The NAAC Experts have answered a few basic questions patients and caregivers often have about anemia. If you have a general question about anemia which has not been answered in our list of Frequently Asked Questions or in our Information Handouts please Submit Your Question to NAAC. Unfortunately, NAAC cannot answer individual questions relating to the diagnosis or treatment of anemia or refer you to a doctor.
What are the symptoms of anemia?
The symptoms of anemia can include headache, fatigue, weakness, difficulty in thinking. With severe anemia, other symptoms, such as shortness of breath and rapid heartbeat, may be experienced.
At what point are people considered anemic?
This varies with gender and age. Both hemoglobin and hematocrit values are used to define anemia. These laboratory values are obtained from a CBC (complete blood count) test, performed at a doctor's office. The normal range of hemoglobin values is 14.0 g/dL to 17.4 g/dL for adult men and 12.3 g/dL to 15.3 g/dL for nonpregnant women. The World Health Organization defines anemia as less than 12 g/dL for nonpregnant women and less than 13 g/dL for men. The normal average hematocrit for adult males is 46%, and the range is 40% to 52%. For adult females, the normal average hematocrit is 41%, and the range is 35% to 47%. Values that fall below the lower limits can indicate anemia and deserve medical thought and further testing.
Which people are at the highest risk for anemia?
Groups of individuals who are at risk for developing anemia include:
- infants who may not have adequate iron intake
- children going through a rapid growth spurt, during which the iron available cannot keep up with the demands for a growing red cell mass
- women in childbearing years who have an excessive need for iron because of blood loss during menstruation
- pregnant women, in whom the growing fetus creates a high demand for iron.
People with ongoing gastrointestinal blood loss are at risk of developing iron deficiency, as are individuals with leukemia or cancer who must receive chemotherapy or radiation to treat their disease. The drugs or radiation used to treat these diseases frequently suppress the bone marrow's ability to make cells of all classes-red blood cells, white blood cells, and platelets.
In addition, many individuals with chronic inflammatory conditions, such as rheumatoid arthritis or chronic infections, may become anemic through a combination of an inadequate supply of iron for red blood cell production and bone marrow suppression. We now recognize that the increased anemia seen in the elderly may be a form of bone marrow suppression from chronic inflammation. Recognition and treatment of the anemia in the elderly has gained clinical interest because correcting the anemia may have beneficial effects on quality of life.
Are some types of anemia inherited?
Yes, some types of anemia are due to inherited or genetic defects. Sickle cell anemia occurs most frequently in people of African, African-American, and Mediterranean descent. Thalassemia (or Cooley's anemia) is found in people of Mediterranean and Southeast Asian descent. These types of anemia are extremely common. Another inherited anemia is Fanconi anemia, but this is very rare.
Can certain medications cause a person to become anemic?
Yes, medications can cause anemia for many different reasons. For example, chemotherapeutic agents often cause anemia because they the bone marrow's ability to manufacture red blood cells, hemoglobin is carried by RBC's, If there are not enough RBC's, the body does not get the right amount of oxygen. Other types of medication-induced anemia are usually unpredictable, and not well understood (such as drug induced aplastic anemia). Some patients react to drugs because of inherited susceptibility, such as patients with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. G-6-PD is an important enzyme that buffers the mature red cell against oxidative stress. In individuals who are deficient in G-6-PD, exposure to certain chemicals, drugs, or even some foods will result in the alteration of hemoglobin and breakdown of red blood cells.
Blood Donation
I tried to donate blood, but was denied because my blood count (hematocrit value) was too low. What hematocrit value is required to donate blood? What should I do about my low hematocrit value?
Hematocrit is a measure of the percentage of red blood cells in a blood sample. To donate blood, a person’s hematocrit value must be above the threshold of 38%, a level which is established by the U.S. Food and Drug Administration (FDA). If you are found to have a low hematocrit value, you will not be able to donate blood on that particular day. Having a low hematocrit is the most frequent reason for not being able to donate blood. It is normal for hematocrit values to vary from day to day or even hour to hour and values can be influenced by such things as diet, hydration and health issues.
