Anemia
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Anemia


Signs and Symptoms
What Causes It?
What to Expect at Your Provider's Office
Treatment Options
Following Up
Special Considerations
Supporting Research
  

Anemia happens when your blood does not have enough red blood cells to properly carry oxygen to your organs and tissues. Because your body doesn't get enough oxygen, you feel tired -- one of the primary symptoms of anemia.

Your blood contains three types of cells -- white blood cells, which fight off infection; platelets, which help blood to clot; and red blood cells, which carry oxygen from your lungs throughout your body. Red blood cells are made in your bone marrow. They contain hemoglobin, an iron-based protein that helps blood cells carry oxygen. With anemia, your body eitherdoesn't make enough red blood cells or loses them faster than they can be replaced.

There are several types of anemia. The most common type is iron deficiency anemia, caused by a lack of iron in your body. Other types include:

  • Vitamin deficiency anemia, megaloblastic anemia -- caused by a lack of folic acid and vitamin B12 in your body.
  • Anemia of chronic disease -- caused when certain chronic diseases (such as cancer, kidney failure, or Crohn's disease) interfere with the production of red blood cells.
  • Aplastic anemia -- caused when bone marrow can't make all three types of blood cells. Aplastic anemia is life threatening.
  • Hemolytic anemias -- caused when red blood cells are destroyed faster than the bone marrow can replace them.
  • Sickle cell anemia -- caused by a type of hemoglobin that makes red blood cells form a crescent or sickle shape. These sickle cells die early, meaning the body is always short of red blood cells. The abnormal shape can block blood flow through small vessels, causing pain. Sickle cell anemia is an inherited condition that affects mainly people of African, Mediterranean, Arabic, or South American descent.

Signs and Symptoms

Symptoms of anemia can be mild at first, and can be mistaken for other symptoms of other conditions. They include:

  • Tiredness
  • Weakness
  • Shortness of breath
  • Pale skin
  • Lightheadedness
  • Headache
  • Feeling cold
  • Rapid heartbeat and chest pain

What Causes It?

Anemia may have the following causes:

  • Iron deficiency anemia -- Blood loss, such as from an ulcer or heavy menstruation or after surgery; not getting enough iron in your diet; pregnancy; side effect of medication
  • Vitamin deficiency anemia -- Not getting enough folic acid and vitamin B12 in your diet, or not being able to absorb these vitamins (due to celiac disease, for example); side effect of medication
  • Aplastic anemia -- May be caused by an autoimmune disorder
  • Hemolytic anemia -- Can be caused by medication, autoimmune disorders
  • Sickle cell anemia -- Inherited

What to Expect at Your Provider's Office

Anemia is often caused by another disease. Your doctor will draw blood and run lab tests, including a complete blood count (CBC) that measures the amount of red blood cells and hemoglobin in your blood. If you are anemic, your doctor may run more tests to see what type of anemia you have.

Treatment Options

What's causing your anemia -- and how serious it is -- will determine your treatment. Your doctor may suggest changes in your diet to make sure you get all the nutrients you need, such as vitamin B12, iron, and folic acid. Your doctor may also suggest nutritional supplements or medication. If your anemia is due to an underlying disease, your doctor will treat that disease.

Drug Therapies

  • Erythropoietin plus iron -- for anemia of chronic disease. Erythropoietin is a hormone that stimulates the production of red blood cells
  • Corticosteroids (such as prednisone) -- for some hemolytic anemias. Corticosteroids suppress the immune system, and may help when anemia is caused by an autoimmune disorder
  • Medications that suppress the immune system, such as antithymocyte globulin or ATG and cyclosporine -- for aplastic anemia

Surgical and Other Procedures

  • Removal of the spleen (splenectomy) -- may be needed in cases of hereditary spherocytosis
  • Transfusions -- may help treat certain types of anemia, including anemia of chronic disease, sickle cell anemia, and aplastic anemia
  • Bone marrow or stem cell transplant -- may be used in severe cases of aplastic anemia or some cases of sickle cell anemia

Complementary and Alternative Therapies

Most often, anemia is caused by a lack of iron or vitamins. Making changes in your diet or taking supplements usually help. You should, however, find out from your doctor what's causing your anemia. For example, too much iron is toxic, and you should not take supplements unless you have iron deficiency anemia and your doctor recommends them. Herbal and nutritional treatments may help when used along with medical treatment.

Nutrition and Supplements

Iron -- Ferrous fumerate, glycerate, or sulfate are the forms of iron your body can absorb most easily. Always ask your doctor before taking an iron supplement. Taking a smaller dose three times a day or taking iron with meals may reduce side effects. If you miss a dose, don't take an extra dose the next time. Keep iron supplements away from children. Even a little excess iron can be fatal. Dietary sources of iron include red meat, especially calf liver, beans, beet greens, blackstrap molasses, almonds, and brewer's yeast. Green leafy vegetables contain both iron and folic acid.

