Anemia: Symptoms, Signs, & Causes

By Edo Paz, MD
Medically reviewed checkmarkMedically reviewed
September 5, 2019

Exhaustion. Fatigue. That feeling that all you want to do is climb into bed and sleep for a week. Most of us who have busy lives, young children, and/or demanding jobs have experienced this at one time or another. It might just be a reality of the craziness of life or, in some cases, it might be due to a medical condition called anemia.

If the above sounds like a description of you, read on to see whether you should consider being tested for anemia.

This article will cover the following topics:

What Is Anemia

Anemia is a common blood disorder, affecting over 3 million Americans. It is defined as a medical condition in which the body does not have enough healthy red blood cells delivering oxygen to all of the tissues in the body, resulting in feelings of weakness and exhaustion.

In this article, I will describe the different types of anemia, the causes, and treatments, all of which differ depending on the specific form. It is important to note that anemia itself can be a sign of an underlying or serious illness, and we always recommend downloading the K Health App and chatting with a doctor to understand your symptoms.

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Causes of Anemia

All types of anemia are caused by a red blood cell deficiency. Before delving into the different types of anemia, it is important to understand what red blood cells are and what they do.

What Are Red Blood Cells?

Red blood cells are one of the three types of blood cells that your body creates. White blood cells work to fight infections, platelets are there to make your blood clot, and red blood cells carry oxygen throughout the body.

Hemoglobin is a protein found in red blood cells. It allows the cells to transport oxygen from your lungs to the rest of your body, and then to bring carbon dioxide back to the lungs for exhalation and release. Red blood cells cells are produced by the bone marrow, which requires certain nutrients like iron, vitamin B-12, folate and others to function properly.

You can develop anemia for any of the following reasons:

  1. Your body does not produce enough red blood cells.
  2. You experience bleeding (i.e. from heavy menstruation, a wound, an ulcer, etc.) that is causing you to lose red blood cells faster than you can replace them.
  3. Your body is destroying its own red blood cells due to an illness.

Various underlying causes can lead to each of these 3 situations, and can present themselves as different types of anemia. Let’s take a closer look at the types of anemia.

Types of Anemia

Iron Deficiency Anemia

This is the most common type of anemia and is caused by a lack of iron. Without an adequate supply of iron, bone marrow cannot produce enough hemoglobin to oxygenate the body’s tissues.

There are a few potential causes of iron deficiency, including:

Bleeding: If you are bleeding and you lose iron more quickly than your body can replace it, you can end up with iron-deficiency anemia. Bleeding may be caused by a number of reasons ranging from ulcers or polyps to long-term use of aspirin, or from donating blood frequently without enough recovery time in between donations. For women, heavy or extended menstrual periods can result in iron deficiency, as can uterine fibroids (noncancerous growths in the uterus that can cause bleeding).

Pregnancy: During pregnancy, your body requires more iron than usual and not having enough can lead to iron deficiency anemia. Studies have shown that 18% of pregnant women in the USA are iron-deficient with 5% having full-blown anemia. The risk of iron deficiency increases through each trimester of pregnancy and gets up to 28% in the third trimester.

Diet: While iron is found in both animal-based foods and some plant-based foods, the body absorbs iron from meat, chicken, and fish twice as well as it does from plant-based foods. If you are anemic, it could be caused by a lack of iron in your diet, especially if you are vegetarian or vegan. A 2015 study comparing vegetarians and meat-eaters found that 40% of the vegetarians were moderately anemic, and 60% were mildly anemic.

Inability to absorb iron: If you suffer from certain conditions such as Crohn’s Disease or Celiac, your body may have difficulty absorbing iron, causing anemia. Patients who have had gastric bypass surgery can also face this challenge.

Other Types of Anemia

Not all cases of anemia are caused by lack of iron. Here is a look at some of the other causes of anemia:

Vitamin Deficiency Anemia: Also called pernicious anemia, vitamin deficiency anemia is caused by a lack of folate and vitamin B-12, both essential ingredients that the body needs to produce healthy red blood cells. For most people with this type of anemia, it is due to a diet that doesn’t contain enough of these nutrients. There are also some people who do consume enough B-12, but whose bodies do not absorb it properly.

