Anaemia

If you have anaemia, you don’t have enough red blood cells or haemoglobin for your body’s needs. Red blood cells use haemoglobin to carry oxygen to your tissues and organs. Symptoms of anaemia can include tiredness, headaches, weakness, and shortness of breath.

Causes of anaemia

There are several reasons why you might have anaemia. It can be due to your diet or it can be a sign of an underlying health condition.

There are three main ways that anaemia develops, and each of them affects the number of red blood cells you have.

Your body isn’t making enough healthy red blood cells

This could be because of iron deficiency, which may lead to iron deficiency anaemia, the most common form of anaemia. Iron deficiency is caused by a lack of iron. You can also fail to produce enough red blood cells if you don’t get enough vitamin B12 or folate in your diet or if you aren’t absorbing these nutrients properly. Red blood cells are made in the bone marrow. So, bone marrow diseases such as leukaemia and aplastic anaemia can also be a cause of anaemia.

There are many reasons why you may have a deficiency of iron, vitamin B12, or folate.

• Pregnancy – if you’re pregnant, you’ll need more iron and folate than normal so the amount you get from your diet may no longer be enough.
• Diet – if your diet is lacking in foods such as red meat and dark leafy green vegetables or you follow a vegan diet, you’re at greater risk of anaemia. This is because the iron is better absorbed from meat than from plant-based sources and most vegan foods don’t contain vitamin B12.
• A condition that affects the absorption of nutrients from your bowel. Some health conditions, such as Crohn’s disease, coeliac disease or pernicious anaemia might lead to a deficiency in some nutrients.

Your body breaks down your red blood cells too quickly

Even if you do make enough red blood cells, they can sometimes be broken down too quickly by your body. This is called haemolytic anaemia. Haemolytic anaemia can be triggered by an underlying health condition or by using medicines such as penicillin and non-steroidal anti-inflammatory drugs (NSAIDs).

You’ve lost a lot of blood

You might lose a lot of blood suddenly – for example, because of an injury. Or it could occur gradually over time. Gradual blood loss can be caused by:

• heavy periods (menorrhagia)
• a condition that causes bleeding in your bowel – for example, piles or peptic ulcers
• a stomach ulcer
• an operation
• giving birth
• regular blood donation

Other causes of anaemia

Some less common anaemia causes are described below.

• Having a condition that affects your immune system – for example, infections, cancers (such as bowel cancer), and other diseases. These conditions can cause ongoing inflammation in your body, which can lead to fewer red blood cells being produced.
• An autoimmune condition such as rheumatoid arthritis or lupus. These conditions can cause your body to destroy red blood cells.
• A genetic disorder such as thalassaemia or sickle cell disease. These cause red blood cells to be destroyed or misshapen so they don’t work properly.
• Chemotherapy for cancer treatment can affect your bone marrow. This may result in anaemia.
• Chronic kidney disease can affect the production of your red blood cells and lead to anaemia.

Symptoms of anaemia

IIf you have anaemia that’s developed slowly over time, you may not have any symptoms at all. But you might eventually start to notice some signs of anaemia.

Anaemia symptoms may include:

• looking pale
• feeling tired and weak
• not feel able to do as much exercise as you normally would
• dizziness
• feeling lightheaded
• shortness of breath when you exercise
• a thumping or unusual beating of your heart (palpitations)

You may have other symptoms too, depending on what’s causing your anaemia. For instance, your poo (faeces) may be dark and tarry-looking if you have a condition that’s causing bleeding in your bowels. You may have a sore tongue or changes in your taste if you’re deficient in iron, folate, or vitamin B12. Restless leg syndrome is also a common symptom of iron deficiency anaemia. Hair thinning can also be a sign of iron deficiency anaemia.

These symptoms can be caused by other things, but if you have any of them, contact your GP surgery for advice.

When to seek urgent help

Seek immediate medical advice if you or someone else has the following symptoms:

• heavy blood loss (such as from the bowel)
• trouble breathing
• chest pains
• dizziness and fainting

Call the emergency services on 999 or go to your local accident and emergency department.

