Last updated date: 11-Mar-2024

Medically Reviewed By

Medically reviewed by

Dr. Lavrinenko Oleg

Medically reviewed by

Dr. Hakkou Karima

Originally Written in English

All you need to know about anemia


    Anemia occurs when there are less healthy red blood cells in the body than normal. The purpose of the red blood cells is to transport the oxygen to all of the body’s tissues and organs. Therefore, if blood contains a low number of red blood cells, so is the oxygen level.

    The symptoms induced by anemia are the result of decreased oxygen levels in the vital organs and tissues.

    In order to measure anemia, we measure the amount of hemoglobin. If the level of hemoglobin is normal, there is no anemia. But, the lower the level of hemoglobin goes, the deeper anemia gets.

    According to the World Health Organization, one-third of the women worldwide who are at a reproductive age suffer from anemia. Furthermore, globally, 40% of pregnant women and more than 40% of children under 5 years old suffer from anemia.


    What causes Anemia?

    The usual lifespan for red blood cells is between 100 and 120 days. Normally, a healthy person’s body daily replaces 0.8% or even up to 1% of total red blood cells. In order to keep this process day-to-day ongoing, it is essential to follow a diet that contains iron, vitamin B-12 and folate.

    Anemia could occur as a result of processes that affect the balance of the restoring blood cells process, such:

    • By decreasing the production of red blood cells;
    • By increasing the destruction of red blood cells.

    Elements that contribute to a decreased production of red blood cells are:

    • Following a diet that lacks  iron, vitamin B-12, or folate;
    • Hypothyroidism;
    • Insufficiently stimulate the red blood cells production with erythropoietin, which is a hormone that is produced by the kidneys.

    Elements that stimulate the destruction of red blood cells are usually related to hemorrhages, which are caused by factors such as:

    • Endometriosis;
    • Accidents;
    • Surgery;
    • Gastrointestinal lesions;
    • Cirrhosis, which involves scarring of the liver;
    • heavy Menstruation;
    • Childbirth;
    • Uterine over bleeding;
    • Fibrosis (scar tissue) within the bone marrow;
    • Hemolysis: a rupture of red blood cells that can occur with some medications;
    • Liver or spleen disorders;
    • Genetic disorders such as: glucose-6-phosphate dehydrogenase (G6PD) deficiency; thalassemia or sickle cell anemia.

    Globally, the main cause of anemia is the deficiency of iron. It is linked to almost half of all cases of anemia and it is also an impactful nutritional disorder at a macro scale.


    Anemia Symptoms

    The most common symptoms of anemia are the pale color of the skin and the feeling of being cold.

    Moreover, those who suffer from anemia could also have symptoms such as:

    • Dizziness, usually during physical activities or just when standing up;
    • Cravings that are atypical, just like the appetite for ice, dirt or clay;
    • Constipation
    • Focusing problems and fatigue;
    • Tongue inflammation, which could make the tongue look glossy red and painful.

    If the anemia gets severe, the symptoms might become more intense. In case of an acute anemia nails could become fragile and breakable, there is a high possibility of fainting and often shortness of breath and chain pains could occur, as well.

    In the case of a person who suffers from severe anemia, the blood oxygen levels could get so low that the person could suffer from a heart attack. Also, if suffering of severe anemia, a physical check could point to symptoms such as:

    • Low or high blood pressure;
    • Pale or yellow skin;
    • An increased heart rate;
    • A heart murmur;
    • Enlarged lymph nodes;
    • Enlarged spleen or liver.

    If you suffer from anemia, If you are experiencing chest pains or fainting, it is very important to consult a doctor and get immediate medical attention.


    Anemia Diagnosis

    Anemia diagnosis

    The process of diagnosing anemia commences with a physical exam along with a check of the personal and family health history. It could seriously make a difference if it is known from the beginning that the family health history contains certain types of anemia, such as sickle cell anemia. Moreover, it is very important to know, as well, if the patient has been exposed to toxic agents, in order to filter in or out a possible environmental cause.


    Types of Anemia 

    Iron deficiency is known to be the most common nutritional disorder worldwide. It affects massive numbers of women and children in developing countries and it is also the one and only nutrient deficiency that affects persons from the industrialized countries, as well.

