What is anaemia?

Anaemia develops when you don’t have enough robust, healthy red blood cells to carry oxygen throughout your body. The blood cells may lack enough haemoglobin, the protein that gives blood its red colour. Iron deficiency anaemia is the most common form of anaemia and is more prevalent in females. It affects 8% of women in the UK and 3% of men.

Symptoms of anaemia

If you’re often tired even though you've slept well or you lack the energy for normal activities, you may have anaemia. It can be an underlying cause of memory or mood problems. Symptoms range from none at all, to mild or even life-threatening and may include:

• Tiredness
• Lethargy (lack of energy)
• Shortness of breath
• Pale skin
• Headache
• Tinnitus or ringing in the ears
• An altered sense of taste

Heart-related symptoms

People with anaemia have less oxygen in their blood, which means the heart must work harder to pump enough oxygen to their organs. Cardiac-related symptoms include arrhythmia (an abnormal heart rhythm), shortness of breath and chest pain.

Anaemia in children

Many children in the UK are anaemic, most often because they don’t have enough iron in their diet. If your child has symptoms of tiredness, faintness, or recurrent infections, see your GP who may recommend blood tests.

Anaemia risk factors

Women and people with chronic diseases have the greatest risk of anaemia. When women lose blood in heavy menstrual periods, they may become anaemic. Pregnancy also causes changes in a woman’s blood volume that can result in anaemia. Chronic diseases such as kidney disease can affect the body’s ability to make red blood cells. A diet low in iron, folate or vitamin B12 also increases your risk. Some types of anaemia are hereditary.

Teenagers and anaemia

If your teenager is often fatigued, anaemia might be a cause. Teens are at risk of iron-deficiency anaemia because of their sudden growth spurts. Teenage girls are also more prone to anaemia because of their menstrual periods and often poor dietary habits.

Cause: Low iron intake

A diet that's low in iron can cause anaemia. Iron from plants and supplements isn't absorbed as well as the iron in red meat. Digestive concerns such as Crohn’s disease, coeliac disease, or even having a gastric bypass operation can interfere with iron absorption. Also, some foods and medicines can hinder iron uptake when taken with iron-rich foods. They include:

• Dairy
• Other calcium-rich foods
• Calcium supplements
• Antacids
• Coffee
• Tea

Cause: Vitamin deficiency

The body needs both vitamin B12 and folate to make red blood cells. A diet too low in these vitamins sometimes can cause anaemia. An autoimmune disorder or digestive problem can also prevent your body from absorbing enough B12. Animal-based foods and fortified breakfast cereals are good sources of B12. Folate is in leafy green vegetables, fruits, dried beans and peas. It’s also added to breads, pastas and cereals as folic acid.

Cause: Illness

Chronic illness or infection can cause the body to make fewer red blood cells. This can result in a drop in haemoglobin. If you have significant blood loss, then you may develop iron-deficiency anaemia. Some medicine and medical treatments can also put you at risk of anaemia. Consult your GP to see if you need iron or other supplements.

Cause: Aplastic anaemia

Aplastic anaemia is a rare disorder in which the bone marrow doesn’t make enough blood cells to supply the body. According to the Aplastic Anaemia Trust, it affects only about 150 to 200 people a year in the UK. It’s thought to occur when an outside event causes the body’s immune system to attack the bone marrow. Certain factors can increase your risk of developing the condition. They include viral infection or exposure to certain chemicals or medications.  In severe cases, people need blood transfusions or even a bone marrow transplant.

Cause: Blood loss

Losing too many red blood cells is a common cause of anaemia. Heavy periods, ulcers, injury or surgery can cause enough blood loss to lead to iron-deficiency anaemia. Women who have heavy menstrual periods should consider being tested for iron deficiency.

Cause: Faulty blood cell mechanics

Inherited disorders can affect your body’s production of red blood cells. Known as thalassaemias, they can cause the body to make fewer healthy red blood cells and less haemoglobin – and may be treated with blood transfusions. Among people with haemolytic anaemia, red blood cells are destroyed and cleaned out of the bloodstream too quickly.