Vitamin C (250 - 500 mg 2 times per day) helps your body absorb iron. Dietary sources include citrus fruits and juices, tomatoes, broccoli, and cauliflower. Vitamin C supplements may interact with other medications, including chemotherapy drugs, estrogen, warfarin (Coumadin), and others.

Vitamin B12 (1,000 mcg via injection once a day for 1 - 2 weeks, then every 1 - 3 months; or orally, 1,000 - 2,000 mcg per day) helps in cases of vitamin deficient or pernicious anemia. Dietary sources include liver, meats, eggs, tuna, and cheese. People with pernicious anemia cannot absorb the proper amount of vitamin B12 and may need lifelong supplements.

Folic acid (400 - 1,000 mcg per day) -- For folic acid deficiency, which can cause anemia. Good food sources include green leafy vegetables, orange juice, and grains. Taking folic acid supplements can hide a vitamin B12 deficiency, so always take vitamin B12 when taking folic acid. Folic acid may interact with the chemotherapy drugs 5-fluorouracil and capecitabine (Xeloda). It may also interact with the antiseizure drugs phenytoin (Dilantin), phenobarbital, and primidone (Mysoline).

Blackstrap molasses, also known as pregnancy tea (1 tbs. per day in a cup of hot water), is a good source of iron, B vitamins, and minerals. Blackstrap molasses is also a very gentle laxative.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, take herbs only under the supervision of a health care provider.

  • Spirulina, or blue-green algae, may treat some anemias. Dose is 1 heaping tsp. per day. If you take medications to suppress your immune system, ask your doctor before taking spirulina.
  • Alfalfa (Medicago sativa), dandelion (Taraxacum officinale) root or leaf, burdock (Arctium lappa), and yellowdock (Rumex crispus) have traditionally been used to fortify and cleanse the blood. For mild cases of anemia, they may help bring levels of hemoglobin into normal range. Dosage is 1 tbs. per cup of water. Simmer roots for 20 minutes and leaves for 5 minutes. You may use a single herb, or a combination of these four herbs. These herbs may interact with several medications, including warfarin (Coumadin), lithium, and digoxin, among others. 
  • Gentian (Gentiana lutea) is often used in Europe to treat anemia by stimulating the digestive system to more easily absorb iron and other nutrients. Chinese herbalists do not use gentian if someone has chronic pain or frequent urination. Add 1 tsp. powdered dried rhizome to 3 cups of water. Take 1 tbs. about a half hour before eating. Gentian may lower blood pressure, so be careful if you already take medication for high blood pressure. Taking gentian could cause your blood pressure to drop too low.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of anemia based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

A homeopath will usually consider anemia as symptomatic of an underlying condition, and treat that condition.

  • Ferrum phosphoricum -- For iron deficiency
  • Calcarea phosphorica -- Particularly for children with nighttime bone aches, cool hands and feet, lack of energy, or poor digestion

Following Up

Eating a normal, balanced diet is very important if a nutrition problem is causing your anemia. You should avoid drugs that can cause stomach problems and too much alcohol if they are causing your anemia.

Special Considerations

Complications from anemia can range from loss of productivity due to weakness and fatigue to coma and death.

Pregnant women need more iron and folic acid than normal. A folic acid deficiency during pregnancy can cause birth defects know as neural-tube defects, such as spina bifida.

Supporting Research

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

CDC Recommendations to prevent and control iron deficiency in the United States. Centers for Disease Control and Prevention. MMWR Recomm Rep 1998;47:1-29.

Elia M. Oral or parenteral therapy for B12 deficiency. Lancet. 1998;352:1721-22.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

McClung JP, Karl JP, Cable SJ, Williams KW, Nindl BC, Young AJ, Lieberman HR. Randomized, double-blind, placebo-controlled trial of iron supplementation in female soldiers during military training: effects on iron status, physical performance, and mood. Am J Clin Nutr. 2009 Jul;90(1):124-31.

Mozaffari-Khosravi H, Noori-Shadkam M, Fatehi F, Naghiaee Y. Once Weekly Low-dose Iron Supplementation Effectively Improved Iron Status in Adolescent Girls. Biol Trace Elem Res. 2009 Aug 4. [Epub ahead of print]

Peña-Rosas JP, Viteri FE. Effects and safety of preventive oral iron or iron+folic acid supplementation for women during pregnancy. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD004736.

Selmi C, Leung PS, Fischer L, German B, Yang CY, Kenny TP, Cysewski GR, Gershwin ME. The effects of Spirulina on anemia and immune function in senior citizens. Cell Mol Immunol. 2011 May;8(3):248-54.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995:181.

Watanabe F. Vitamin B12 sources and bioavailability. Exp Biol Med (Maywood). 2007 Nov;232(10):1266-74. Review.


Review Date: 12/30/2011
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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