Overview

Anemia is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your
body's tissues. Having anemia, also referred to as low hemoglobin, can make you feel tired and weak.

There are many forms of anemia, each with its own cause. Anemia can be temporary or long term and can
range from mild to severe. In most cases, anemia has more than one cause. See your doctor if you suspect
that you have anemia. It can be a warning sign of serious illness.

Treatments for anemia, which depend on the cause, range from taking supplements to having medical
procedures. You might be able to prevent some types of anemia by eating a healthy, varied diet.

Types
1. Aplastic anemia
Aplastic anemia is a condition that occurs when your body stops producing enough new blood cells. The
condition leaves you fatigued and more prone to infections and uncontrolled bleeding.

A rare and serious condition, aplastic anemia can develop at any age. It can occur
suddenly, or it can come on slowly and worsen over time. It can be mild or severe.

Treatment for aplastic anemia might include medications, blood transfusions or a stem cell
transplant, also known as a bone marrow transplant.

Symptoms

Aplastic anemia can have no symptoms. When present, signs and

symptoms can include:

•Fatigue

•Shortness of breath

•Rapid or irregular heart rate

•Pale skin

•Frequent or prolonged infections

•Unexplained or easy bruising Bone marrow

•Nosebleeds and bleeding gums

•Prolonged bleeding from cuts

•Skin rash

•Dizziness

•Headache

•Fever

Aplastic anemia can be short-lived, or it can become chronic. It can be severe and even fatal
Causes
Stem cells in the bone marrow produce blood cells — red cells, white cells and platelets. In aplastic anemia,
stem cells are damaged. As a result, the bone marrow is either empty (aplastic) or contains few blood cells
(hypoplastic).

The most common cause of aplastic anemia is from your immune system attacking the stem cells in your
bone marrow. Other factors that can injure bone marrow and affect blood cell production include:

•Radiation and chemotherapy treatments. While these cancer-fghting therapies kill cancer cells, they
can also damage healthy cells, including stem cells in bone marrow. Aplastic anemia can be a
temporary side effect of these treatments.
•Exposure to toxic chemicals. Toxic chemicals, such as some used in pesticides and insecticides, and
benzene, an ingredient in gasoline, have been linked to aplastic anemia. This type of anemia might
improve if you avoid repeated exposure to the chemicals that caused your illness.
•Use of certain drugs. Some medications, such as those used to treat rheumatoid arthritis and some
antibiotics, can cause aplastic anemia.
•Autoimmune disorders. An autoimmune disorder, in which your immune system attacks healthy cells,
might involve stem cells in your bone marrow.
•A viral infection. Viral infections that affect bone marrow can play a role in the development of aplastic
anemia. Viruses that have been linked to aplastic anemia include hepatitis, Epstein-Barr,
cytomegalovirus, parvovirus B19 and HIV.
•Pregnancy. Your immune system might attack your bone marrow during pregnancy.
•Unknown factors. In many cases, doctors aren't able to identify the cause of aplastic anemia
(idiopathic aplastic anemia).

Connections with other rare disorders

Some people with aplastic anemia also have a rare disorder known as paroxysmal nocturnal
hemoglobinuria, which causes red blood cells to break down too soon. This condition can lead to aplastic
anemia, or aplastic anemia can evolve into paroxysmal nocturnal hemoglobinuria.

Fanconi's anemia is a rare, inherited disease that leads to aplastic anemia. Children born with it tend to be
smaller than average and have birth defects, such as underdeveloped limbs. The disease is diagnosed with
the help of blood tests.

Risk factors
Aplastic anemia is rare. Factors that can increase risk include:

•Treatment with high-dose radiation or chemotherapy for cancer

•Exposure to toxic chemicals

•The use of some prescription drugs — such as chloramphenicol, which is used to treat bacterial
infections, and gold compounds used to treat rheumatoid arthritis
•Certain blood diseases, autoimmune disorders and serious infections

•Pregnancy, rarely

Prevention
There's no prevention for most cases of aplastic anemia. Avoiding exposure to insecticides, herbicides,
organic solvents, paint removers and other toxic chemicals might lower your risk of the disease.
2. Iron defciency anemia
3. Sickle cell anemia
4. Thalassemia
5. Vitamin defciency anemia

Symptoms
Anemia signs and symptoms vary depending on the cause and severity of anemia. Depending on the
causes of your anemia, you might have no symptoms.

Signs and symptoms, if they do occur, might include:

•Fatigue

•Weakness

•Pale or yellowish skin

•Irregular heartbeats

•Shortness of breath

•Dizziness or lightheadedness

•Chest pain

•Cold hands and feet

•Headaches

At frst, anemia can be so mild that you don't notice it. But symptoms worsen as anemia worsens.

When to see a doctor

Make an appointment with your doctor if you feel fatigued and you don't know why.

Fatigue has many causes besides anemia, so don't assume that if you're tired you must be anemic. Some
people learn that their hemoglobin is low, which indicates anemia, when they donate blood. If you're told
that you can't donate because of low hemoglobin, make an appointment with your doctor

Causes

Anemia can be due to a condition present at birth (congenital) or to a condition you develop (acquired).
Anemia occurs when your blood doesn't have enough red blood cells.

This can happen if:

•Your body doesn't make enough red blood cells

•Bleeding causes you to lose red blood cells more quickly than they can be replaced

•Your body destroys red blood cells

What red blood cells do
Your body makes three types of blood cells — white blood cells to fght infection, platelets to help your
blood clot, and red blood cells to carry oxygen from your lungs to the rest of your body and carbon dioxide
from the body back to the lungs.

