Anemia

Q: Whatisanemia?
A: Anemia(uh-NEE-mee-uh)occurs
whenyouhavelessthanthenormal
numberofredbloodcellsinyour
bloodorwhentheredbloodcells
inyourblooddonthaveenough
hemoglobin(HEE-muh-gloh-bin).
Hemoglobinisaprotein.Itgivesthe
redcolortoyourblood.Itsmainjob
istocarryoxygenfromyourlungs
toallpartsofyourbody.Ifyouhave
anemia,yourblooddoesnotcarry
enoughoxygentoallthepartsofyour
body.Withoutoxygen,yourorgans
andtissuescannotworkaswellasthey
should.Morethan3millionpeoplein
theUnitedStateshaveanemia.Women
andpeoplewithchronicdiseasesareat
thegreatestriskforanemia.
Q: Whatarethetypesandcauses
ofanemia?
A: Anemiahappenswhen:
1. thebodylosestoomuchblood
(suchaswithheavyperiods,certain
diseases,andtrauma);or
2. thebodyhasproblemsmakingred
bloodcells;or
3. redbloodcellsbreakdownordie
fasterthanthebodycanreplace
themwithnewones;or
4. morethanoneoftheseproblems
happenatthesametime.
Therearemanytypesofanemia,all
withdifferentcauses:
Iron deficiency anemia (IDA).
IDAisthemostcommontypeof
anemia.IDAhappenswhenyou
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don'thaveenoughironinyour
body.Youneedirontomakehemo-
globin.Peoplewiththistypeof
anemiaaresometimessaidtohave
iron-poorbloodortiredblood.
Apersoncanhavealowironlevel
becauseofbloodloss.Inwomen,
ironandredbloodcellsarelost
whenbleedingoccursfromvery
heavyandlongperiods,aswellas
fromchildbirth.Womenalsocan
loseironandredbloodcellsfrom
uterinefibroids,whichcanbleed
slowly.Otherwaysironandred
bloodcellscanbelostinclude:
ulcers,colonpolyps,orcolon
cancer
regularuseofaspirinandother
drugsforpain
infections
severeinjury
surgery
Eatingfoodslowinironalsocan
causeIDA.Meat,poultry,fish,eggs,
dairyproducts,oriron-fortified
foodsarethebestsourcesofiron
foundinfood.Pregnancycancause
IDAifawomandoesntconsume
enoughironforbothherandher
unbornbaby.
Somepeoplehaveenoughiron
intheirblood,buthaveproblems
absorbingitbecauseofdiseases,such
asCrohnsdiseaseandCeliacdis-
ease,ordrugstheyaretaking.
Vitamin deficiency anemia (or
Foods that are fortified have important
vitamins and minerals added, such as
cereal with added folic acid.
megaloblastic [MEG-uh-loh-
BLASS-tik] anemia).Lowlevels
ofvitaminB12orfolatearethe
mostcommoncausesofthistypeof
anemia.
Vitamin B12 deficiency anemia(or
pernicious[pur-NISH-us]anemia).
Thistypeofanemiahappensdueto
alackofvitaminB12inthebody.
YourbodyneedsvitaminB12to
makeredbloodcellsandtokeep
yournervoussystemworkingnor-
mally.Thistypeofanemiaoccurs
mostofteninpeoplewhosebodies
arenotabletoabsorbvitaminB12
fromfoodbecauseofanautoim-
munedisorder.Italsocanhappen
becauseofintestinalproblems.
Youalsocangetthistypeofane-
miaifthefoodsyoueatdonthave
enoughvitaminB12.VitaminB12
isfoundinfoodsthatcomefrom
animals.Fortifiedbreakfastcereals
alsohavevitaminB12.Folicacid
supplements(pills)cantreatthis
typeofanemia.But,folicacidcan-
nottreatnervedamagecausedbya
lackofvitaminB12.
Withthistypeofanemia,yourdoc-
tormaynotrealizethatyou'renot
gettingenoughvitaminB12.Not
gettingenoughvitaminB12can
causenumbnessinyourlegsand
feet,problemswalking,memory
loss,andproblemsseeing.The
treatmentdependsonthecause.But
youmayneedtogetvitaminB12
shotsortakespecialvitaminB12
pills.