Anemia of Inflammation: This is caused by an underlying disease that interferes with the production of red blood cells, such as cancer, HIV, rheumatoid arthritis, kidney disease, Crohn’s disease, or other inflammatory diseases.

Aplastic Anemia: Aplastic anemia is very rare and life-threatening. It’s caused by viral infections, which impact the bone marrow, certain medications, autoimmune disorders, or exposure to toxic chemicals, and without treatment, it results in the body failing to produce enough red blood cells to survive.

Anemias associated with bone marrow disease: Diseases such as leukemia and myelofibrosis that affect the production of red blood cells in the bone marrow can also cause anemia. Depending on the specific type of cancer, the impact can range from mild to life-threatening.

Hemolytic Anemias: When red blood cells are destroyed faster than they can be replaced by the bone marrow, you can develop hemolytic anemia. This type of anemia can be genetic, or it can develop later in life because of an underlying disease (including sickle cell anemia) or as the result of an infection.

Sickle Cell Anemia: Sickle Cell Anemia is a genetic disease, usually diagnosed in babies or young children, that can be serious. It occurs when defective hemoglobin causes red blood cells to form in an abnormal shape. These misshapen, “sickle-shaped” cells die prematurely, resulting in a shortage of red blood cells and therefore, anemia.

Anemia caused by other diseases: Any disease that impacts the body’s ability to make red blood cells can cause anemia. For example, a person with kidney disease can develop anemia when the kidneys do not produce enough of a certain hormone that signals the bone marrow to produce more red blood cells. In addition, some types of chemotherapy can also impede the body’s ability to create more red blood cells and anemia is a side effect of this treatment.

Anemia Symptoms

Symptoms of anemia can vary slightly depending on the underlying cause. Particularly when caused by a chronic disease, other symptoms of the disease may completely mask the symptoms of anemia. If you are unsure if your symptoms might be anemia, you can download the K Health app and chat directly with a medical professional about your specific situation.

Generally, symptoms of anemia include:

Often, anemia starts off mild with symptoms that are barely noticeable. If not addressed, however, they will worsen over time. The most common sign of anemia is fatigue, but since many things cause fatigue it is often easy to ignore. If you feel exhausted and its combined with some of the other symptoms listed above, you may be suffering from anemia.

Iron deficiency anemia can cause one unusual symptom called Pica, which is a craving to chew or eat things that are not food, such as cardboard or dirt. It is more common in people with nutritional deficiencies, but if you have these odd cravings you should definitely check with a doctor.

Who Is at Risk for Anemia?

The truth is that anemia is quite common and can be caused by so many different things that virtually anyone is at risk for it.

There are, however, a few factors that indicate increased risk:

  • Eating a diet low in iron, vitamin B-12 and folate.
  • Being diagnosed with Crohn’s Disease, Celiac disease or any other intestinal disorder that impacts the absorption of nutrients.
  • Menstruating – particularly for women who experience heavy or prolonged periods.
  • Pregnancy – taking a multivitamin that includes folic acid and iron can help mitigate the risk of anemia during pregnancy.
  • Having a chronic condition such as cancer, kidney disease, or Diabetes that can lead to a low red blood cell count.
  • A family history of anemia.
  • A medical history of certain types of infections, blood diseases, autoimmune disorders, alcoholism, exposure to toxic chemicals, or the use of certain medications.
  • Being over the age of 65.

Because the signs of anemia can sometimes be mild and easily overlooked, if you have any of the risk factors you should check with a doctor (or check on the K Health app) if you have concerns.

How Is Anemia Diagnosed?

If your doctor suspects that you have anemia, s/he will order a simple blood test to check your red blood cell count and hemoglobin levels. A diagnosis of anemia is given if the blood test results show less than 13.5 gm/dl of hemoglobin for a man or less than 12.0 gm/dl for a woman.

There is no specific anemia test, but rather, a doctor will order a complete blood count (CBC), which is a routine blood test that counts the number of each type of cell in the bloodstream. If the test results indicate anemia, follow-up testing may be done to determine the underlying cause. These tests include a blood smear, which provides information about the shape of your red blood cells and identifies whether or not there are abnormal cells, and a reticulocyte count, which tests the number of immature red blood cells present. Both of these tests can help classify exactly which type of anemia a person has, which in turn can inform the type of treatment needed.

