Anemia affects almost 1 in 4 people worldwide. But while billions of people live with the disease, its signs and symptoms aren’t just part of everyday life.
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“Anemia is one of the most common global problems, yet sometimes, because it’s so common, it’s just thought of as being normal,” says Dr. Parminder S. Suchdev, associate director of the Emory Global Health Institute, anemia researcher and pediatrician who treats anemia.
Anemia can range in intensities, with severe cases requiring hospitalization — or even resulting in death. Menstruating and pregnant individuals are among those most vulnerable to anemia, but anyone can be at risk. Concerningly, anemia cases have increased in recent years. In 2021, researchers reported as many as 420 million more anemia cases than were reported in 1990. Though some suggest this rise may be due to population growth, it is clear that anemia has not disappeared — and that many are in need of treatment.
Learn about anemia types, risk factors, signs and symptoms, and treatment to help you better understand this disease and take care of yourself should you suspect a diagnosis.
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What Is Anemia?
Anemia is a common but serious blood disorder that can occur when someone’s hemoglobin levels are too low to support their body’s needs. Hemoglobin is a protein in the blood, found in the red blood cells, that helps carry oxygen throughout the body.
Having ample hemoglobin levels is important for certain functions such as maintaining energy throughout the day, thinking clearly and feeling strong while exercising. When people are anemic, they may experience symptoms like dizziness or fainting episodes, which can be due to low levels of hemoglobin.
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Anemia Signs and Symptoms
Stereotypically, anemia is associated with looking pale and feeling cold. But not everyone who experiences anemia will display these symptoms — and even for those that do, they are just a small part of this diagnosis.
Additional symptoms associated with anemia include:
— Fatigue
— Lightheadedness
— Chest palpitations
— Shortness of breath
— Cold intolerance
— Pica, or when people crave or chew on substances without nutritional value, like ice
People with anemia experience not only a range of symptoms, but varying degrees of symptom intensity too. For instance, Suchdev says that some people with anemia can be prone to fainting, whereas others may not feel dizzy at all — and may experience few to no symptoms for months to years.
While that may seem like a plus, mild symptoms of anemia can be dangerous in their own way. Concerningly, these may allow the condition to simmer silently, undetected by a medical professional. Undetected anemia may not be treated properly or efficiently, allowing ample time for the condition to worsen. In some cases, symptoms only begin down the line when a person’s blood count is so low that they experience a medical emergency without warning.
“When the anemia is mild, people can be walking around and might not even know they are anemic; if the anemia is severe, you might be tired, weak, or you might faint,” Suchdev says. It is not until anemia becomes severe that it can be life-threatening, Suchdev adds.
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Risk Factors for Anemia
Anyone can be at risk for anemia, but some people can be more vulnerable than others. In the U.S., women within menstruating age, particularly, can be at higher risk for iron-deficiency anemia due to blood loss from heavy periods.
Women who are pregnant can be at higher risk for severe complications if they come down with anemia, both to themselves and to their growing baby. Anemia also increases risks for maternal mortality and morbidity.
“Almost one in two pregnant women in the world have anemia — and that’s affecting generation after generation of population,” Suchdev says.
At-risk groups for anemia can be broken into people who are at risk for developing anemia and those that are at risk for extreme consequences of anemia.
At-risk groups for developing anemia
— People who aren’t consuming a nutritious diet. This could be people who are vegan or vegetarian who are not supplementing missing nutrients, or others who are not eating enough iron, vitamin B12 and folate.
— People with a history of intestinal disorders. Some intestinal disorders, like Crohn’s disease and celiac disease, affect the absorption of nutrients.
— People who are menstruating and experience heavy periods. This can contribute to increased blood loss.
— People who are pregnant: Pregnancy can increase risks for anemia as both the pregnant person and the growing baby are using blood.
— People with chronic conditions such as cancer, renal or liver failure. These conditions may cause a decrease in red blood cells.
— People with a family history of an inherited anemia, such as sickle-cell anemia. Family histories of inherited anemia may increase your risk of developing anemia.
— People with a history of certain infections, blood diseases and autoimmune disorders. Certain blood diseases and infections can impact blood supply or red blood cell creation, increasing anemia risk.
Additionally, people who are exposed to toxic chemicals or who take certain medications that affect red blood cell production can be at increased risk for anemia.
At-risk groups for extreme consequences of anemia
— Pregnant people. Anemia is a cause of maternal mortality and morbidity. Because pregnant people are already using their bodies to support a growing baby, anemia can further deplete them of energy and blood supply.
