Signs and Symptoms

Many people with mild anemia have no complaints.

Symptoms of anemia can be mild at first, and can be mistaken for symptoms of other conditions. They include:

• Tiredness
• Weakness
• Shortness of breath
• Pale skin
• Lightheadedness, dizziness
• Headache
• Feeling cold
• Rapid heartbeat and chest pain
• Irritability

What Causes It?

Anemia may have the following causes:

• Iron-deficiency anemia may be caused by blood loss, such as from an ulcer or heavy menstruation or after surgery; not getting enough iron in your diet; pregnancy; side effect of medication
• Vitamin-deficiency anemia may result from not getting enough folic acid and vitamin B12 in your diet, or not being able to absorb these vitamins (due to celiac disease, for example); side effect of medication
• Aplastic anemia may be caused by an autoimmune disorder
• Hemolytic anemia can be caused by medication, autoimmune disorders
• Sickle cell anemia is inherited
• Anemia of inflammation, which is the second most common anemia after iron-deficiency anemia, occurs as a result of a chronic disease.

What to Expect at Your Provider's Office

Anemia is often caused by another disease. Your doctor will draw blood and run lab tests, including a complete blood count (CBC) that measures the amount of red blood cells and hemoglobin in your blood. If you are anemic, your doctor may run more tests to see what type of anemia you have.

Treatment Options

The cause of your anemia, and how serious your anemia is, will determine your treatment. Your doctor may suggest changes in your diet to make sure you get all the nutrients you need, such as vitamin B12, iron, and folic acid. Your doctor may also suggest nutritional supplements or medication. If your anemia is due to an underlying disease, your doctor will treat that disease.

Drug Therapies

• Erythropoietin plus iron for anemia of chronic disease. Erythropoietin is a hormone that stimulates the production of red blood cells.
• Corticosteroids (such as prednisone) for some hemolytic anemias. Corticosteroids suppress the immune system, and may help when anemia is caused by an autoimmune disorder.
• Medications that suppress the immune system, such as antithymocyte globulin or ATG and cyclosporine for aplastic anemia.

Surgical and Other Procedures

• Removal of the spleen (splenectomy) may be needed in cases of hereditary spherocytosis.
• Transfusions may help treat certain types of anemia, including anemia of chronic disease, sickle cell anemia, and aplastic anemia.
• Bone marrow or stem cell transplant may be used in severe cases of aplastic anemia, or some cases of sickle cell anemia.

Complementary and Alternative Therapies

Most often, anemia is caused by a lack of iron or vitamins. Making changes to your diet or taking supplements usually help. You should, however, find out from your doctor the cause of your anemia. For example, too much iron is toxic, and you should not take supplements unless you have iron-deficiency anemia and your doctor recommends them. Herbal and nutritional treatments may help when used along with medical treatment.

Nutrition and Supplements

Iron: Ferrous fumerate, glycerate, or sulfate are the forms of iron your body can absorb most easily. Always ask your doctor before taking an iron supplement. Taking a smaller dose 3 times a day, or taking iron with meals, may reduce side effects. If you miss a dose, DO NOT take an extra dose the next time. Keep iron supplements away from children. Even a little excess iron can be fatal. Dietary sources of iron include red meat, especially calf liver, beans, beet greens, blackstrap molasses, almonds, and brewer's yeast. Green leafy vegetables contain both iron and folic acid.

Vitamin C helps your body absorb iron. Dietary sources include citrus fruits and juices, tomatoes, broccoli, and cauliflower. Vitamin C supplements may interact with other medications, including chemotherapy drugs, estrogen, warfarin (Coumadin), and others.

Vitamin B12 helps in cases of vitamin deficient or pernicious anemia. Dietary sources include liver, meats, eggs, tuna, and cheese. People with pernicious anemia cannot absorb the proper amount of vitamin B12 and may need lifelong supplements.

Folic acid can be taken for folic acid deficiency, which can cause anemia. Good food sources include green leafy vegetables, orange juice, and grains. Taking a folic acid supplement can hide a vitamin B12 deficiency, so always take vitamin B12 when taking folic acid. Folic acid may interact with the chemotherapy drugs 5-fluorouracil and capecitabine (Xeloda). It may also interact with the antiseizure drugs phenytoin (Dilantin), phenobarbital, and primidone (Mysoline).

Blackstrap molasses , also known as pregnancy tea (1 tablespoon per day in a cup of hot water), is a good source of iron, B vitamins, and minerals. Blackstrap molasses is also a very gentle laxative.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medicines. For these reasons, take herbs only under the supervision of a health care provider.

• Spirulina , or blue-green algae, may treat some anemias. Dose is 1 heaping teaspoon per day. If you take medications to suppress your immune system, ask your doctor before taking spirulina.
• Alfalfa ( Medicago sativa ), dandelion ( Taraxacum officinale ) root or leaf, burdock ( (Arctium lappa ), and yellowdock ( Rumex crispus ): have traditionally been used to fortify and cleanse the blood. For mild cases of anemia, they may help bring levels of hemoglobin into normal range. Simmer roots for 20 minutes and leaves for 5 minutes. You may use a single herb, or a combination of these four herbs. These herbs may interact with several medications, including warfarin (Coumadin), and other blood-thinning medications, as well as lithium, and digoxin, among others.
• Gentian ( Gentiana lutea ): is often used in Europe to treat anemia by stimulating the digestive system to more easily absorb iron and other nutrients. Chinese herbalists do not use gentian if someone has chronic pain or frequent urination. Gentian may lower blood pressure, so be careful if you already take medication for high blood pressure. Taking gentian could cause your blood pressure to drop too low.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of anemia based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, which is your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

A homeopath will usually consider anemia as symptomatic of an underlying condition, and treat that condition.

• Ferrum phosphoricum : For iron deficiency
• Calcarea phosphorica : Particularly for children with nighttime bone aches, cool hands and feet, lack of energy, or poor digestion

Following Up

Eating a normal, balanced diet is very important if a nutrition problem is causing your anemia. You should avoid drugs that can cause stomach problems, and too much alcohol, if they are causing your anemia. A growing number of studies have reported an association between anemia and an increased risk of heart disease, including heart failure.

Special Considerations

Complications from anemia can range from loss of productivity due to weakness and fatigue to coma and death.

Pregnant women need more iron and folic acid than women who are not pregnant. A folic acid deficiency during pregnancy can cause a group of birth defects known as neural-tube defects, such as spina bifida.

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