Treatment Options for Anemia

In general, the treatment for anemia will vary depending on the cause, for example:

Iron Deficiency Anemia: If the cause is lack of iron, the treatment can be as simple as changing your diet or taking dietary supplements. For women whose iron deficiency anemia is caused by heavy menstrual periods, treatment may include hormonal birth control or, in extreme cases, surgery such as endometrial ablation or a hysterectomy.

Chronic disease: If anemia is caused by an underlying chronic condition, then treatment of that condition should cure the anemia. In some cases, specific medication may be prescribed to treat anemia directly. For example, if you have a chronic kidney condition, you may need erythropoietin injections to help stimulate the production of more red blood cells.

Aplastic Anemia: Treatment requires medication and blood transfusions. As described above, this is a serious and life-threatening type of anemia, but it’s extremely rare, with only 600-900 people diagnosed per year in the United States.

Hemolytic Anemia: Treatment varies, depending on what exactly is causing the destruction of the body’s red blood cells. It may include antibiotics or other medications to suppress the immune system.

In cases of iron deficiency anemia in which the cause is determined to be nutritional (as opposed to blood loss or other potential causes described above), the treatment and solution may be as simple as changing your diet and eating foods that are higher in iron.

It is easier for the body to absorb iron that comes from animal-based foods such as:

  • Chicken or beef liver
  • Oysters
  • Clams
  • Beef
  • Turkey
  • Tuna
  • Eggs
  • Shrimp
  • Leg of lamb
  • Plant-based foods that are high in iron include:
  • Kidney, lima, and navy beans
  • Tofu
  • Lentils
  • Molasses
  • Spinach
  • Whole wheat bread
  • Peanut butter
  • Brown rice

When eating plant-based sources of iron, try combining them with vitamin C (such as a glass of orange juice), This will help your body absorb the iron. Also, avoid drinking coffee or tea with meals as they make it more difficult for the body to absorb iron.

What If Anemia Is Left Untreated?

Even if the symptoms of anemia start out mild, if left untreated the condition will worsen and can become quite severe with significant consequences, including:

Severe fatigue: Untreated anemia can lead to such severe exhaustion that the completion of everyday tasks becomes impossible.

Pregnancy complications: Pregnant women with untreated anemia are more likely to face certain complications including premature delivery.

Heart problems: Anemia requires the heart to pump more blood to compensate for the lack of oxygen in the blood. Over time, it can lead to irregular heartbeat, an enlarged heart, and even heart failure.

Death: This is only in very extreme cases, but it is possible to die from anemia. Sickle cell anemia, for example, can have fatal complications. A sudden loss of a significant amount of blood can also result in acute severe anemia, which is life-threatening.

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How to Prevent Anemia

Anemia caused by chronic disease or other medical conditions can’t necessarily be prevented, but there are things you can easily do to help prevent iron deficiency anemia, such as:

Treat the cause of your blood loss. This may mean talking to your doctor and finding solutions for heavy menstrual periods or problems with your digestive system.

Make sure you eat enough high-iron foods, (see anemia diet above) such as chicken, beef, leafy vegetables, and beans.

Combine iron-rich foods with those that contain vitamin C, such as orange juice, strawberries, and broccoli. The vitamin C helps the body absorb iron more efficiently.

When to See a Doctor

Although it is not necessarily urgent, it is a good idea to see your doctor if you exhibit any symptoms of anemia, particularly if you fall into one of the greater risk categories. Remember, the most common sign of anemia is fatigue, something that’s easy for most of us to explain away as part of our daily lives. But, according to Dr. Harvey Luksenburg, a blood disease specialist at the National Institute of Health, “women who feel symptoms of sluggishness and fatigue may be iron deficient…Even if you’ve lived with it a long time, get it checked. I’ve seen startling changes when women were put on iron supplements. Some say they’ve never felt better.”

If you have been diagnosed with anemia, it’s important to monitor the condition regularly together with your doctor. You want to ensure that the condition is improving, and that no underlying cause has been overlooked.

How K Health Can Help

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K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Edo Paz, MD

Edo Paz is the VP of Medical at K Health. Dr. Paz has two degrees in chemistry from Harvard and earned his medical degree from Columbia University. He did his medical training in internal medicine and cardiology at New York-Presbyterian. In addition to his work at K Health, Dr. Paz is a cardiologist at White Plains Hospital, part of the Montefiore Health System.