Diagnosis of anaemia

Your GP will ask about your symptoms and examine you. They may ask you questions about your diet and any medicines you’re taking, as well as any recent illnesses and your family history. Your GP may ask you to have a blood test. This will check:

• if you have low haemoglobin levels (anaemia may be suspected if this is below 130g per litre)
• how many blood cells you have
• the size and shape of your blood cells
• your levels of iron, vitamin B12, and folate if needed

A blood test may be all you need if it’s obvious what’s causing your anaemia. By finding out the cause of your anaemia your doctor can help you get the right treatment. But if there isn’t an obvious cause, you may need to have further tests and scans. These can include blood tests and sometimes endoscopies (a test where a tube with a camera is used to look inside your body).

Depending on the results of your tests, your GP may refer you to a specialist doctor such as a haematologist (a doctor who specialises in blood disorders).

Treatment of anaemia

The treatment you need will depend on what’s causing your anaemia. If it’s due to a health condition, you’ll need to have the condition treated. And if medicines are the cause, you may need to stop taking them and find an alternative.

Sometimes your doctor may not give you any treatment if your anaemia doesn’t cause you too many problems. But you may need anaemia treatment if it’s starting to have a significant impact on your quality of life. Some of the main treatments for various types of anaemia are discussed below.

Nutritional supplements and diet

If you’re deficient in iron, folate, or vitamin B12, you may need to take supplements of these nutrients. Your GP may prescribe these for you. Iron and folate are usually taken as tablets. Vitamin B12 can be given as injections. You may need to continue to take supplements for several months until the levels in your blood are back to normal. Sometimes, you may need to carry on taking them for life.

Iron supplements can cause side-effects such as constipation, diarrhoea, nausea, and sickness. Talk to your pharmacist if you have any problems – you may be able to try a different type of tablet.

Your GP may also give you some advice on how to get more iron, vitamin B12 or folate in your diet. This will help to maintain your levels of these nutrients and may stop you from getting anaemia again if your diet didn’t have enough. Here are some good dietary sources of iron, folate, and vitamin B12.

Iron

• red meats including beef and lamb
• dark green vegetables including spinach, cabbage, and kale
• dried fruits such as apricots, prunes, and raisins
• iron-fortified bread

Folate

• poultry, pork, and shellfish
• chickpeas and peas
• brown rice
• green vegetables including spinach, kale, and broccoli
• citrus fruits such as oranges
• fortified foods such as cereals

Vitamin B12

• red meats, including beef and lamb
• eggs
• milk and other dairy products
• fish such as salmon and cod
• fortified soy, bread, and cereal products
• fortified yeast

Treatments for severe and ongoing anaemia

If you have severe anaemia or it can’t be treated with nutritional supplements, your doctor may offer you one or more of the following treatments.

• Erythropoietin stimulating agents. These can help your bone marrow to make more red blood cells. It might be an option if you have anaemia associated with a long-term health condition such as kidney disease.
• A blood transfusion may be required if you have particularly severe symptoms. This will give you blood from a carefully selected donor into one of your veins via a drip in your arm.
• Medicines that suppress your immune system may be suggested by your doctor if your anaemia is caused by an autoimmune condition

If you have certain types of anaemia – for example, sickle cell anaemia – your treatment will be tailored to your personal circumstances. You will be given a tailored plan to help you manage your health. Ask your doctor to explain your options.

Complications of anaemia

You may develop complications if your anaemia is severe, and you don’t get appropriate treatment. For example, anaemia can make an existing heart problem such as angina or heart failure worse.

Other complications can vary depending on the type of anaemia you have. For example, if you have iron-deficiency anaemia, it might lower your immunity making it harder to fight infections.

Pregnancy is a common cause of iron-deficiency anaemia. Complications of this can affect you and your baby. You may be more likely to have infections and severe blood loss after giving birth. And complications for your baby may include:

• being born prematurely
• small birth weight

You will need to take iron supplements prescribed to you while you’re pregnant to prevent these effects.

Prevention of anaemia

Although you can’t prevent many types of anaemia, eating a healthy, well-balanced diet will help. This will make sure you’re getting enough iron, folate, and vitamin B12. To find out about good sources of these foods, see our treatment section. Talk to your GP or pharmacist if you follow a vegan diet because they can provide advice about which supplements you might need to take.

If you’re at risk of developing iron-deficiency anaemia, your GP may suggest you take regular iron tablets to prevent it. Some of the reasons why you may be at risk include:

• you have heavy periods
• your anaemia keeps coming back
• you have a condition that affects absorption of iron, folate, or vitamin B12 from your bowel