gainesville, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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