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Overview of Anemia
Anemia is a condition in which the number of red blood cells or the amount of hemoglobin

(the protein that carries oxygen in them) is low.

Red blood cells contain hemoglobin, a protein that enables them to carry oxygen from the
lungs and deliver it to all parts of the body. When the number of red blood cells is reduced or
the amount of hemoglobin in them is low, the blood cannot carry an adequate supply of
oxygen. An inadequate supply of oxygen in the tissues causes the symptoms of anemia.

Causes of Anemia
The causes of anemia are numerous, but most can be grouped within three major
mechanisms that produce anemia:

Blood loss (excessive bleeding)

Inadequate production of red blood cells

Excessive destruction of red blood cells

 Common Causes of Anemia

Mechanism Examples

Bladder tumors

Cancer in the digestive tract

Heavy menstrual bleeding

Hemorrhoids
Chronic excessive bleeding
Kidney tumors

Nosebleeds

Polyps in the digestive tract

Ulcers in the stomach or small intestine

Injuries

Childbirth
Sudden excessive bleeding
A ruptured blood vessel

Surgery

Aplastic anemia

Chronic disorders

Folate deficiency

Iron deficiency

Leukemia

Decreased red blood cell production Lymphoma

Metastatic cancer

Myelodysplasia (abnormalities in bone marrow tissue)

Myelofibrosis

Multiple myeloma

Vitamin B12 deficiency

Increased red blood cell destruction Autoimmune reactions against red blood cells

An enlarged spleen

Glucose-6-phosphate dehydrogenase (G6PD) deficiency

Hemoglobin C disease
Mechanism Examples

Hemoglobin S-C disease

Hereditary elliptocytosis

Hereditary spherocytosis

Mechanical damage to red blood cells

Paroxysmal nocturnal hemoglobinuria

Sickle cell disease

Thalassemia
 More About Some Causes of Anemia

Cause Mechanism Treatment Comments

Extremely large spleens cause

The disorder that caused
the spleen to enlarge is
An enlarged spleen traps and treated.
Enlarged spleen
destroys abnormal red blood cells. Sometimes the spleen
must be removed
surgically.
abdominal pain and a feeling
of fullness after eating a small
amount of food.
Often, an enlarged spleen also
traps platelets and white blood
cells, thus reducing their
number in the bloodstream.

Abnormalities in blood vessels

Mechanical The cause of the damage
(such as an aneurysm), an artificial The spleen filters the damaged
damage to red is identified and
or damaged heart valve, can break red cells out of the blood.
blood cells corrected.
normal red blood cells apart.

Eculizumab, a drug that

The immune system destroys red People may have severe
blocks the complement
blood cells. stomach cramps and clotting
system, helps relieve
Paroxysmal in the large veins of the
Hemoglobin from these damaged symptoms.
nocturnal abdomen and legs.
hemoglobinuria cells is concentrated in urine
People with blood clots
during the night, resulting in dark, Symptoms often occur in
may need to take an
reddish urine in the morning. episodes (paroxysmally).
anticoagulant.

This hereditary disorder can

Red blood cells become misshapen
Hereditary
and rigid, getting trapped and
spherocytosis
destroyed in the spleen.
Treatment is usually not
needed, but severe
anemia may require
removal of the spleen.
also cause bone abnormalities,
such as a tower-shaped skull.
This disorder can sometimes
cause gallstones.

Red blood cells are oval or Severe anemia may

Hereditary The anemia is usually mild
elliptical in shape rather than the require removal of the
elliptocytosis and requires no treatment.
normal disk shape. spleen.

Glucose-6-phosphate
dehydrogenase (G6PD) deficiency:
The G6PD enzyme is missing from
G6PD deficiency is a
hereditary disorder that
In G6PD deficiency,
anemia can be prevented almost always affects males.

Red blood cell red blood cell membranes, making by avoiding things that About 10% of black males and
cells more fragile. trigger it, such as drugs.
enzyme a smaller percentage of white
abnormalities Pyruvate kinase (PK) deficiency, In PK deficiency, some people of Mediterranean
origin have G6PD deficiency.
which is usually present at birth people may benefit from
(congenital), also makes red blood removal of the spleen.
Pyruvate kinase deficiency is
cells more fragile.
rare.