Sickle cell anaemia

Sickle cell anaemia is an inherited disorder in which the body produces an abnormal form of haemoglobin. This causes red blood cells to change from round to a sickle shape and become stuck together. That can make it difficult for them to pass through blood vessels, leading to pain and damage to body tissues. The red blood cells also die more quickly than normal red blood cells. Sickle cell anaemia is a common genetic disorder affecting around a quarter of a million people in England – mostly among those with African-Caribbean ancestry.

Diagnosis: Full blood count

A full blood count test will check your levels of red blood cells, white blood cells, platelets, and haemoglobin. It will also check other factors such as average size, variability in size, volume, and haemoglobin concentration of red blood cells. If you have iron-deficiency anaemia, your red blood cells may be smaller than normal. Your health care provider also may ask about your symptoms, medicines you take, and your family history.

Diagnosis: Other blood tests

If the full blood count shows that you have anaemia, you may have additional blood tests. Your blood cells may be checked for an abnormal  appearance. Haemoglobin electrophoresis detects the type of haemoglobin in your blood. A reticulocyte count tests how well your bone marrow makes new red blood cells. Iron studies may be performed to measure iron stores in your body, as well as iron levels in your blood.

Diagnosis: Bone marrow test

If your body is producing too few or too many blood cells or their structure appears abnormal, you may need a bone marrow test. Bone marrow – the spongy tissue inside bones – contains stem cells that turn into blood cells. Your doctor will remove a small sample of bone marrow through a needle. The procedure takes about 30 minutes and will cause some soreness.

Treatment: Supplements

Iron tablets are often needed for anaemia that's caused by a deficiency in that mineral. Ferrous iron is more easily absorbed than ferric iron. It's best taken with food, especially orange juice and other foods rich in vitamin C. But don't mix your iron pill with calcium, coffee or tea, which can block absorption. And never take iron without a doctor's advice or let children near the pills. An iron overdose can be dangerous. Some people may need folic acid or vitamin B12 supplements, too.

Iron and pregnancy

Many pregnant women develop iron-deficiency anaemia. Pregnant women should get 14.8 milligrams of iron each day in their diet. Your antenatal vitamin also may contain iron. You may be tested for anaemia during pregnancy and after having your baby.

Treatment: Medicines

Drugs for anaemia often treat the root illness. So in some cases, where the anaemia is due to chronic kidney disease, an injection of the hormone erythropoietin (EPO) may be needed. If an autoimmune disorder causes your body to attack its own red blood cells, then a corticosteroid, such as prednisolone, can slow the attack and help correct anaemia. In sickle cell anaemia, a cancer drug called hydroxycarbamide can reduce the number of painful episodes.

Treatment: Procedures

If you have severe anaemia, you may need a transfusion of blood that matches your type. When the body's production of red blood cells doesn't work right, anaemia may be treated or cured with a transplant. In these cases, bone marrow or cord blood from a donor replaces the person's faulty bone marrow, so the body can start producing healthy blood cells. When blood cells are destroyed too quickly, blood plasma treatments or even removing the spleen may be needed.

Preventing anaemia

You can prevent some types of anaemia with a healthy diet. Foods containing iron include lean red meat, liver, fish, tofu, lentils and beans, dark green leafy vegetables, and dried fruits. Also eat foods with vitamin B12 and folic acid, such as eggs and dairy products, spinach and bananas. Many breads, cereals, and other foods are fortified with all three key nutrients: iron, B12, and folic acid. Vitamin C, found in citrus, other fruits, and vegetables, will help your body absorb iron.

Iron overload

Too much iron can cause serious problems. Iron overload can be a result of repeated blood transfusions or an inherited condition, but taking too much iron is also a risk. The many symptoms of iron overload are related to excess iron depositing in organs and causing problems in the liver, heart and pancreas. Iron levels can be reduced through phlebotomy (blood removal) or medications.

Living with anaemia

Treating your anaemia and eating a balanced diet can give you more energy and enhance your life. Most people can manage their anaemia through a healthy diet and iron or vitamin supplements, if a doctor says they are deficient in one of the key nutrients. If you have a chronic disease, then good management of your condition will also help you prevent or manage anaemia.

Related reading

• Symptoms of anaemia
• Energy foods slideshow
• 12 causes of fatigue and how to fight it
• Vitamin B12 (cobalamin)
• Iron deficiency anaemia
• Sickle cell anaemia