Feature Articles

What is Anemia: Reporting Symptoms and Finding a Cause

June 9, 2009

Are you feeling tired and run down? Has your doctor told you that you have anemia? If so, you may be wondering what this means and what you’ll need to do next.

The answer is, it’s different depending on what may be causing you to feel tired, run down, or to be anemic. For many people, correcting anemia may be as simple as getting more iron either through their diet or by taking an iron supplement. If you have an illness like diabetes, rheumatoid arthritis, chronic kidney disease or a gastrointestinal condition, you may be more susceptible to having anemia and your doctor may already be monitoring you for it. Solutions here will vary too. For some patients, anemia may be the first sign of a serious condition which their doctor has yet to diagnose. No matter what category fits you best, the first step is talking to your doctor or healthcare professional about your symptoms.

To help you recognize anemia before it becomes a serious burden, read this article to learn about the various symptoms you might experience, how to talk about these symptoms with your doctor, and review some of the steps your doctor may follow to determine if your symptoms are related to anemia.

Symptoms of Anemia
  • Fatigue
  • Weakness
  • Pale skin
  • Brittle nails
  • Chest pain
  • Dizziness
  • Irritability
  • Coldness of hands or feet
  • Trouble breathing
  • Fast or irregular heartbeat
  • Headache
  • Fuzzy thinking
  • Loss of concentration
  • Depression
  • Loss of sex drive
  • Decreased work performance
  • Desire to eat ice or other peculiar things

How Does it Feel to Have Anemia?

People with anemia often feel tired or fatigued. Under normal circumstances you may feel tired after working long hours or strenuously exercising. With anemia, your body may be just as tired following moderate exercise or activities which you didn’t expect would wear you out. Some people may believe these feelings are just the cost for living a busy life or getting older, but sometimes it can be the first indication you have anemia.

With anemia you might notice that you often feel weak, dizzy, irritable, short of breath or depressed. You may also have pale skin, brittle nails, chest pain, a coldness in your hands or feet, or an irregular heartbeat. Some people with anemia may also have a desire to eat ice or other peculiar things, experience sexual dysfunction, or have trouble concentrating or performing mental tasks. These are all symptoms which might indicate you have anemia.

It is important to discuss any of these symptoms of anemia with your doctor. In doing so, be as detailed as you can about what made you feel tired or fatigued and when these problems started to occur. To help you tell your doctor about your symptoms which could be related to anemia, see the anemia Symptoms Quiz for you to fill out and take to your doctor.

Anemia Without the Symptoms

If you have mild or moderate anemia, you may not experience symptoms. Initially, the symptoms may be so faint you may not notice them or you may have slowly gotten used to them as your anemia became worse. This can happen because the body will actually adapt to anemia over time. With anemia, a person’s blood is not able to deliver as much oxygen throughout the body. The heart can then compensate for the blood’s poor oxygen delivery by pumping faster so that muscles and organs receive the oxygen they need to work and exercise properly. This overworking of a person’s heart can make any heart troubles they may have worse or can even lead to a condition called left ventricular hypertrophy.1

As anemia gets worse though, more symptoms usually become noticeable and can potentially keep you from completing your regular routine. This is why it is extremely important to keep track of any symptoms which may be caused by anemia and tell your doctor about them. With help from your doctor, you can find out if these symptoms are related to anemia.

Anemic Ranges of Hemoglobin
and Hematocrit Values
Age/Sex (yrs) Hemoglobin (g/dL) Hematocrit (%)
Adult Men < 13.0 < 39
Non-pregnant Women < 12.0 < 36
Pregnant Women < 11.0 < 33
WHO. Worldwide Prevalence of Anaemia 1993-2005.2
*These are only guidelines and some physicians feel the thresholds should be higher for adults.

What Happens to My Body When I’m Anemic?

The red blood cells in your blood deliver oxygen where it is needed. They pick up oxygen from your lungs and move it throughout your body so that your muscles and organs can work properly. Unfortunately, a low amount of healthy red blood cells can mean your body isn’t receiving enough oxygen and can make you feel tired. If your level of red blood cells is lower than expected, you are considered to have anemia.

The amount of red blood cells in your body is often measured as hemoglobin and hematocrit level. You may have learned your hemoglobin or hematocrit level when you went to donate blood before a medical procedure or from a routine doctor’s visit. A doctor can determine your current hemoglobin and hematocrit levels by performing a routine blood test called a complete blood count (CBC) test. Performing this test is the only sure way to know if you have anemia and how severe it is.

Determining the Cause of Anemia

Dr. Artz quoteOnce you have been diagnosed with anemia, your doctor may need to evaluate you further to determine what is causing your anemia. This is an important step because proper treatment of anemia depends on correctly determining its cause. Diagnosing anemia is also very important because anemia could be the first indication of a serious illness. Dr. Andrew Artz, a hematologist from the University of Chicago Pritzker School of Medicine believes that, “Anemia is often considered to be relatively harmless, but should always prompt further evaluation as to what caused it. Worsening anemia may lead to considerable problems.”

