The National Heart, Lung and Blood Institute estimates that more than 3 million Americans have some form of anemia, but many people don’t realize it. “It’s fairly insidious in its onset,” said Mark Goldberg, MD, a hematologist at Brigham and Women’s Hospital in Boston. Anemia may signal a serious underlying illness, so it’s important to spot and treat it as soon as possible.
Anemia is a common blood disorder in which the body has a deficiency of red blood cells or the iron-rich protein hemoglobin needed to carry oxygen from the lungs through the body. “The main symptom is fatigue, but most people don’t recognize the fatigue and will just adapt to it,” said Dr. Goldberg. Other common symptoms include dizziness, headaches, or shortness of breath.
“The symptoms can creep up on you,” said Anuradha Paranjape, MD, chief of internal medicine at Temple University School of Medicine in Philadelphia. “Most often we hear people saying, ‘Doc, I’ve been tired for months but can’t figure out why.’”
Anemia is usually detected with a routine test known as a complete blood count (CBC). Even once anemia is diagnosed, it may not be obvious what is causing it and what is the best form of treatment.
Aplastic anemia is a condition in which the bone marrow doesn’t produce enough red blood cells. Hemolytic anemias, on the other hand, occur when red blood cells break up in the bloodstream. Blood transfusions and a bone marrow transplant are treatment options for both types of anemia.
The most common form of the disorder is iron-deficiency anemia. According to the American Society of Hematology, it’s usually brought on by blood loss that could be associated with internal bleeding or a heavy menstrual period. It can also be triggered by insufficient iron in a person’s diet, a problem with the small intestine’s ability to absorb iron, or a sharp drop in iron levels during pregnancy.
“Even if the doctor figures out you’re iron deficient, it’s important to also figure out why,” said Goldberg. “When there’s anemia, we pretty much always evaluate the GI tract and look for ulcers and tumors, as those are very serious causes of anemia that need to be addressed.”
One way of identifying the underlying cause of anemia is with a reticulocyte or young red blood cell count. A high reticulocyte count suggests red blood cells are being produced but getting lost in the body; whereas a low count indicates insufficient red blood cell production or a nutritional iron deficiency.
If it’s determined that blood loss is to blame, then it’s critical to “both get the bleeding to stop and replace the iron lost,” said Patrick Foy, MD, a hematologist at Froedtert Lutheran Hospital and the Medical College of Wisconsin.
“If you’re losing blood from somewhere, once you address that the anemia will go away fairly quickly,” said Paranjape. “For iron-deficiency, it’s pretty straightforward whether you take an iron supplement or adjust your diet.”
“Particularly if you’re a vegan [who doesn’t eat meat, eggs, or dairy], you’re going to run low not only on iron but vitamin B12 and folic acid, which also help produce healthy red blood cells” said Dr. Foy. For those patients, Paranjape recommends foods fortified with iron and vitamin B12, such as cereals, bread products, and soy milk.
According to the Mayo Clinic, untreated iron-deficiency anemia can lead to serious health concerns including a rapid or irregular heartbeat, developmental delays in children, and, in pregnant women, an increased risk for premature births and low birth weight babies. A recent study from researchers at the University of California, San Francisco suggests that older adults with anemia may be more likely to develop dementia.
“There are so many different causes and degrees of anemia,” said Goldberg. “It’s important to identify which one you have in order to get the best treatment.”