Folate deficiency anemia. Folate,also
calledfolicacid,isalsoneededto
makeredbloodcells.Thistypeof
anemiacanoccurifyoudontcon-
sumeenoughfolateorifyouhave oago 2
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problemsabsorbingvitamins.Italso
mayoccurduringthethirdtrimester
ofpregnancy,whenyourbodyneeds
extrafolate.FolateisaBvitamin
foundinfoodssuchasleafygreen
vegetables,fruits,anddriedbeans
andpeas.Folicacidisfoundinforti-
fiedbreads,pastas,andcereals.
Anemias caused by underlying
diseases.Somediseasescanhurt
thebody'sabilitytomakeredblood
cells.Forexample,anemiaiscom-
moninpeoplewithkidneydisease.
Theirkidneyscan'tmakeenoughof
thehormonesthatsignalthebody
tomakeredbloodcells.Plus,iron
islostindialysis(whatsomepeople
withkidneydiseasemusthaveto
takeoutwastefromtheblood).
Anemias caused by inherited
blood disease. Ifyouhaveablood
diseaseinyourfamily,youareat
greaterrisktoalsohavethisdisease.
Herearesometypes:
Sickle cell anemia.Theredbloodcells
ofpeoplewithsicklecelldiseaseare
hardandhaveacurvededge.These
cellscangetstuckinthesmallblood
vessels,blockingthef lowofblood
totheorgansandlimbs.Thebody
destroyssickleredcellsquickly.But,
itcan'tmakenewredbloodcellsfast
enough.Thesefactorscauseanemia.
Thalassemia (thal-uh-SEE-mee-uh).
Peoplewiththalassemiamakeless
hemoglobinandfewerredblood
cellsthannormal.Thisleadstomild
orsevereanemia.Onesevereform
ofthisconditionisCooleysanemia.
Aplastic (ay-PLAS-tik) ane-
mia.Thisisarareblooddisorder
inwhichthebodystopsmaking
enoughnewbloodcells.Allblood
cellsredcells,whitecells,and
plateletsareaffected.Lowlevels
ofredbloodcellsleadstoanemia.
Withlowlevelsofwhitebloodcells,
thebodyislessabletofightinfec-
tions.Withtoofewplatelets,the
bloodcantclotnormally.Thiscan
becausedbymanythings:
cancertreatments(radiationor
chemotherapy)
exposuretotoxicchemicals(like
thoseusedinsomeinsecticides,
paint,andhouseholdcleaners)
somedrugs(likethosethattreat
rheumatoidarthritis)
autoimmunediseases(likelupus)
viralinfections
familydiseasespassedonby
genes,suchasFanconianemia
Q: Whatarethesignsofanemia?
A: Anemiatakessometimetodevelop.In
thebeginning,youmaynothaveany
signsortheymaybemild.Butasitgets
worse,youmayhavethesesymptoms:
fatigue(verycommon)
weakness(verycommon)
dizziness
headache
numbnessorcoldnessinyourhands
andfeet
lowbodytemperature
paleskin
rapidorirregularheartbeat
shortnessofbreath
chestpain
irritability
notdoingwellatworkorinschool
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Allofthesesignsandsymptomscan
occurbecauseyourhearthastowork
hardertopumpmoreoxygen-rich
bloodthroughthebody.
Q: HowdoIfindoutifIhave
anemia?
A: Yourdoctorcantellifyouhaveane-
miabyabloodtestcalledaCBC.Your
doctoralsowilldoaphysicalexamand
talktoyouaboutthefoodyoueat,the
medicinesyouaretaking,andyour
familyhealthhistory.Ifyouhaveane-
mia,yourdoctormaywanttodoother
teststofindoutwhat'scausingit.
Q: Whatsthetreatmentfor
anemia?
