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Anaemia - an overview

Anaemia – an overview. Information from Bupa about the symptoms, causes, diagnosis and treatment of anaemia, and how to prevent it.

Anaemia is a condition in which your blood can't carry enough oxygen to meet the needs of your body. This is because you either don't have enough red blood cells or not enough of a protein called haemoglobin in your red blood cells.

Anaemia is a condition that affects your blood. Your blood is made up of fluid called plasma and blood cells, which include:

  • red blood cells (erythrocytes) that contain haemoglobin
  • white blood cells (leucocytes) that are part of your immune system and help fight infection
  • platelets (thrombocytes) that are tiny fragments of cells that help your blood clot

Blood cells are made by your bone marrow, which is a spongy substance in the centre of your bones.

There are different types of anaemia, which are categorised by their cause. These include:

  • iron-deficiency anaemia (one of the most common causes of anaemia)
  • vitamin B12-deficiency anaemia
  • folate-deficiency anaemia
  • sickle cell anaemia
  • anaemia of chronic disease
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  • Symptoms Symptoms of anaemia

    Common symptoms of anaemia include:

    • feeling tired
    • feeling short of breath
    • feeling your heart racing or thumping, which is called palpitations

    These symptoms may be caused by problems other than anaemia. If you have any of these symptoms, see your GP for advice.

  • Diagnosis Diagnosis of anaemia

    Your GP will ask about your symptoms and examine you. He or she may also ask about your medical history. If your GP suspects you have anaemia, he or she will ask you to have a blood test. Your blood will be sent to a laboratory for the following tests.

    • A full blood count. This is to check the level of haemoglobin in your blood and how many of each of the different types of blood cell you have.
    • A blood film test. This involves looking at your blood under a microscope to check the size and shape of your red blood cells. It will also assess the different white cells that are present.
    • Levels of vitamin B12, iron and folate.

    You may need to have further tests to help identify the cause of your anaemia. Depending on the type of anaemia you have, your GP may refer you to a specialist.

  • Treatment Treatment of anaemia

    The treatment you have will depend on the cause of your anaemia, and it can vary considerably from person to person. For example, some people may just need to adjust their diet and take supplements of iron, folic acid or vitamin B12. Others may need to have a blood transfusion. If you have anaemia caused by kidney failure, you may need to have injections of the hormone erythropoietin (also known as Epo).

    Your GP or specialist will always treat the underlying cause of your anaemia before considering a blood transfusion.

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  • Causes Causes of anaemia

    There are many possible causes of anaemia. Most fall into the following four groups.

    • Anaemia caused by bleeding. You can lose a lot of blood through an injury or from having an operation, for example. If you have prolonged or heavy periods, this can also lead to anaemia. These types of bleeding are usually obvious. However, sometimes bleeding can happen quite slowly and you may not be aware of it. For instance, bleeding from a stomach ulcer or from within your bowel.
    • Your body may not make enough healthy red blood cells and/or haemoglobin. This may happen if you don't get enough of the nutrients in your diet that you need to make the red cells. These nutrients include iron, vitamin B12 and folate. It can also happen if you have a health condition that stops your body absorbing nutrients, such as coeliac disease.
    • Your body may have a problem with the normal production of red blood cells. This can happen, for example, if you have kidney disease or a problem with your bone marrow. Anaemia associated with other conditions such as these is known as anaemia of chronic disease.
    • Your body may destroy its own red blood cells prematurely, which is called haemolytic anaemia. Red blood cells usually survive for about 120 days before they are broken down and replaced but in haemolytic anaemia, the breakdown happens too soon. Haemolytic anaemia can be caused by an inherited condition, such as thalassaemia, or you can develop it after certain infections, such as meningitis. You can also develop this type of anaemia if your body produces antibodies against your own red blood cells (autoimmune haemolytic anaemia).
  • Complications Complications of anaemia

    If you have anaemia, your heart has to work harder to get oxygen to your vital organs. If you don't get treatment, this may lead to problems with your heart and lungs. There are other complications related to specific types of anaemia.

  • Prevention Prevention of anaemia

    You can reduce your risk of developing anaemia by eating a healthy, balanced diet. This supplies all the vitamins most people need. Only take supplements if your GP recommends it.

    The best sources of iron and vitamin B12 are red meat and fortified foods, such as breakfast cereals and bread. Fortified means particular nutrients are added to the food during their manufacture. Dark green vegetables, dried fruit such as raisins, apricots and prunes, beans and lentils are all also good sources of iron. Dairy products such as eggs are also a good source of vitamin B12.

    The best sources of folate are green vegetables, such as broccoli, Brussels sprouts, asparagus and peas. Chickpeas and brown rice are also good sources of folate.

    If you have a condition that affects how well you absorb nutrients, or if you’re pregnant, you may need to take supplements. It may benefit you to take iron tablets if you're menstruating. Ask your GP for advice.

  • FAQs FAQs

    Are there foods I shouldn’t eat if I have anaemia?


    If you have anaemia, there aren’t any particular foods you should cut out altogether. However, try to limit your intake of tea, coffee and alcohol, where possible.


    The main nutrients you need to make healthy red blood cells and the oxygen-carrying substance haemoglobin are iron, vitamin B12 and folate. A healthy, balanced diet can provide enough of these essential nutrients. However, there are certain substances found in some foods that can interfere with the absorption of iron. For example, phenols found in tea and coffee stop you from absorbing iron, so where possible it’s best to limit your intake.

    Vitamin C, on the other hand, helps your body to absorb more iron. Therefore include foods that are rich in vitamin C in your diet to get as much iron out of the food you eat. For example, drink fresh orange juice with your meal or have a fruit dessert.