— Unborn babies. When a pregnant woman has anemia, this may impact the development of their baby.
— Young children. Anemia can impact neuro development in young children.
— Labor workers or athletes. Anemia can impact energy levels and performance.
Suchdev explains that even in a normal pregnancy, “the body is set up where the baby is going to take the blood it needs to preserve itself.” When anemia is involved, hemoglobin levels can drop drastically.
“Women who start off anemic can become more anemic, and then that’s an independent risk of maternal mortality,” Suchdev says.
Even before they’re born, anemia can have consequences on the baby too.
“Having anemia in utero can make (your baby) more likely to be born preterm or have a low birth weight,” Suchdev adds. “Also, being anemic can affect (your baby’s) neuro development — how the brain develops.”
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What Causes Anemia?
Anemia occurs when some force or condition reduces the body’s hemoglobin levels, or hinders its ability to produce red blood cells. There are many ways this can happen, including nutritional deficiencies, infections and cancer. The most common cause of anemia is iron deficiency.
Types of Anemia
— Iron-deficiency anemia
— Vitamin-deficiency anemia
— Anemia of chronic disease
— Sickle-cell anemia
— Aplastic anemia
— Hemolytic anemia
Iron-deficiency anemia
The most common form of anemia, iron-deficiency anemia occurs when people’s iron levels are low enough that they in turn impact their red blood cell supply. Iron is essential for creating red blood cells. So, when the body does not have enough iron, it may not be able to make enough red blood cells, either.
Some people can experience iron deficiency without experiencing iron-deficiency anemia if their deficiency is mild enough that it has not affected their red blood cell count. Similarly, people without an iron deficiency may experience anemia, if their anemia has a different cause.
Vitamin-deficiency anemia
Deficiencies in other key nutrients, such as folate and vitamin B12, can impact red blood cell production and increase risks for anemia.
Anemia of chronic disease
Various chronic diseases, like cancer, HIV/AIDS, rheumatoid arthritis, Crohn’s disease and other chronic inflammatory diseases, may interfere with red blood cell production and increase risks for anemia.
Sickle-cell anemia
Sickle-cell anemia is an inherited condition where the body makes irregularly shaped — sickle-shaped — red blood cells. These cells can die prematurely, impairing someone’s red blood cell count and causing them to experience anemia.
Aplastic anemia
Red blood cells are formed in the bone marrow. When the bone marrow is impaired, people can be at risk for anemia. Aplastic anemia is a type of anemia that is connected to bone marrow. It is a rare but life-threatening form of anemia that can occur when a decrease in bone marrow inhibits the body’s ability to produce red blood cells.
Hemolytic anemia
Hemolytic anemia can occur when red blood cells are destroyed faster than the bone marrow can replace them. Hemolytic anemia can be inherited or develop later in life.
Iron Deficiency vs. Anemia
The most common type of anemia is iron-deficiency anemia, when a person’s anemia is caused by low levels of iron. Iron is an important component of hemoglobin that’s present in the red cells and actually gives blood its red color.
“Hemoglobin helps transport oxygen from the lungs to the body,” explains Dr. Kadakkal Radhakrishnan, a pediatric gastroenterologist and hepatologist at Cleveland Clinic Children’s. “It’s also present in myoglobin in muscles, and it helps muscles both store and use oxygen. In addition, iron is present in the mitochondria — the power house of the cell — and helps generate ATP, the energy molecule in the body. If you aren’t getting enough iron, the tissues and organs won’t get the oxygen they need, and anemia may develop.”
However, iron deficiency and anemia are not one and the same, and people can be diagnosed with one condition and not the other.
To understand why, it can help to think about how iron levels impact anemia risks. Perhaps comparable to how hemoglobin supports the movement of oxygen throughout your cells, iron supports the building of hemoglobin to begin with. It is a key worker in the red blood cell creation process.
What’s more, it’s a hard worker. As such, your iron won’t stop trying to create red blood cells just because its levels aren’t at their peak. At the same time, hard work can only work so hard. At some point, iron levels can be low enough to impact red blood cell supply and cause anemia.
Even without anemia, however, iron deficiency is a real health problem that is important to address. People with iron deficiency may experience some similar symptoms to anemia, like low energy levels or coldness in their hands or feet. Talking to your doctor about treatments and interventions — some of which may be similar to anemia treatments — can help you take care of iron deficiency symptoms and prevent your iron levels from dropping further and causing iron-deficiency anemia.
How Is Anemia Diagnosed?