Being deferred from donation due to a low hematocrit does not always mean that you have anemia or a medical problem. However, if you have been denied from donating blood because of a low hematocrit value it is possible that you have anemia. Decreased hematocrit often indicates anemia caused by an iron or vitamin deficiency. Further testing may be necessary to determine if you are anemic and if so, the cause of the anemia. If you find your hematocrit value is low or think you might be anemic, you should schedule an appointment with your doctor.
Blood Transfusion
Are blood transfusions commonly used to correct anemia, and are they dangerous?
Blood transfusions are used to treat anemia as a last resort. The physican first identifies the cause of the anemia and corrects the cause, if possible. With concern over the safety of the blood supply, more attention is being given to anemia management. Most blood transfusions are given because of excessive bleeding at the time of surgery, with trauma, or because of bone marrow suppression, in patients with cancer or leukemia on chemotherapy. Blood transfusions are much safer than ever before but we also know that blood transfusions affect the immune system and may increase certain risks. There is also a concern for human error, which in 1/16,000 transfusions results in a patient receiving a transfusion of blood that is not matched with his/ her blood type.
Iron Deficiency Anemia
What is iron deficiency anemia and can I correct it by changing my diet?
Iron is an essential part of hemoglobin, and without enough hemoglobin, anemia develops and the body does not get the right amount of oxygen. Iron deficiency anemia develops after the body has had a low level of iron for a long time, either because of iron loss or inadequate iron intake over a long period of time. It can be caused by blood loss, not taking in or absorbing enough iron, increased demands for iron (like pregenancy or rapid growth). In each case, iron supplementation may be necessary, in order to correct the iron deficiency. In the case of poor absorption, supplemental iron may have to be given intravenously or vitamin C may be given because it assists with absorbing iron.
I have been diagnosed with iron deficiency anemia and my doctor prescribed iron supplements. How long will it take for my blood to become normal?
It depends on the degree of anemia at the beginning of treatment. Most people with mild to moderate iron deficiency anemia will correct the anemia over a period of 2 to 3 months. However, the anemia is corrected, the iron stored by the body is still low. Physicians often recommend an additional 6 months of oral iron therapy once the anemia has been reversed, in order to replenish iron stores. This will help prevent the iron deficiency anemia from recurring quickly.
Surgery
My hemoglobin is 9 g/dL and I am scheduled for surgery. Should I postpone the surgery?
If you have Hb of 9, you should discuss this with your doctor as soon as possible.
Many patients with similar hemoglobin levels have had surgery without problems. If minimal blood loss is expected for a minor procedure, no treatment may be necessary. If a greater blood loss is expected for more extensive procedures, you should ask your doctor about being treated with erythropoietin and iron to accelerate the recovery of your hemoglobin to a normal level before surgery. An anemic patient who undergoes high-blood-loss surgery has a greater risk of surgical complications and need for a blood transfusion, which also carries some risk.
Women's Health
I have been told that heavy menstrual periods cause anemia. Is there anything I can do to prevent the anemia?
Anemia that results from heavy periods is usually due to iron deficiency. You can try to meet the increased demands for iron that are placed on the body by the heavy monthly blood loss by increasing the intake of iron-rich foods, but supplemental oral iron medications may be required. Discuss your concerns with your health care provider.
What causes anemia during pregnancy?
Pregnancy places major demands on the body, because the mother must meet the needs of both her body and her growing baby. The body needs enough iron and folate to make the right amount of red blood cells. To prevent anemia during pregnancy, the expectant mother should stay in close contact with her doctor, and be sure to eat a diet that includes foods rich in iron and folate, like liver and dark green leafy vegetables. Folate also plays an important role in the normal development of a baby's spinal cord and can help prevent serious disorders like spina bifida. If your diet does not provide adequate nutrients, you may want to talk with your doctor about nutritional supplements.
What is the relationship between fibroid tumors and anemia in women?
The relationship here is usually caused by the increased menstrual blood loss associated with the fibroids. Aggressive iron supplementation may be required to prevent iron deficiency anemia from developing.