    In order to transport the oxygen from the lungs to the rest of the organs and tissues, the body requires iron, which is one of the main ingredients of the healthy red blood cells. Iron deficiency anemia is the result of low-iron intake for long periods of time. The iron deficiency anemia can also be caused by significant blood loss or other medical conditions that could interfere with iron absorption process from the gastrointestinal tract.

    Megaloblastic anemia is based on deficiency of Vitamin B9 (Folate) or Vitamin B12 (cobalamin).  The body requires folates and cobalamin to create the needed amount of red blood cells to transport the blood to the organs and tissues. Just like the iron deficiency anemia, megaloblastic anemia is the result of low vitamin intake. The less vitamins are intake, the less red blood cells are produced. Unfortunately, there are also cases of persons who are consuming the needed amounts of vitamins, but due to some specific medical conditions, their bodies are not able to absorb them. This is one of the causes of vitamin deficiency anemia, which is also referred to as pernicious anemia. The pernicious anemia could massively affect the nerves or it can stimulate different degrees of neuropathy. Moreover, a severe case of pernicious anemia could lead from confusion and irritability even to dementia.

    The second most spread type of anemia worldwide is the anemia of chronic disease. It can be referred to as inflammation anemia, as well. It is called so as it appears only when there is another illness or medical condition that is already affecting the body, such as chronic diseases or viral infections such HIV or as autoimmune disease such as lupus, arthritis or inflammatory chronic bowel disease.

    Hemolytic anemia is the kind of anemia that is represented by the fact that the red blood cells are destroyed quicker than they are produced. This process of red blood cells destruction is called hemolysis. Without the proper amounts of red blood cells, the body is unable to carry the oxygen to the organs and tissues, therefore, it is unable to optimally work.

    The hemolytic anemia could be inherited or acquired. The inherited hemolytic anemia occurs when the parents transfer the responsible gene to their child or children. The acquired hemolytic anemia is a medical condition that is developed in time. The main symptoms of hemolytic anemia are:

    • Absolute paleness or even lack skin color;
    • Yellowish skin, eyes, and mouth (jaundice);
    • Dark-colored urine;
    • Fever;
    • Confusion;
    • Lack of energy for physical activities;
    • Enlarged spleen and liver;
    • Increased heart rate (tachycardia);
    • Heart murmur;
    • Weakness;
    • Dizziness.

    Sickle cell anemia is actually an inherited disorder of the red blood cells. This disorder is represented by the fact that there are not enough red blood cells to transport the oxygen because of their deformation.

    In normal situations, the red blood cells are flexible and they can easily move throughout the blood vessels. In the situation of sickle cell anemia, the red blood cells change their form and structure and they become rigid and shaped as sickles or crescent moons. Due to their form and stiffness, the affected red blood cells can obstruct the blood vessels and slow down or even block the blood flow, resulting in less oxygen carried to the organs and tissues. Up to now, there are no cures available for this type of anemia, but the symptoms can be improved by treatment.

    Fanconi anemia is a genetic disorder which is very rare. Most of the patients that are diagnosed with Fanconi anemia are not even 10 years old and only about 10% of all the Fanconi anemia patients are diagnosed when they are adults. Usually, it is diagnosed in children as in case that they are affected by this disorder, they are born with malformations, such as small size, abnormal thumbs, skin pigmentation, small heads, small eyes, abnormal kidney structures or cardiac and skeletal anomalies. It is highly associated with progressive deficiency of all types of bone marrow production of cells. The persons that are affected by this rare disorder are prone to develop cancer of blood-forming cells in the bone marrow which are referred to as acute myeloid leukemia (AML), or tumors of the head, neck, skin, gastrointestinal system, or genital tract. This type of anemia affects both women and men equally.

    Thalassaemia is a kind of inherited anemia that alters the process of producing hemoglobin. Therefore, the levels of red blood cells are highly affected by this medical condition. Due to the way that this condition affects the body, those who suffer from it could become deeply anemic. It is known that thalassaemia usually affects Mediterranean, Middle East and South Asian persons. Thalassaemia is divided into two types, depending on its severity:

    • Alpha thalassaemia;
    • Beta thalassaemia.