Red blood cells contain hemoglobin — an iron-rich protein that gives blood its red color. Hemoglobin
enables red blood cells to carry oxygen from your lungs to all parts of your body and to carry carbon dioxide
from other parts of the body to your lungs to be exhaled.

Most blood cells, including red blood cells, are produced regularly in your bone marrow — a spongy
material found within the cavities of many of your large bones. To produce hemoglobin and red blood cells,
your body needs iron, vitamin B-12, folate and other nutrients from the foods you eat.

Causes of anemia
Different types of anemia have different causes. They include:

•Iron defciency anemia. This most common type of anemia is caused by a shortage of iron in your
body. Your bone marrow needs iron to make hemoglobin. Without adequate iron, your body can't
produce enough hemoglobin for red blood cells.
Without iron supplementation, this type of anemia occurs in many pregnant women. It's also caused by
blood loss, such as from heavy menstrual bleeding; an ulcer in the stomach or small bowel; cancer of
the large bowel; and regular use of some pain relievers that are available without a prescription,
especially aspirin, which can cause infammation of the stomach lining resulting in blood loss. It's
important to determine the source of iron defciency to prevent recurrence of the anemia.
•Vitamin defciency anemia. Besides iron, your body needs folate and vitamin B-12 to produce enough
healthy red blood cells. A diet lacking in these and other key nutrients can cause decreased red blood
cell production. Some people who consume enough B-12 aren't able to absorb the vitamin. This can
lead to vitamin defciency anemia, also known as pernicious anemia.
•Anemia of infammation. Certain diseases — such as cancer, /, rheumatoid arthritis, kidney disease,
Crohn's disease and other acute or chronic infammatory diseases — can interfere with the production
of red blood cells.
•Aplastic anemia. This rare, life-threatening anemia occurs when your body doesn't produce enough
red blood cells. Causes of aplastic anemia include infections, certain medicines, autoimmune diseases
and exposure to toxic chemicals.
•Anemias associated with bone marrow disease. A variety of diseases, such as leukemia and
myelofbrosis, can cause anemia by affecting blood production in your bone marrow. The effects of
these types of cancer and cancer-like disorders vary from mild to life-threatening.
•Hemolytic anemias. This group of anemias develops when red blood cells are destroyed faster than
bone marrow can replace them. Certain blood diseases increase red blood cell destruction. You can
inherit a hemolytic anemia, or you can develop it later in life.
•Sickle cell anemia. This inherited and sometimes serious condition is a hemolytic anemia. It's caused
by a defective form of hemoglobin that forces red blood cells to assume an abnormal crescent (sickle)
shape. These irregular blood cells die prematurely, resulting in a chronic shortage of red blood cells.

Risk factors
These factors place you at increased risk of anemia:

•A diet lacking in certain vitamins and minerals. A diet consistently low in iron, vitamin B-12, folate and
copper increases your risk of anemia.
•Intestinal disorders. Having an intestinal disorder that affects the absorption of nutrients in your small
intestine — such as Crohn's disease and celiac disease — puts you at risk of anemia.
 •Menstruation. In general, women who haven't had menopause have a greater risk of iron defciency
anemia than do men and postmenopausal women. Menstruation causes the loss of red blood cells.
•Pregnancy. Being pregnant and not taking a multivitamin with folic acid and iron, increases your risk
of anemia.
•Chronic conditions. If you have cancer, kidney failure or another chronic condition, you could be at
risk of anemia of chronic disease. These conditions can lead to a shortage of red blood cells.
Slow, chronic blood loss from an ulcer or other source within your body can deplete your body's store
of iron, leading to iron defciency anemia.
•Family history. If your family has a history of an inherited anemia, such as sickle cell anemia, you also
might be at increased risk of the condition.
•Other factors. A history of certain infections, blood diseases and autoimmune disorders increases
your risk of anemia. Alcoholism, exposure to toxic chemicals and the use of some medications can
affect red blood cell production and lead to anemia.
•Age. People over age 65 are at increased risk of anemia.

Complications
Left untreated, anemia can cause many health problems, such as:

•Extreme fatigue. Severe anemia can make you so tired that you can't complete everyday tasks.
•Pregnancy complications. Pregnant women with folate defciency anemia can be more likely to have
complications, such as premature birth.
•Heart problems. Anemia can lead to a rapid or irregular heartbeat (arrhythmia). When you're anemic
your heart pumps more blood to make up for the lack of oxygen in the blood. This can lead to an
enlarged heart or heart failure.
•Death. Some inherited anemias, such as sickle cell anemia, can lead to life-threatening
complications. Losing a lot of blood quickly results in acute, severe anemia and can be fatal. Among
older people, anemia is associated with an increased risk of death.

Prevention
Many types of anemia can't be prevented. But you can avoid iron defciency anemia and vitamin defciency
anemias by eating a diet that includes a variety of vitamins and minerals, including:

•Iron. Iron-rich foods include beef and other meats, beans, lentils, iron-fortifed cereals, dark green
leafy vegetables and dried fruit.
•Folate. This nutrient, and its synthetic form folic acid, can be found in fruits and fruit juices, dark green
leafy vegetables, green peas, kidney beans, peanuts, and enriched grain products, such as bread,
cereal, pasta and rice.
•Vitamin B-12. Foods rich in vitamin B-12 include meat, dairy products, and fortifed cereal and soy
products.
•Vitamin C. Foods rich in vitamin C include citrus fruits and juices, peppers, broccoli, tomatoes, melons
and strawberries. These also help increase iron absorption.
If you're concerned about getting enough vitamins and minerals from food, ask your doctor whether a
multivitamin might help.