Anemia: finding the cause before treating it

Anemia means a lower than normal hemoglobin, the protein in red cells that carries oxygen. It causes tiredness, breathlessness on effort, palpitations, headaches and pale skin — symptoms that often develop so slowly that people adapt to them.

Because anemia has so many possible causes, the most important step is not the treatment but the diagnosis.

Iron Deficiency, the most Common Cause

Iron deficiency is the leading cause of anemia worldwide. In women it is often due to heavy periods or pregnancy; in men and in women after menopause it raises the question of hidden blood loss from the gut, which needs to be looked for.

Treatment is iron replacement, by mouth or, when tablets are not tolerated, not absorbed or not fast enough, through an intravenous infusion. The cause of the deficiency must be treated as well, or the anemia will return.

Other Causes

Vitamin B12 and folate deficiency produce large red cells and can affect the nerves as well as the blood. Chronic kidney disease, chronic inflammation, thyroid disease and inherited conditions such as thalassemia trait each have their own pattern.

Less often the problem is in the bone marrow itself — myelodysplastic syndromes, aplastic anemia or a marrow infiltrated by another disease. Here a bone marrow examination is part of the work-up.