Anemia

What is anemia?

Red blood cells carry oxygen from your lungs to the rest of your body. They do this with a protein called hemoglobin. When you have anemia, your blood has fewer red blood cells or less hemoglobin than normal, so your body gets less oxygen than it needs.

Anemia can be mild and found only on a routine blood test, or it can be more serious. It is a sign that something else is going on, so the goal is always to find and treat the cause.

If your doctor referred you to a hematologist for anemia, that does not mean you have cancer. Hematologists are specialists in blood conditions of every kind, and most people we see for anemia do not have cancer.

Symptoms

Mild anemia may cause no symptoms at all. When symptoms do happen, they can include:

• Feeling tired or weak
• Shortness of breath, especially with activity
• Dizziness or feeling lightheaded
• Pale skin
• Cold hands and feet
• Headaches
• A fast or uneven heartbeat

Tell your care team about any symptoms, even if they seem small. Some people get used to feeling tired and don’t realize how much better they could feel.

Common causes

Anemia has many possible causes. The most common include:

• Low iron. Your body needs iron to make hemoglobin. Iron can run low from blood loss (such as heavy menstrual periods or bleeding in the stomach or bowel), from not getting enough iron in your diet, or from not absorbing it well.
• Low vitamin B12 or folate. These vitamins help your body make healthy red blood cells.
• Long-term health conditions. Kidney disease, inflammation and some other ongoing conditions can lower red blood cell production.
• Cancer and its treatment. Some cancers and some treatments, such as chemotherapy, can lower red blood cell counts.
• Inherited conditions. Conditions such as sickle cell disease and thalassemia affect how red blood cells are made.
• Bone marrow problems. Less often, anemia comes from a problem in the bone marrow, where blood cells are made.

Tests and diagnosis

Your care team will ask about your health, symptoms, diet, medicines and any bleeding. Blood tests usually come next. These may include:

• A complete blood count (CBC), which measures your red cells, white cells, platelets and hemoglobin
• Iron studies, such as ferritin, which show how much iron your body has stored
• Vitamin B12 and folate levels
• A reticulocyte count, which shows how quickly your bone marrow is making new red blood cells
• A peripheral blood smear, where your blood cells are looked at under a microscope

Depending on the results, your care team may suggest other tests to look for a source of blood loss, or, less often, a bone marrow biopsy.

Treatment options

Treatment depends on the cause and on how severe the anemia is. It may include:

• Iron, taken by mouth or given through an IV (an iron infusion). Infusions can raise iron levels faster for people who can’t take or absorb iron pills.
• Vitamin B12 or folate, as pills or shots.
• Treating the cause, such as finding and stopping a source of bleeding, or managing a related health condition.
• Medicines that help your body make more red blood cells, in some situations.
• A blood transfusion, when anemia is severe or causing serious symptoms.

What to expect

At your first visit, your physician will review your blood work and history with you, and may order more tests. Once the cause is clear, you’ll talk through a treatment plan together. Many people start to feel better within a few weeks of starting treatment, though it can take longer for iron stores to fully recover. Your care team will check your blood counts again to make sure treatment is working.