Anemia caused by excessive bleeding

Anemia may be caused by excessive bleeding. Bleeding may be sudden, as may occur as a
result of an injury or during surgery. Often, bleeding is gradual and repetitive (chronic
bleeding), typically due to abnormalities in the digestive or urinary tract or heavy menstrual
periods. Chronic bleeding typically leads to low levels of iron, which leads to worsening
anemia.

Anemia due to inadequate red blood cell production

Anemia may also result when the body does not produce enough red blood cells (see also
Formation of Blood Cells.). Many nutrients are needed for red blood cell production. The
most critical are iron, vitamin B12, and folate (folic acid), but the body also needs trace
amounts of copper, as well as a proper balance of hormones, especially erythropoietin (a
hormone that stimulates red blood cell production). Without these nutrients and hormones,
production of red blood cells is slow and inadequate, or the red blood cells may be deformed
and unable to carry oxygen adequately.

Chronic disease also may affect red blood cell production. In some circumstances, the bone
marrow space may be invaded and replaced (for example, by leukemia, lymphoma, or
metastatic cancer), resulting in decreased production of red blood cells.

Anemia due to excessive red blood cell destruction

Anemia may also result when too many red blood cells are destroyed. Normally, red blood
cells live about 120 days. Scavenger cells in the bone marrow, spleen, and liver detect and
destroy red blood cells that are near or beyond their usual life span. If red blood cells are
destroyed prematurely (hemolysis), the bone marrow tries to compensate by producing new
cells faster. When destruction of red blood cells exceeds their production, hemolytic anemia
results. Hemolytic anemia is relatively uncommon compared with the anemia caused by
excessive bleeding and decreased red blood cell production. Hemolytic anemia may result
from disorders of the red blood cells themselves, but more often it results from other
disorders that cause red blood cells to be destroyed.

Symptoms of Anemia
Symptoms vary depending on the severity of the anemia and how rapidly it develops. Some
people with mild anemia, particularly when it develops slowly, have no symptoms at all.
Other people may experience symptoms only during physical exertion. More severe anemia
may cause symptoms even when people are resting. Symptoms are more severe when mild or
severe anemia develops rapidly, such as when bleeding that occurs when a blood vessel
ruptures.

Mild anemia often causes fatigue, weakness, and paleness. In addition to these symptoms,
more severe anemia may cause faintness, dizziness, increased thirst, sweating, a weak and
rapid pulse, and rapid breathing. Severe anemia may cause painful lower leg cramps during
exercise, shortness of breath, and chest pain, especially if people already have impaired
blood circulation in the legs or certain types of lung or heart disease.

Some symptoms may also give clues to the cause of the anemia. For example, black tarry
stools, blood in the urine or stool, or coughing up blood suggests that anemia is caused by
bleeding. Dark urine or jaundice (a yellowish tinge to the skin or the whites of the eyes)
suggests that red blood cell destruction may be the cause of anemia. A burning or prickling
feeling in the hands or feet may indicate vitamin B12 deficiency.

Anemia in older adults

Many disorders that cause anemia, such as cancer, including blood cancers such as
myelodysplasia and multiple myeloma, tend to be more common among older people. Thus,
many older people develop anemia. Anemia of chronic disease and iron deficiency anemia
caused by abnormal bleeding are the most common causes of anemia among older people.
Anemia is not a normal consequence of aging, and a cause should always be sought when
anemia is identified.

Symptoms of anemia are basically the same regardless of age. Also, even when anemia is
mild, older people are more likely to become confused, depressed, agitated, or listless than
younger people. They may also become unsteady and have difficulty walking. These
problems can interfere with being able to live independently. However, some older people
with mild anemia have no symptoms at all, particularly when anemia develops gradually, as
it often does.

In older people, anemia caused by vitamin B12 deficiency may be mistaken for dementia
because this type of anemia may affect mental function.

Having anemia may shorten the life expectancy of older people. Thus, identifying the cause
and correcting it are particularly important.

Diagnosis of Anemia
Blood tests

Sometimes anemia is detected before people notice symptoms when routine blood tests are
done.

Low levels of hemoglobin or a low hematocrit (the percentage of red blood cells in the total
blood volume) found in a blood sample confirm the anemia. Other tests, such as examining a
blood sample under a microscope and, less often, examining a sample taken from the bone
marrow, help determine the cause of the anemia.

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