• Pallor (pale skin)
• Fatigue or exhaustion
• Weakness
• Dizziness
• Shortness of breath
• Abnormal or fast heartbeat
• Headache
• Difficulty thinking clearly
• Cold hands and feet
• Chest pain
• Pounding or a “whooshing” sound in ears

Many of these symptoms can be mistaken for other conditions. It is important to see your healthcare provider if you experience any of the above signs or symptoms. Because some cases of anemia are caused by internal bleeding, treating yourself at home is not a safe decision.

Aplastic anemia. A rare type of anemia caused by the failure of bone marrow to make an adequate supply of red blood cells. The few blood cells that the bone marrow are normal.

Hemolytic anemia. Characterized by the destruction of healthy red blood cells in the bloodstream or the spleen.

Iron deficiency anemia. Caused by a dietary lack of iron. Iron-deficiency anemia is the largest cause of anemia worldwide due to malnourishment or poor nutrition.

Vitamin deficiency anemia. Similar to anemia caused by iron-deficiency. Folic acid and vitamin B12 are both crucial vitamins used to produce red blood cells. A nutritional deficiency in either of these vitamins will cause this state of anemia.

Pernicious anemia. This type of anemia is caused by a nutritional deficiency due to the inability of the stomach to absorb vitamin B12. The lack of B12 causes an excess of large, fragile blood cells.

Sickle cell disease. An inherited type of hemolytic anemia characterized by the production of abnormally shaped red blood cells. These misshapen cells are rigid and clog circulation.

Thasellemia. An inherited type of anemia caused by a defective gene that produces abnormal hemoglobin leading to the destruction of red blood cells.

Women who are in their childbearing years have the highest risk for anemia. This is because some women bleed heavily during monthly cycles. Anemia rates are also very high during the first two trimesters (6 months) of pregnancy when the liquid portion of blood increases very quickly and the blood cells are essentially diluted.

Newborns and infants are also at risk. Babies do not produce iron quickly enough and most of their iron stores in the first few months come from their mother. They need to be fed iron-fortified formula or mom needs adequate iron in her diet if breastfeeding. Cow’s milk does not provide enough iron for babies up to 2 years of age and puts them at risk for anemia.

Risk factors for other types of anemia include:

• Surgery (blood loss)
• Trauma (blood loss)
• Low dietary intake of iron, vitamin B12, and folic acid
• Genetic disorders in the family (e.g., sickle cell anemia; thalassemia)
• Diseases that cause anemia (e.g., kidney disease; cancer; diabetes; liver disease)
• Long-term infections in the body
• Autoimmune conditions

If you have symptoms or risk factors for anemia, you will need to see your healthcare provider who will take a thorough medical and family history. If you do not have symptoms of anemia but are at risk, your doctor may test for anemia during a routine physical. Pregnant women and infants are routinely checked.

The doctor will do a physical examination and check your pulse for a fast heart rate, watch your breathing for rapid breaths, feel your liver and spleen for enlargement, and check for skin pallor. Sometimes, anemia can be caused by blood loss in the digestive tract, so they may perform a rectal test for blood.

You will likely have a blood workup to check for the number of red blood cells and amount of hemoglobin in the blood. This can almost always give a positive diagnosis of anemia. Depending on your history and physical, these tests include:

• Complete blood count (e.g., hemoglobin; hematocrit; platelets)
• Iron levels
• Ferritin
• Transferrin level
• Total iron-binding capacity
• Hemoglobin electrophoresis (if certain genetic causes are suspected, like thalassemia or sickle cell)
• Reticulocyte count (checks for new red blood cells)
• Vitamin B12 levels

If the above results from these are inconclusive, more tests may be performed to find the cause of anemia. These may include scoping the digestive tract to look for bleeding and a bone marrow biopsy. You may also be tested for kidney disease.

Once anemia is diagnosed, your doctor will determine the best treatment based on its cause.

Blood loss. Stop bleeding and giving blood transfusions. Since blood is rich in iron, an essential component of hemoglobin, iron replacement is also given.

Iron deficiency. Treatment is aimed at correcting the deficiency. Mild cases are usually treated with diet and moderate cases are treated with iron supplementation. This should be carefully monitored because taking iron supplements in large amounts can be toxic. If the problem lies with another vitamin deficiency, those vitamins will be replaced such as vitamin C, vitamin B12, and folic acid.

Chronic disease. The underlying disease that is causing the anemia must be brought under control. Short-term treatments include blood transfusions (in liver and kidney disease), and erythropoietin injections that can stimulate the bone marrow to make more red blood cells.

Bone marrow disorders. Bone marrow helps to make red blood cells. A bone marrow transplant may be needed.

Hemolytic anemia. In this case, your anemia can be controlled by stopping the processes in the body that are damaging red blood cells. This includes suppressing the immune response, removing the spleen, or cleaning the blood with plasmapheresis. In severe cases of thalassemia or sickle cell disease, blood transfusions may be given.

Anemia should always be evaluated and diagnosed by a doctor. In milder cases, the doctor may allow you to try certain home remedies to help bring up your iron stores. These include:

• Iron rich diet
• Including beans, iron enriched breads and cereals, spinach and lean meats
• Blackstrap molasses
• An “apple a day”
• Cook in cast iron skillet
• Dandelion or alfalfa

American Society of Hematology. (2020, December 30). Anemia. Retrieved from hematology.org: https://www.hematology.org/education/patients/anemia/iron-deficiencyCleveland Clinic Staff.

Anemia. (2020, April 06). Retrieved from Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/3929-anemia

Medline Plus. (2020, November 30). Anemia. Retrieved from Medline Plus: https://medlineplus.gov/anemia.html

NIH. Avoiding anemia. Retrieved from National Institute of Health: https://newsinhealth.nih.gov/2014/01/avoiding-anemia

Soundarya, N., & Suganthi, P. (2016, November). A review on anaemia – types, causes, symptoms, and their treatments. Journal of science and technology investigation. Retrieved from https://www.researchgate.net/publication/324247750_A_review_on_anaemia_-_types_causes_symptoms_and_their_treatments

World Health Organization. (2006). Worldwide prevalence of anaemia 1993-2005. Retrieved from Centers for Disease Control and Prevention Atlanta: https://apps.who.int/iris/bitstream/handle/10665/43894/9789241596657_eng.pdf;jsessionid=20EE801AD43D1EA613AB1A2248EA7E51?sequence=1