Doctors most commonly use a blood test to diagnose anemia. On a blood test, anemia can be detected by looking at a person’s hemoglobin levels.
Low hemoglobin levels can indicate anemia. For adults, anemia is typically diagnosed at a hemoglobin level of 13.5 grams per deciliter or less for biological men, and of 12 grams per deciliter or less for biological women.
However, while these numbers can be used as benchmarks for diagnosing anemia, they are not a universal standard. Importantly, there are some factors that may inflate or manipulate a person’s hemoglobin levels. Suchdev explains that habits like smoking and environmental factors like living in high altitude areas can artificially raise hemoglobin levels. It is important for doctors and patients to keep this in mind, as someone may have a perceivably normal hemoglobin level but actually be experiencing a dangerous case of anemia, he says.
Once anemia is detected on a blood test, a doctor should follow up with other tests or assessments to determine what kind of anemia is to blame. This could include taking an additional blood test to check iron levels, asking about a family history of diseases or checking in about chronic conditions the patient is experiencing.
“We need to think of anemia itself not as a disease, but a signal,” Suchdev says. “It’s a condition that is trying to tell us to figure out what the cause is.”
Anemia Treatment
Treatment for anemia can vary based on the type of anemia a person has, what is causing it, and just how low their red blood cell count has fallen. Because treatment can be so variable, it is essential that a doctor not only diagnose you with anemia but determine what type of anemia you are experiencing — and what is causing this condition.
Because anemia has different types and causes, the same treatment won’t work for every patient. For instance, someone with iron-deficiency anemia may benefit from treatments that raise their iron levels — such as taking supplements or consuming iron-rich foods in their diet — but someone with aplastic-anemia, which is related to the bone marrow and can be caused by some cancers and autoimmune diseases, will not improve their anemia by taking iron. For these people, treating the underlying disease can be most effective in treating their anemia.
Interventions can further differ depending on how low a person’s red blood cell count has fallen. For instance, a woman with a hemoglobin level of 12 grams per deciliter — the higher end of the scale — may be able to boost her hemoglobin level to a safe range with iron supplementation, whereas a woman with a hemoglobin level of 5 grams per deciliter could be in need of more aggressive treatment, such as a blood transfusion.
Treatments for Iron-Deficiency Anemia
For people with iron-deficiency anemia, treatment involves interventions to raise their iron levels — which can in turn help build up hemoglobin supply. In non-emergency cases, doctors may offer a patient dietary advice or iron supplements to treat their condition. IV iron can also be used in non-emergency situations to treat iron-deficiency anemia.
Dietary interventions for iron-deficiency anemia
People who don’t eat enough iron can be at higher risk for iron-deficiency anemia. On the flip side, people who have iron-deficiency anemia may be able to improve their condition by increasing their iron intake.
Some whole foods that are high in iron include:
— Red meat
— Veal
— Liver
— Fish
— Shellfish
— Pork
— Chicken
— Kale
— Spinach
— Some nuts and seeds
— Some fruits and berries
In addition, some processed foods are fortified with iron before hitting the shelves. Similar to how the government added iodine to salt, this is a public health tactic to fight iron deficiency. Some commonly iron-fortified foods include:
— Breakfast cereals
— Processed breads
— Processed pastas
Supplemental treatment for iron-deficiency anemia
While increasing dietary iron intake can be a good idea for people with iron-deficiency anemia, it’s not the solution for everyone. Notably, many iron-rich foods are meat products, which are off the table for people who are vegan or vegetarian.
Additionally, many foods that are considered high in iron aren’t high enough in iron to make a substantial difference on a blood test — unless you eat a whole lot of them.
If dietary iron isn’t meeting your needs, supplements may add some extra support. Suchdev explains that supplements can be a great option because they are readily available and relatively affordable. However, some people report experiencing digestive distress — like constipation — after taking iron supplements, and both children and adults can be at risk for overdosing if they take too much at once.
If taking iron supplements, it’s important to check in with your doctor about dosing recommendations and discuss any potential side effects. It’s also important to be mindful of how often you take these supplements. Suchdev says that in contrast to a daily multivitamin, most iron supplements work best if they are taken a few times a week, as opposed to every day.
For both dietary iron and iron supplements, the treatment is only as good as your body can absorb — and tolerate — it.
“The problem with eating iron, whether it’s coming from meat sources or supplementation by pills, is that absorption is heavily affected by other medications and other medical conditions,” as well as the general environment of someone’s digestive system, says Dr. Ahmed Sawas, a hematologist at Columbia University Irving Medical Center. Most importantly, he adds, iron absorption relies on an acidic stomach.