A: Withanytypeofanemia,therearetwo
treatmentgoals:
1) togetredbloodcellcountsor
hemoglobinlevelsbacktonormalso
thatyourorgansandtissuescanget
enoughoxygen
2) totreattheunderlyingcauseofthe
anemia
Thetreatmentyourdoctorprescribes
foryouwilldependonthecauseof
theanemia.Forexample,treatment
forsicklecellanemiaisdifferentthan
treatmentforanemiacausedbylow
ironorfolicacidintake.Treatmentmay
includechangesinfoodsyoueat,tak-
ingdietarysupplements(likevitamins
orironpills),changingthemedicines
youaretaking,orinmoresevereforms
ofanemia,medicalproceduressuchas
bloodtransfusionorsurgery.
Q: Whatwillhappenifmyanemia
goesuntreated?
A: Sometypesofanemiamaybelife
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threateningifnotdiagnosedandtreat-
ed.Toolittleoxygeninthebodycan
damageorgans.Withanemia,theheart
mustworkhardertomakeupforthe
lackofredbloodcellsorhemoglobin.
Thisextraworkcanharmtheheartand
evenleadtoheartfailure.
Q: HowdoIpreventanemia?
A: Therearestepsyoucantaketohelp
preventsometypesofanemia.
Eatfoodshighiniron:
cereal/breadswithironinit
(100%iron-fortifiedisbest.
Checkfoodlabel.)
liver
lentilsandbeans
oysters
tofu
green,leafyvegetablessuchas
spinach
redmeat(leanonly)
fish
driedfruitssuchasapricots,
prunes,andraisins
Formoresourcesofiron,visitwww.
cc.nih.gov/ccc/supplements/iron.
html.
Eatanddrinkfoodsthathelpyour
bodyabsorbiron,likeorangejuice,
strawberries,broccoli,orotherfruits
andvegetableswithvitaminC.
Don'tdrinkcoffeeorteawithmeals.
Thesedrinksmakeitharderforyour
bodytoabsorbiron.
Calciumcanhurtyourabsorption
ofiron.Ifyouhaveahardtimeget-
tingenoughiron,talktoyourdoc-
toraboutthebestwaytoalsoget
enoughcalcium.
Makesureyouconsumeenough
folicacidandvitaminB12.
Makebalancedfoodchoices.Most
peoplewhomakehealthy,balanced
foodchoicesgettheironandvita-
minstheirbodiesneedfromthe
foodstheyeat.Foodfadsanddieting
canleadtoanemia.
Talktoyourdoctorabouttaking
ironpills(supplements).DoNOT
takethesepillswithouttalkingto
yourdoctorfirst.Thesepillscome
intwoforms:ferrousandferric.
Theferrousformisbetterabsorbed
byyourbody.Buttakingironpills
cancausesideeffects,likenausea,
vomiting,constipation,anddiarrhea.
Reducethesesideeffectsbytaking
thesesteps:
Startwithhalfoftherecom
mendeddose.Graduallyincrease
tothefulldose.
Takethepillindivideddoses.
Forexample,ifyouarepre
scribedtwopillsdaily,takeone
inmorningwithbreakfastand
theotherafterdinner.
Takethepillwithfood.
Ifonetypeofironpilliscausing
problems,askyourdoctorfor
anotherbrand.
It is important to keep iron pills tightly
capped and away from childrens reach. In
children, death has occurred from ingesting
200 mg of iron.
Ifyouareanon-pregnantwoman
ofchildbearingage,gettestedfor
anemiaeveryfiveto10years.This
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canbedoneduringaregularhealth
exam.Testingshouldstartinadoles-
cence.
Ifyouareanon-pregnantwoman
ofchildbearingagewiththeserisk
factorsforirondeficiency,gettested
everyyear:
heavyperiods
lowironintake
havebeendiagnosedwithanemia
inthepast
Followyourdoctorsordersfor
treatingtheunderlyingcauseofyour
anemia.Thiswillpreventtheane-
miafromcomingbackorbecoming
serious.
Q: HowmuchirondoIneedevery
day?
