Overview
Anemia is a condition in which the blood does not have enough healthy red blood cells (erythrocytes) or hemoglobin. Hemoglobin is the protein that carries oxygen to all tissues; in its deficiency, tissues do not receive enough oxygen.
Anemia affects more than 2 billion people worldwide. It is especially common in women, pregnant women, young children, and the elderly. Anemia is not a disease by itself; it is a sign of an underlying cause.
Types of Anemia
- Iron deficiency anemia (most common)
- Vitamin B12 deficiency anemia (megaloblastic)
- Folic acid deficiency anemia
- Anemia of chronic disease
- Aplastic anemia
- Hemolytic anemia (destruction of red cells)
- Sickle cell anemia (hereditary)
- Thalassemia (Mediterranean anemia, common in our region)
Symptoms
Mild anemia may have no symptoms. As it worsens:
- Extreme fatigue, weakness
- Pale or yellowish skin
- Shortness of breath
- Palpitations, rapid heartbeat
- Dizziness, lightheadedness
- Cold hands and feet
- Headache
- Chest pain
- Difficulty concentrating
- Brittle nails
- Hair loss
- Decreased exercise tolerance
Symptoms specific to B12 deficiency:
- Numbness, tingling in hands and feet
- Balance disturbance
- Memory problems
- Jaundice
- Burning, redness of the tongue
Causes
Anemia results from three main mechanisms:
1. Blood loss:
- Heavy menstrual bleeding
- Gastrointestinal bleeding
- Surgery
- Trauma
2. Insufficient cell production:
- Iron, B12, folic acid deficiency
- Bone marrow disorders
- Chronic kidney disease (erythropoietin deficiency)
- Chronic inflammatory diseases
- Cancer
3. Increased cell destruction:
- Autoimmune hemolytic anemia
- Hereditary diseases (thalassemia, sickle cell anemia)
- Some infections (malaria)
- Some medications
Risk Factors
- Diet poor in iron and vitamins
- Intestinal diseases
- Being female (especially of reproductive age)
- Pregnancy
- Chronic diseases
- Family history (thalassemia, sickle cell anemia)
- Age 65 and over
- Vegetarian diet
- Some medications
Complications
- Extreme fatigue; decreased work and school performance
- Heart problems (arrhythmia, heart failure)
- Pregnancy complications (preterm birth, low birth weight)
- Growth and developmental delay in children
- Risk of falls (in the elderly)
- Death (untreated severe anemia)
When to See a Doctor
- If you have persistent weakness and fatigue
- If you look pale
- If you have shortness of breath and palpitations
- If you have a family history of anemia
- If you are or are planning to become pregnant
- If you have heavy menstrual bleeding
Diagnosis and Treatment
Diagnosis:
- Complete blood count: Hemoglobin, hematocrit, red cell indices (MCV, MCH, MCHC)
- Peripheral smear: Cell shape and size
- Iron panel: Serum iron, ferritin, transferrin saturation
- Vitamin B12, folic acid levels
- Reticulocyte count
- Hemoglobin electrophoresis (when thalassemia is suspected)
- Tests to find the underlying cause (endoscopy, colonoscopy)
Treatment (by cause):
- Iron deficiency: Iron tablets; intravenous iron when needed
- B12 deficiency: B12 injections or high-dose oral B12
- Folic acid deficiency: Folic acid tablets
- Anemia of chronic disease: Erythropoietin (epoetin)
- Aplastic anemia: Bone marrow transplant, immunosuppressive therapy
- Hemolytic anemia: Corticosteroids, splenectomy when needed
- Thalassemia/sickle cell: Regular transfusions, bone marrow transplant
- Severe cases: Blood transfusion
Prevention
Iron sources: Red meat, liver, dried legumes, dark green vegetables, dried fruits
B12 sources: Animal foods (meat, fish, eggs, dairy)
Folic acid sources: Green leafy vegetables, citrus fruits, legumes
General recommendations:
- Eat a balanced and varied diet
- Consume with vitamin C to enhance iron absorption
- Separate tea and coffee from meals
- Take supplements during pregnancy
- Get regular check-ups if you are in a risk group
- Thalassemia screening (especially in Aegean and Mediterranean regions)
- B12 supplementation for vegetarians
- Get intestinal diseases treated