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    Anemia

    Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues.

    Different types of anemia include:

    Iron deficiency anemia is the most common type of anemia.

    Causes

    Although many parts of the body help make red blood cells, most of the work is done in the bone marrow. Bone marrow is the soft tissue in the center of bones that helps form all blood cells.

    Healthy red blood cells last between 90 and 120 days. Parts of your body then remove old blood cells. A hormone called erythropoietin (EPO) made in your kidneys signals your bone marrow to make more red blood cells.

    Hemoglobin is the oxygen-carrying protein inside red blood cells. It gives red blood cells their color. People with anemia do not have enough hemoglobin.

    The body needs certain vitamins, minerals, and nutrients to make enough red blood cells. Iron, vitamin B12, and folic acid are three of the most important ones. The body may not have enough of these nutrients due to:

    • Changes in the lining of the stomach or intestines that affect how well nutrients are absorbed (for example, celiac disease)
    • Poor diet
    • Surgery that removes part of the stomach or intestines

    Possible causes of anemia include:

    • Iron deficiency
    • Vitamin B12 deficiency
    • Folate deficiency
    • Certain medicines
    • Destruction of red blood cells earlier than normal (which may be caused by immune system problems)
    • Long-term (chronic) diseases such as chronic kidney disease, cancer, ulcerative colitis, or rheumatoid arthritis
    • Some forms of anemia, such as thalassemia or sickle cell anemia, which can be inherited
    • Pregnancy
    • Problems with bone marrow such as lymphoma, leukemia, myelodysplasia, multiple myeloma, or aplastic anemia
    • Slow blood loss (for example, from heavy menstrual periods or stomach ulcers)
    • Sudden heavy blood loss

    Symptoms

    You may have no symptoms if the anemia is mild or if the problem develops slowly. Symptoms that may occur first include:

    • Feeling weak or tired more often than usual, or with exercise
    • Headaches
    • Problems concentrating or thinking
    • Irritability
    • Loss of appetite
    • Numbness and tingling of hands and feet

    If the anemia gets worse, symptoms may include:

    • Blue color to the whites of the eyes
    • Brittle nails
    • Desire to eat ice or other non-food things (pica syndrome)
    • Lightheadedness when you stand up
    • Pale skin color
    • Shortness of breath with mild activity or even at rest
    • Sore or inflamed tongue
    • Mouth ulcers
    • Abnormal or increased menstrual bleeding

    Exams and Tests

    Your health care provider will perform a physical examination, and may find:

    • A heart murmur
    • Low blood pressure, especially when you stand up
    • Slight fever
    • Pale skin
    • Rapid heart rate

    Some types of anemia may cause other findings on a physical exam.

    Blood tests used to diagnose some common types of anemia may include:

    Other tests may be done to find medical problems that can cause anemia.

    Treatment

    Treatment should be directed at the cause of the anemia, and may include:

    • Blood transfusions
    • Corticosteroids or other medicines that suppress the immune system
    • Erythropoietin, a medicine that helps your bone marrow make more blood cells
    • Supplements of iron, vitamin B12, folic acid, or other vitamins and minerals

    Possible Complications

    Severe anemia can cause low oxygen levels in vital organs such as the heart, and can lead to heart failure.

    When to Contact a Medical Professional

    Contact your provider if you have any symptoms of anemia or unusual bleeding.

    Open References

    References

    Elghetany MT, Banki K. Erythrocytic disorders. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 33.

    Lin JC, Benz Jr. EJ. Approach to anemia in the adult and child. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 35.

    Means Jr. RT. Approach to the anemias. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 144.

      • Red blood cells - elliptocytosis

        Red blood cells - elliptocytosis - illustration

        Elliptocytosis is a hereditary disorder of the red blood cells (RBCs). In this condition, the RBCs assume an elliptical shape, rather than the typical round shape.

        Red blood cells - elliptocytosis

        illustration

      • Red blood cells - spherocytosis

        Red blood cells - spherocytosis - illustration

        Spherocytosis is a hereditary disorder of the red blood cells (RBCs), which may be associated with a mild anemia. Typically, the affected RBCs are small, spherically shaped, and lack the light centers seen in normal, round RBCs.