Initial Examination – Your doctor will most likely begin by taking your personal and family history and performing a physical examination. If your blood counts were checked in the past by another doctor, you can help your doctor by getting these results. For example, blood counts may have been done prior to a surgical procedure.

Iron Deficiency – A lack of iron, known as iron deficiency, is the most common cause of anemia. Your doctor may conduct some blood tests to check the level of iron in your blood and the level of other proteins which help move iron within your body. These common tests for iron are:

  • Serum Ferritin – Ferritin is a protein that helps store iron in the body. Results of this test can tell doctors how much iron is stored in the body. A low ferritin almost always indicates the body has little iron available to be used to make red blood cells.

  • Serum Iron – This measures the amount of iron free in the bloodstream. Low serum iron may mean a low amount of iron. The serum iron, though, can also be low for other reasons.

  • Total Iron Binding Capacity – Transferrin is a protein that carries iron in the blood. This test measures how much of the transferrin in the blood is not carrying iron. People with iron deficiency anemia have a high level of transferrin and a high total iron binding capacity. That may indicate a low level of iron available to make red blood cells.

  • Transferrin Saturation –The results are given as a percentage and are calculated by dividing the serum iron by the total iron binding capacity. A low serum iron combined with a high total iron binding capacity will lead to a low iron saturation. This usually indicates there is little iron available to make red blood cells.

In the United States, 7% of toddlers ages 1 to 2 years old and 9-16% of menstruating women are iron deficient.3,4 If the test results indicate your level of stored iron is low, your doctor may recommend an iron supplement to help correct your anemia. For more information about taking iron, visit the Patient Guide to Oral Iron Supplements.

Dozing security guardBlood Loss – Your doctor may also want to check if you are bleeding, since loss of blood is closely linked with iron deficiency and is another cause of anemia. Blood loss is often through menstrual periods for women of childbearing age or bleeding in the digestive tract in older adults. A stool sample can be used to determine if gastrointestinal bleeding could be causing your symptoms. If blood is detected in the stool, further examination will be required to determine what is causing the bleeding.

Vitamin Deficiency – A lack of certain vitamins, usually vitamin B12 and folic acid (folate), in your body can also cause anemia. Vitamin B12 and folate are required in order to make new red blood cells. These vitamins can be low because of not getting enough of them in your diet, medical problems that prevent the body from taking up the vitamins, or conditions that require the body to use more vitamins. Your doctor may perform tests to check for vitamin B12 and folate levels. Although shortages of these vitamins are not that common, it is very important to identify because the problem is easily correctable by vitamin supplementation. If there is no vitamin deficiency, extra supplements will not help the anemia. For more information about vitamins and anemia, visit the feature article Anemia and Nutrition: The Importance of Essential Vitamins.

Chronic Conditions – The reticulocyte blood test determines the percentage of young red blood cells in your blood. A higher number of reticulocytes indicates your body is making more red blood cells than normal. If anemia develops despite the body making more red blood cells, this may indicate they are breaking down too quickly. More frequently however, the reticulocyte count is low because the body may not be able to make enough healthy red blood cells. This occurs in iron and vitamin deficiencies and from chronic conditions like cancer, chronic kidney disease, inflammatory bowel disease, or if you are taking medication to treat rheumatoid arthritis or hepatitis C. Please view the Information Handouts for more detailed descriptions on anemia as it relates to each chronic condition.

Dr. Artz quoteDon’t Let Anemia Keep You Down

Anemia may have you feeling down, but that doesn’t mean you have to let it control your wellbeing. According to Dr. Artz, “Anemia will usually not get better without finding the cause. Recognizing and treating anemia are essential steps to feeling better.”

We hopes this overview of anemia symptoms and some possible causes has been helpful. For additional information, please see the links provided within the article. The Symptoms Quiz is another tool you can use to help you discuss your symptoms and their possible connection to anemia with your doctor.


  1. Wish J. Anemia and Kidney Disease: What You Should Know. American Association of Kidney Patients. Link. Accessed: April 15, 2009.
  2. Worldwide Prevalence of Anaemia 1993-2005: WHO Global Database on Anaemia. Edited by Bruno de Benoist, Erin McLean, Ines Egli and Mary Cogswell. Link. Accessed: May 5, 2009.
  3. Adamson JW. Iron deficiency and other hypoproliferative anemias. Link. Accessed: April 15, 2009.
  4. Centers for Disease Control and Prevention. Recommendations to Prevent and Control Iron Deficiency in the United States. MWR 1998; 47(No. RR-3):1-29. Link. Accessed: May 5, 2009.