    Thalassaemia does not cause other health problems, but it can be inherited by children. The main health problems associated with thalassaemia are:

    • Anaemia – acute tiredness, weakness, shortness of breath palpitations and pale skin caused by the lack of red blood cells;
    • High amount of iron in the body – this is related to the regular blood transfusions used to treat anaemia and it can result in problems with the heart, liver or hormone levels, in case it is left untreated.

    Aplastic anemia is another type of anemia that appears when the body is not producing newer blood cells. People affected by this type of anemia can become very exhausted and prone to infections and hemorrhages. This type of anemia is rare, but it can appear at any age. It could occur gradually or suddenly and get worse in time. 

    Aplastic anemia can be treated with medications. In more complicated situations, the treatment could also include blood transfusions or even stem cell transplants.

    In some situations aplastic anemia can occur and it can be silent. But in other situation the aplastic anemia signs and symptoms are:

    • Shortness of breath;
    • Rapid or irregular heart rate;
    • Pale skin;
    • Unexplained or easy bruising;
    • Epistaxis and bleeding gums;
    • Skin rash (anemia rash);
    • Fatigue;
    • Frequent or prolonged infections;
    • Prolonged bleeding from cuts;
    • Dizziness;
    • Headache;
    • Fever.


    Anemia during Pregnancy

    During pregnancy, the blood of women can often lack enough healthy red blood cells and less oxygen reaches to the tissues and to the baby. This could be caused by the fact that the body produces more blood than usual, in order to sustain the baby, so the woman's body does not get enough iron or other necessary nutrients that contribute to this process.

    It is common for women to suffer from mild anemia episodes during pregnancy. Unfortunately, in situations of serious episodes of anemia, the low levels of iron and nutrients could be related to a more harmful medical condition than the diet.

    In cases of mild anemia episodes, the main symptoms of pregnant women are to feel tired and weak. But if the anemia gets severe and it is not well treated, it could lead to preterm delivery.

    Pregnant women could develop various types of anemia. The most common types of anemia that occurs within pregnant women are:

    • Iron-deficiency anemia;
    • Folate-deficiency anemia;
    • Vitamin B12 deficiency.

    These types of anemia are the most common types throughout pregnant women for many reasons.

    The iron-deficiency anemia is the most common type of anemia throughout pregnant women. It occurs due to the fact that the body lacks the necessary amounts to produce hemoglobin, which is a protein that has the role of transporting the oxygen from the lungs to all over the body. If there is a deficiency of iron, the blood is not able to deliver enough oxygen to all of the body’s tissues.

    The folate-deficiency anemia is considered a potentially dangerous type of anemia. In order to produce new cells and healthy red blood cells, the body requires folates. The body can absorb folates from a healthy diet based on green and leafy vegetables, especially.

    The  folate-deficiency anemia could be harmful for the baby and it could lead to some birth defects, such as neural tube abnormalities or low birth weight.

    As women need extra folate when they are pregnant, the diets they follow might not cover the necessary amount. Therefore, in order to help the body produce enough red blood cells that carry the oxygen from lungs to the tissues, pregnant women should try supplements that could improve the situation. The supplements used to improve this kind of anemia are based on folic acid.

    Vitamin B12 is another ingredient that the body uses in order to create healthy red blood cells. During pregnancy, if women do not consume meat, dairy products and eggs, they are most probably not getting the needed amount of vitamin B12 and the body becomes unable to produce the red blood cells. The deficiency of Vitamin B12 in women could be an important factor of anemia during pregnancy. This could lead to other complications such as birth defects, neural tube abnormalities or even preterm labor.

    Moreover, the loss of blood during childbirth can be another cause for anemia.

    During pregnancy, all women are prone to become anemic. This is caused by the fact that their bodies need bigger amounts of iron and folic acid, in order to help the baby grow.

    The symptoms of anemia that most of the pregnant women accuse are:

    • Feeling tired or weak;
    • Rapid heartbeat;
    • Trouble concentrating;
    • Dizziness;
    • Shortness of breath;
    • Pale skin, lips, and nails.

    The bigger risks of anemia throughout pregnant women are at those who:

    • Are pregnant with multiples (more than one baby)
    • Have had two pregnancies in a short period of time, like one after another;
    • Are used to vomit in the mornings, due to morning sickness;
    • Are very young, such as teenagers;
    • Have diets that are not containing the necessary amount of iron;
    • Had other anemia episodes before getting pregnant.