        Red blood cells - spherocytosis

        illustration

      • Red blood cells - multiple sickle cells

        Red blood cells - multiple sickle cells - illustration

        Sickle cell anemia is an inherited disorder in which abnormal hemoglobin (the red pigment inside red blood cells) is produced. The abnormal hemoglobin causes red blood cells to assume a sickle shape, like the ones seen in this photomicrograph.

        Red blood cells - multiple sickle cells

        illustration

      • Ovalocytoses

        Ovalocytoses - illustration

        Red blood cells (RBCs) are normally round. In ovalocytosis, the cells are oval. Other conditions that produce abnormally shaped RBCs include spherocytosis and elliptocytosis.

        Ovalocytoses

        illustration

      • Red blood cells - sickle and Pappenheimer

        Red blood cells - sickle and Pappenheimer - illustration

        This photomicrograph of red blood cells (RBCs) shows both sickle-shaped and Pappenheimer bodies.

        Red blood cells - sickle and Pappenheimer

        illustration

      • Red blood cells, target cells

        Red blood cells, target cells - illustration

        These abnormal red blood cells (RBCs) resemble targets. These cells are seen in association with some forms of anemia, and following the removal of the spleen (splenectomy).

        Red blood cells, target cells

        illustration

      • Hemoglobin

        Hemoglobin - illustration

        Hemoglobin is the most important component of red blood cells. It is composed of a protein called heme, which binds oxygen. In the lungs, oxygen is exchanged for carbon dioxide. Abnormalities of an individual's hemoglobin value can indicate defects in the normal balance between red blood cell production and destruction. Both low and high values can indicate disease states.

        Hemoglobin

        illustration

        • Red blood cells - elliptocytosis

          Red blood cells - elliptocytosis - illustration

          Elliptocytosis is a hereditary disorder of the red blood cells (RBCs). In this condition, the RBCs assume an elliptical shape, rather than the typical round shape.

          Red blood cells - elliptocytosis

          illustration

        • Red blood cells - spherocytosis

          Red blood cells - spherocytosis - illustration

          Spherocytosis is a hereditary disorder of the red blood cells (RBCs), which may be associated with a mild anemia. Typically, the affected RBCs are small, spherically shaped, and lack the light centers seen in normal, round RBCs.

          Red blood cells - spherocytosis

          illustration

        • Red blood cells - multiple sickle cells

          Red blood cells - multiple sickle cells - illustration

          Sickle cell anemia is an inherited disorder in which abnormal hemoglobin (the red pigment inside red blood cells) is produced. The abnormal hemoglobin causes red blood cells to assume a sickle shape, like the ones seen in this photomicrograph.

          Red blood cells - multiple sickle cells

          illustration

        • Ovalocytoses

          Ovalocytoses - illustration

          Red blood cells (RBCs) are normally round. In ovalocytosis, the cells are oval. Other conditions that produce abnormally shaped RBCs include spherocytosis and elliptocytosis.

          Ovalocytoses

          illustration

        • Red blood cells - sickle and Pappenheimer

          Red blood cells - sickle and Pappenheimer - illustration

          This photomicrograph of red blood cells (RBCs) shows both sickle-shaped and Pappenheimer bodies.

          Red blood cells - sickle and Pappenheimer

          illustration

        • Red blood cells, target cells

          Red blood cells, target cells - illustration

          These abnormal red blood cells (RBCs) resemble targets. These cells are seen in association with some forms of anemia, and following the removal of the spleen (splenectomy).

          Red blood cells, target cells

          illustration

        • Hemoglobin

          Hemoglobin - illustration

          Hemoglobin is the most important component of red blood cells. It is composed of a protein called heme, which binds oxygen. In the lungs, oxygen is exchanged for carbon dioxide. Abnormalities of an individual's hemoglobin value can indicate defects in the normal balance between red blood cell production and destruction. Both low and high values can indicate disease states.

          Hemoglobin

          illustration

        A Closer Look

         

        Review Date: 3/31/2024

        Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 12-17-2024.

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