    If you have an inherited condition called G6PD deficiency and eat fava beans, it can cause sudden and severe anaemia. Fava beans cause your red blood cells to break down rapidly, which results in severe anaemia and jaundice (yellowing of the whites of your eyes). Therefore if you have this condition, check the ingredients of foods to make sure they don't contain fava beans.

    How do I know if I have anaemia?


    Anaemia can often be difficult to recognise and diagnose by the symptoms alone. You will probably need a blood test to confirm that you have anaemia.


    Symptoms of anaemia can be quite vague so it's possible to have the condition for a long time without realising it.

    The most common symptoms and signs of anaemia include feeling tired, looking pale and feeling short of breath when you exert yourself. You may also have the sensation of your heart racing or thumping (called palpitations).

    Other symptoms that occur in certain types of anaemia include having:

    • brittle nails
    • mouth sores or ulcers
    • pins and needles in your hands or feet
    • a sore tongue
    • itchy skin
    • a ringing sound in your ears

    These symptoms may be caused by problems other than anaemia. If you have any of these symptoms, see your GP for advice.

    I have anaemia and need a blood transfusion. What does it involve and what are the risks?


    A blood transfusion is when blood or some of its components are put straight into your bloodstream. It’s done through a small tube (cannula), which is put into a vein, usually in your arm.


    Your doctor will usually only recommend you have a blood transfusion if you’re lacking blood or certain components of blood. The most common reason for having a blood transfusion is to replace blood that is lost during major surgery or an injury. Sometimes you may have a blood transfusion to treat severe anaemia.

    The blood is given to you through a fine, plastic tube called a cannula. This is put into a vein in your arm and connects to a drip that controls the flow of blood into your body. It takes up to four hours for one bag of blood to transfuse. However, you can have it more quickly if you need to.

    During a blood transfusion, you may get a slight temperature, chills or a rash. If this happens, a nurse may give you paracetamol and an antihistamine. However, your healthcare team may need to slow down the rate at which the blood is transfused or even stop the transfusion.

    The biggest risk of having a blood transfusion is being given the wrong blood type but this risk is small. Before you have a blood transfusion, you will have a blood test to determine your blood type. This will be tested (cross-matched) with a sample of suitable donated blood. Immediately before your blood transfusion, your doctor or nurse will check your details and make sure you get the blood that is intended for you.

    The risk of getting an infectious disease from a blood transfusion is very low. All blood donors are carefully selected to make sure the blood they donate is as safe as possible. All donated blood is tested for infectious diseases such as hepatitis B, hepatitis C and HIV before it's available for use.

    There are a number of other possible risks of blood transfusion, which may depend on your personal health. Ask your doctor for information to explain these to you.

    I'm a vegetarian – is there anything I can do to help prevent myself from developing anaemia?


    You can help to reduce your risk of developing anaemia by eating a healthy, balanced diet with enough iron, folic acid and vitamin B12.


    If you’re vegetarian or vegan, you may miss out on some nutrients. These can include iron and vitamin B12 that are in meat, fish, poultry and dairy products. If you don’t get enough of these nutrients, you may be more at risk of developing anaemia.

    Good non-meat sources of iron include:

    • beans
    • dried fruit and nuts
    • brown rice and wholegrain bread
    • fortified breakfast cereals
    • dark, green leafy vegetables

    Good non-meat sources of vitamin B12 include:

    • eggs, milk and cheese
    • yeast extract
    • fortified breakfast cereals, soya milk, yoghurts and desserts

    If you follow a vegan diet, you may need to take vitamin B12 supplements.

    It’s also important to have enough folate in your diet, which you can get from green vegetables, such as broccoli, Brussels sprouts, asparagus and peas. Chickpeas and brown rice are also good sources of folate.

    For more information about healthy eating, speak to your GP.

  • Resources Resources

    Further information


    • Goddard AF, James MW, Mcintyre AS, et al. Guidelines for the management of iron deficiency anaemia. Gut 2011; 60:1309–16. doi:10.1136/gut.2010.228874.
    • Anemia. Medscape., published 4 November 2011
    • Components of blood. NHS Blood and Transplant., accessed 8 July 2013
    • Fernández-Gaxiola AC, De-Regil LM. Intermittent iron supplementation for reducing anaemia and its associated impairments in menstruating women. Cochrane Database of Systematic Reviews 2011, Issue 12. doi: 10.1002/14651858.CD009218.pub2.
    • Anaemia of chronic disease. PatientPlus., published 10 June 2013
    • Anaemia – suspected. Map of Medicine., published 21 January 2013
    • Anaemia – iron deficiency. NICE Clinical Knowledge Summaries., published February 2013
    • Iron deficiency anemia. Medscape., published 23 September 2013
    • Anemia of chronic disease and renal failure. Medscape., published 28 October 2013
    • Hemolytic anemia. Medscape., published 21 February 2013
    • Iron. Food Standards Agency., accessed 9 July 2013
    • Vegetarian diets – keeping a healthy balance. British Dietetic Association., published August 2011
    • Vitamin B12 and folate deficiency. Map of Medicine., published 28 March 2012
    • Will I need a blood transfusion? NHS Blood and Transplant., published 31 July 2011
    • Blood transfusion – FAQs. NHS Blood and Transplant., accessed 9 July 2013
    • Vitamin B12. Food Standards Agency., accessed 9 July 2013
    • Glucose-6-phosphate dehydrogenase deficiency. Medscape., published 10 January 2012
    • Favism. PatientPlus., published 22 June 2011
    • Jaundice. PatientPlus., published 22 June 2011
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