Anemia happens when the number of healthy red blood cells in your body is too low. Red blood cells carry oxygen to all of the body’s tissues, so a low red blood cell count indicates that the amount of oxygen in your blood is lower than it should be.
Many of the symptoms of anemia are caused by decreased oxygen delivery to the body’s vital tissues and organs.
Anemia is measured according to the amount of hemoglobin — the protein within red blood cells that carries oxygen from the lungs to the body’s tissues.
Anemia affects more than 1.6 billion people around the world. Women and people with chronic diseases such as cancer have the highest risk of developing anemia.
Dietary iron, vitamin B-12, and folate are essential for red blood cells to mature in the body. Normally, 0.8 to 1 percent of the body’s red blood cells are replaced every day, and the average lifespan for red cells is 100 to 120 days. Any process that has a negative effect on this balance between red blood cell production and destruction can cause anemia.
Causes of anemia are generally divided into those that decrease red blood cell production and those that increase red blood cell destruction.
Factors that decrease red blood cell production
The things that typically decrease red blood cell production, causing anemia, include:
- inadequate stimulation of red blood cell production by the hormone erythropoietin, which is produced by the kidneys
- inadequate dietary intake of iron, vitamin B-12, or folate
- hypothyroidism
Factors the increase red blood cell destruction
On the other hand, any disorder that destroys red blood cells at a rate faster than they’re made can cause anemia. This typically occurs due to hemorrhaging, which can happen because of:
- endometriosis
- accidents
- gastrointestinal lesions
- menstruation
- childbirth
- excessive uterine bleeding
- surgery
- cirrhosis, which involves scarring of the liver
- fibrosis (scar tissue) within the bone marrow
- hemolysis, a rupture of red blood cells that can occur with some medications or Rh incompatibility
- disorders of the liver and spleen
- genetic disorders such as:
- glucose-6-phosphate dehydrogenase (G6PD) deficiency
- thalassemia
- sickle cell anemia
Overall, however, iron deficiency is the most common cause of anemia. It accounts for nearly half of all anemia cases, and is a major nutritional disorder worldwide.
Daily requirements for vitamins and iron vary according to sex and age.
Women need more iron and folate than men because of iron losses during their menstrual cycle and fetal development during pregnancy and breastfeeding.
Iron
According to the National Institutes of Health, the recommended daily iron intake for adults ages 19 to 50 are as follows:
| For men | 8 mg |
| For women | 18 mg |
| During pregnancy | 27 mg |
| While breastfeeding | 9 mg |
Men and women over age 50 require only 8 milligrams (mg) of iron daily. A supplement may be needed if adequate iron levels can’t be acquired through diet alone.
Good sources of dietary iron include:
- chicken and beef liver
- dark turkey meat
- red meats, such as beef
- seafood
- fortified cereals
- oatmeal
- lentils
- beans
- spinach
Folate
Folate is the form of folic acid that occurs naturally in the body.
Males and females over the age of 14 require 400 micrograms of dietary folate equivalents (mcg/DFE) per day.
For women who are pregnant or breastfeeding, the recommended intake increases to 600 mcg/DFE and 500 mcg/DFE per day, respectively.
Examples of foods rich in folate are:
- beef liver
- lentils
- spinach
- great northern beans
- asparagus
- eggs
You can also add folic acid to your diet with fortified cereals and breads.
Vitamin B-12
The daily adult recommendation for vitamin B-12 is 2.4 mcg. Women and teens who are pregnant need 2.6 mcg per day, and those who are breastfeeding require 2.8 mcg daily.
Beef liver and clams are two of the best sources of vitamin B-12. Other good sources include:
- fish
- meat
- poultry
- eggs
- other dairy products
Vitamin B-12 is also available as a supplement for those who don’t get enough from their diet alone.
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A diagnosis of anemia begins with both your health history and your family health history, along with a physical exam.
A family history of certain types of anemia such as sickle cell anemia can be helpful. A history of exposure to toxic agents in the home or workplace might point to an environmental cause.
Laboratory tests are often what’s used to help doctors find out the cause of the anemia.
Tests to diagnose anemia include:
- Complete blood count (CBC). The CBC blood test shows the number and size of the red blood cells. It also shows if levels of other blood cells like white blood cells and platelets are normal.
- Serum iron levels. This blood test shows if iron deficiency is the cause of anemia.
- Ferritin test. This blood test analyzes iron stores.
- Vitamin B-12 test. This blood test shows vitamin B-12 levels and helps your doctor determine if they’re too low.
- Folic acid test. This blood test reveals if serum folate levels are low.
- Stool test for occult blood. This test applies a chemical to a stool specimen to see if blood is present. If the test is positive, it means that blood is being lost somewhere in the gastrointestinal tract, from the mouth to the rectum. Problems like stomach ulcers, ulcerative colitis, and colon cancer can cause blood in stool.
Additional tests
Based on the results of these tests, doctors may order additional tests such as:
- an upper GI
- a barium enema
- chest X-rays
- a CT scan of your abdomen
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