Sawas explains that iron in the foods you eat, particularly in meat, is bound to protein in the food. For the body to best utilize the iron, an acidic stomach environment and strong digestive enzymes are needed to separate it from the protein. While some people’s body’s may make quick work of this, others may struggle to reap the benefits of foods high in iron.
Antacid drugs like proton pump inhibitors can make it increasingly hard for people to absorb iron. Further, surgeries like the gastric bypass surgeries can inhibit a person’s iron absorption capabilities, Sawas adds.
IV iron treatment for anemia
IV iron can be a good alternative for people who cannot absorb dietary iron or iron supplements, or who need to restore their iron supplies quickly. However, the treatment is not accessible or affordable for everyone.
In an IV iron treatment, also referred to as an iron infusion, liquid iron slowly enters a patient’s vein — typically a vein on the arm — through an IV. The iron used is made in a lab and does not come from a donor, making the treatment less risky than other infusions like a blood transfusion.
However, it is not free of risks altogether, and it is possible to have allergic reactions from IV iron.
An IV iron treatment can last anywhere from about 30 minutes to a few hours, depending on how much iron is being dispensed. People may need multiple iron infusions to treat their anemia. Exactly how many infusions a person needs and how frequently they need to receive them — such as weekly, biweekly or monthly — will vary based on individual scenarios and their doctor’s advice.
When Is Anemia Treated as a Medical Emergency?
Broadly speaking, the lower a person’s hemoglobin number, the more severe their case of anemia may be. However, numbers don’t account for everything — like vulnerabilities or coexisting conditions — so doctors can’t just look at a chart to decide if one person’s cases of anemia is better or worse than someone else’s.
Being said, the National Cancer Institute grades anemia’s severity on a scale of mild to life-threatening, based on hemoglobin numbers.
The scale is as follows:
— Mild anemia: Hemoglobin levels of 10 grams per deciliter to the lower limit of normal, which would be up to about 13.5 grams per deciliter for men or 12 for women
— Moderate anemia: Hemoglobin levels of 8 to 10 grams per deciliter
— Severe anemia: Hemoglobin levels 6.5 to 7.9 grams per deciliter
— Life-threatening anemia: Hemoglobin levels lower than 6.5 grams per deciliter
Blood transfusions for anemia
People with severe or life-threatening anemia are at times recommended more expedited treatments, like blood transfusions, to raise their red blood cell count. A blood transfusion is an emergency intervention to raise a person’s blood count.
Like an iron infusion, it involves placing an IV into one of your veins — commonly in the arm — and hooking that up to a bag of blood that has been donated to the hospital for these types of purposes. Duration can vary, but the process may take a few hours. Like other kinds of IV drips, the blood will slowly drip down the bag, through the IV and into the patient’s arm, replenishing their red blood cell supply.
While the process is smooth and easy for many, blood transfusions can be risky for others. The body does not always readily accept blood from an outside source and can at times respond poorly — exhibiting an immune reaction such as hives — during a blood transfusion. Due to the potential for complications, patients who undergo blood transfusions are typically required to sign paperwork consenting to the intervention, first. Also due to potential risks, blood transfusions are reserved for those who need them most.
While the blood-transfusion threshold continues to be debated, this intervention is typically recommended for people with hemoglobin levels lower than 7 to 8 grams per deciliter.
Some, but not all, people who undergo blood transfusions may also need IV iron treatments in the weeks or months to come.
Anemia Prevention
Preventing anemia can require patients to be proactive about taking care of their health. This can mean following a nutritious diet — with key nutrients like iron and folate — and scheduling regular check-ups.
Because people can experience anemia for some time without symptoms, simply calling up your doctor when you feel faint won’t help you catch a case before it starts. Instead, Sawas recommends setting up yearly appointments with a primary care doctor so that they can evaluate your hemoglobin levels (this is done in common blood panels, offered at most physical exams), and assess your risk for anemia. This is particularly important for young women and other people who may be at higher risk for anemia, he says.
“That’s probably my biggest advice,” Sawas says. “Nutritionally, I think people should eat a balanced diet to prevent anemia specifically — eating good, healthy fruits is also good. But if you’re going to avoid meat, you probably need to consider supplementing the iron.”
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Anemia: Signs, Treatment and Prevention originally appeared on usnews.com
Update 09/10/24: This story was previously published at an earlier date and has been updated with new information.