A: Mostpeoplegetenoughironbymak-
inghealthy,balancedfoodchoicesand
eatingiron-richfoods.Butsomegroups
ofpeopleareatgreaterriskforlowiron
levels:
teenagegirls/womenofchildbearing
age(whohaveheavybleedingdur-
ingtheirperiod,whohavehadmore
thanonechild,oruseanintrauter-
inedevice[IUD])
olderinfantsandtoddlers(mainly
thosewhodrinkalotofmilkorare
havingagrowthspurt)
pregnantwomen(abouthalfofpreg-
nantwomenhaveiron-deficiency
anemia)
Femaleathleteswhoengageinregu-
lar,intenseexercise
Thesegroupsofpeopleshouldbe
screenedattimesforirondeficiency.If
thetestsshowthatthebodyisn'tgetting
enoughiron,ironpills(supplements)
maybeprescribed.Inextremecases
ofirondeficiency,yourdoctormight
prescribeironshots.Manydoctors
prescribeironpillsduringpregnancy
becausemanypregnantwomendon't
getenoughiron.Ironpillscanhelp
whendietalonecan'trestoretheiron
levelbacktonormal.Talkwithyour
doctortofindoutifyouaregetting
enoughironthroughthefoodsyoueat
orifyouoryourchildneedstobetak-
ingironpills.Pleaseseethechartbelow
toseehowmanymilligrams(mg)of
ironyoushouldconsumeeveryday.
Q: HowmuchirondoIneedifIam
pregnant?
A: Pregnantwomenneedtoconsume
twiceasmuchironaswomenwho
arenotpregnant.Butabouthalfofall
pregnantwomendonotgetenough
Age Infants&Children Women Pregnant Breastfeeding
7 to 12 months 11 mg
1 to 3 years 7 mg
4 to 8 years 10 mg
9 to13 years 8 mg
14 to18 years 15 mg 27 mg 10 mg
19 to 50 years 18 mg 27 mg 9 mg
51+ years 8 mg
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iron.Duringpregnancy,yourbody
needsmoreironbecauseofthegrowing
fetus,thehighervolumeofblood,and
bloodlossduringdelivery.Ifapregnant
womandoesnotgetenoughironfor
herselforhergrowingbaby,shehas
anincreasedchanceofhavingpreterm
birthandalow-birth-weightbaby.If
you'repregnant,followthesetips:
Makesureyouget27mgofiron
everyday.Takeanironsupplement
(pill).Itmaybepartofyourprenatal
vitamin.Starttakingitatyourfirst
prenatalvisit.
Gettestedforanemiaatyourfirst
prenatalvisit.
Askifyouneedtobetestedforane-
mia4to6weeksafterdelivery.
Q: Iamtakingmenopausalhor-
monetherapy(MHT).Doesthat
affecthowmuchironIshould
take?
A: Itmight.Ifyouarestillgettingyour
periodwhiletakingMHT,youmay
needmoreironthanwomenwhoare
postmenopausalandnottakingMHT.
Talktoyourdoctor.
Q: Doesbirthcontrolaffectmyrisk
foranemia?
A: Itcould.Somewomenwhotakebirth
controlpillshavelessbleedingdur-
ingtheirperiods.Thiswouldlower
theirriskforanemia.Butwomenwho
useanintrauterinedevice(IUD)may
havemorebleedingandincreasetheir
chancesofgettinganemia.Talktoyour
doctor.
Q: Iamavegetarian.Whatsteps
shouldItaketomakesureIget
enoughiron?
A: Itdependsonthefoodchoicesyou
make.Sincemeat,poultry,andseafood
arethebestsourcesofironfoundin
food,somevegetariansmayneedto
takeahigheramountofironeachday
thanwhatisrecommendedforother
people.Followthetipsabovetoprevent
anemia,andtrytotakevitaminCwith
theiron-richfoodsyoueat.
Q: Whathappensifmybodygets
moreironthanitneeds?
A: Ironoverloadhappenswhentoomuch
ironbuildsupinthebodyovertime.