    If you do not know that you are anemic, you could easily confuse the symptoms of anemia with the symptoms that women usually have during pregnancy. This is due to the fact that at the beginning of anemia, it does not show any specific symptoms. This makes it very important to check the blood samples of anemia at the prenatal doctor appointments.

    The most important risks to which pregnant women are exposed to are due to iron deficiency anemia, anemia resulting from loss of blood or to folate deficiency anemia.

    The risks of severe or not treated iron-deficiency anemia could be a preterm and low weight baby at birth, a massive loss of blood during birth, postpartum depression; a baby that has anemia or developmental delays.

    In case of untreated folate-deficiency anemia, the risks to which pregnant women are exposed to are preterm and low-birth-weight delivery or it could seriously affect the spine or brain of the baby.


    Anemia Test

    In order to accurately diagnose anemia, doctors might perform different lab tests. These tests are performed to find out exactly which type of anemia the patient has and to find out which are the causes.

    The complete blood count test (CBC) has the purpose of indicating the number and the size of the red blood cells. Moreover, this test also indicates the levels of the other blood cells.

    The serum iron level test indicates if the iron deficiency is the actual cause of anemia.

    Other blood tests may be performed, in order to  detect the cause of anemia. Which are:

    • The ferritin test, it is performed to analyze the iron store;
    • The Vitamin B-12 test, it indicates the level of B-12 Vitamin;
    • The folic acid test indicates if serum folate level is up or low.

    A stool test may also be performed. The procedure of the test is to apply a specific chemical to the stool specimen, in order to detect blood. In case the result is positive, it is considered that blood is leaking from the gastrointestinal tract. Therefore, the leaking could be anywhere from the mouth to the rectum. This situation may be caused by colon cancer or by stomach ulcer.

    The results of the mandatory set of tests that are performed in order to detect anemia might indicate that further corroboration is needed. Therefore, there are performed additional tests, such as:

    • Upper gastrointestinal endoscopy;
    • Colonoscopy;
    • CT scan of the abdomen and pelvis;
    • X-ray of the chest.


    Anemia Treatments

    Anemia treatments

    The treatment of anemia is highly dependent on its cause.

    For example, if anemia is caused by insufficient amounts of dietary iron, vitamin B-12 or folate, it could be usually corrected with nutritional supplements, in order to reestablish the balance. If the digestive tract does not absorb the Vitamin B-12 from the dietary supplements, injection of Vitamin B-12 might be needed.

    Normally, the doctor prescribes a diet that includes the necessary amounts of vitamins, minerals or other nutrients. In most cases of anemia, a well balanced diet could reduce the possibility of recurrence.

    There are also more difficult situations, in which the anemia is labeled as severe. In such a scenario, the treatment scheme includes erythropoietin injections in order to increase the production of red blood cells within the bone marrow. Moreover, it is required to perform transfusions, when bleeding is noticed or when the hemoglobin reaches very low levels.

    Anemia is mostly treatable. As its causes could vary, it is very important to treat it in a timely manner. Any case of anemia that is left untreated could become very harmful.

    Always consult your doctor about the symptoms that you are experiencing. If you are aware of anemia in your family history, it is really important to openly speak about it to your doctor.


    Anemia diet

    In order to avoid anemia, it is highly recommended to keep a diet that is rich in the nutrients that the body needs to produce the red blood cells. Therefore, it is very recommended to keep a healthy diet. 

    The best foods to eat in order to avoid anemia or to improve its symptoms are:

    • Leafy greens, such as: spinach, kale, collard greens, dandelion greens;
    • Meat and poultry; the liver is also a very important source of iron;
    • Seafood, such as tuna or salmon; especially if they are fresh;
    • Beans, such as: soy beans; peas, lima beans and other;
    • Fortified foods like ready to eat cereals, pasta, white rice and other;
    • Dairy products like milk, yogurt, kefir, which are all rich in calcium;
    • Nuts and seeds, such as pumpkin seeds, cashews, pistachio, sunflower seeds or pine nuts.



    Generally, anemia can be avoided. In case of inherited anemia, it can also be treated. The key is to always openly discuss with your doctor about your health and to perform medical checks from time to time. A healthy lifestyle is one of the most important steps in keeping away diseases and other medical complications. An apple a day, keeps the doctor away!