Thisconditioniscalledhemochroma-
tosis(HEE-moh-kroh-muh-TOH-
suhss).Theextraironcandamagethe
organs,mainlytheliver,heart,andpan-
creas.Manyproblemscancauseiron
overload.Mostpeoplewithhemochro-
matosisinherititfromtheirparents.
Itisoneofthemostcommongenetic
(runsinfamilies)diseasesintheUnited
States.Someotherdiseasesalsocan
leadtoironoverload.Italsocanhap-
penfromyearsoftakingtoomuchiron
orfromrepeatedbloodtransfusionsor
dialysisforkidneydisease.
Signsofearlyhemochromatosismay
include:
fatigue
weakness
weightloss
abdominalpain
jointpain
f lutteringinchest
Asironbuildsupinthebody,common
symptomsinclude:
arthritis
missedperiods
earlymenopause
lossofsexdrive
impotence(repeatedinabilitytoget
orkeepanerectionfirmenoughfor
sexualintercourse)
heartproblemslikeshortnessof
breath,chestpain,andchangesin
rateorrhythm
Signsofadvancedhemochromatosis
include:
arthritis
liverdisease,includinganenlarged
liver,cirrhosis,cancer,andliverfail-
ure
damagetothepancreas,possibly
causingdiabetes
chronic(ongoing)abdominalpain
severefatigue
weakeningoftheheartmuscle
heartfailure
changesinskincolor,makingit
lookgray,yelloworbronze(not
causedbysun)
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Treatmentdependsonhowseverethe
ironoverloadis.Thefirststepistoget
ridoftheextraironinthebody.Most
peopleundergoaprocesscalledphle-
botomy(f luh-BOT-uh-mee),which
meansremovingblood.Itissimpleand
safe.Apintofbloodwillbetakenonce
ortwiceaweekforseveralmonthstoa
year,andsometimeslonger.Onceiron
levelsgobacktonormal,youwillgive
apintofbloodevery2to4monthsfor
life.Peoplewhocannotgivebloodcan
takemedicinetoremoveextrairon.
Thisiscalledironchelation(kuh-LAY-
shuhn)therapy.Althoughtreatment
cannotcuretheproblemscausedby
hemochromatosis,itwillhelpmostof
them.Arthritisistheonlyproblemthat
doesnotimproveafterexcessironis
removed.n
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1-800-994-9662
TDD:1-888-220-5446
AllmaterialcontainedinthisFAQisfreeofcopyrightrestrictions,andmaybecopied,
reproduced,orduplicatedwithoutpermissionoftheOfficeonWomensHealthinthe
DepartmentofHealthandHumanServices.Citationofthesourceisappreciated.
ThisFAQwasreviewedby:
CharlesM.Peterson,MD
Director,DivisionofBloodDiseasesandResources
NationalHeart,LungandBloodInstitute
NationalInstitutesofHealth
ContentlastupdatedMay 13,2008.
For more information...
Formoreinformationonanemia,contactwomenshealth.govat800-994-9662orthe
followingorganizations:
Division of Nutrition, Physical
Activity and Obesity, NCCDPHP,
CDC, HHS
Phone:(800)232-4636,(888)232-6348
InternetAddress:http://www.cdc.gov/
nccdphp/dnpa
National Heart, Lung, and Blood
Institute Health Information Center,
NHLBI, NIH, HHS
Phone:(301)592-8573
InternetAddress:http://www.nhlbi.nih.
gov/health/infoctr
American Dietetic Association
Phone:(800)877-1600
InternetAddress:http://www.eatright.org
Aplastic Anemia & MDS International
Foundation, Inc.
Phone:(800)747-2820
InternetAddress:http://www.aamds.org
Cooleys Anemia Foundation
Phone:(800)522-7222
InternetAddress:http://www.thalassemia.
org
Fanconi Anemia Research Fund, Inc.
Phone:(888)326-2664
InternetAddress:http://www.fanconi.org
Iron Disorders Institute
Phone:(888)565-4766
InternetAddress:http://www.irondisor-
ders.org
Sickle Cell Disease Association of
America, Inc.
Phone:(800)421-8453
InternetAddress:http://www.sicklecelldis-
ease.org