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Anaemia - an overview

Anaemia - an
overview

Anaemia is a condition in which your blood can't carry

enough oxygen to meet the needs of your body. This is
because you either don't have enough red blood cells or not
enough of a protein called haemoglobin in your red blood
cells.
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Details

Symptoms of anaemia
Common symptoms of anaemia include:

feeling tired

feeling short of breath

feeling your heart racing or thumping, which is called palpitations

These symptoms may be caused by problems other than anaemia. If you have
any of these symptoms, see your GP for advice.

Diagnosis of anaemia
Your GP will ask about your symptoms and examine you. He or she may also ask
about your medical history. If your GP suspects you have anaemia, he or she will
ask you to have a blood test. Your blood will be sent to a laboratory for the
following tests.

A full blood count. This is to check the level of haemoglobin in your

blood and how many of each of the different types of blood cell you have.

A blood film test. This involves looking at your blood under a

microscope to check the size and shape of your red blood cells. It will also
assess the different white cells that are present.

Levels of vitamin B12, iron and folate.

You may need to have further tests to help identify the cause of your anaemia.
Depending on the type of anaemia you have, your GP may refer you to a
specialist.

Treatment of anaemia
The treatment you have will depend on the cause of your anaemia, and it can
vary considerably from person to person. For example, some people may just
need to adjust their diet and take supplements of iron, folic acid or vitamin B12.
Others may need to have a blood transfusion. If you have anaemia caused by
kidney failure, you may need to have injections of the hormone erythropoietin
(also known as Epo).
Your GP or specialist will always treat the underlying cause of your anaemia
before considering a blood transfusion.

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Causes of anaemia
There are many possible causes of anaemia. Most fall into the following four
groups.

Anaemia caused by bleeding. You can lose a lot of blood through an

injury or from having an operation, for example. If you have prolonged or
heavy periods, this can also lead to anaemia. These types of bleeding are
usually obvious. However, sometimes bleeding can happen quite slowly and
you may not be aware of it. For instance, bleeding from a stomach ulcer or
from within your bowel.

Your body may not make enough healthy red blood cells and/or
haemoglobin. This may happen if you don't get enough of the nutrients in
your diet that you need to make the red cells. These nutrients include iron,

vitamin B12 and folate. It can also happen if you have a health condition that
stops your body absorbing nutrients, such as coeliac disease.

Your body may have a problem with the normal production of red
blood cells. This can happen, for example, if you have kidney disease or a
problem with your bone marrow. Anaemia associated with other conditions
such as these is known as anaemia of chronic disease.

Your body may destroy its own red blood cells prematurely, which is
called haemolytic anaemia. Red blood cells usually survive for about 120 days
before they are broken down and replaced but in haemolytic anaemia, the
breakdown happens too soon. Haemolytic anaemia can be caused by an
inherited condition, such as thalassaemia, or you can develop it after certain
infections, such as meningitis. You can also develop this type of anaemia if
your body produces antibodies against your own red blood cells (autoimmune
haemolytic anaemia).

Complications of anaemia
If you have anaemia, your heart has to work harder to get oxygen to your vital
organs. If you don't get treatment, this may lead to problems with your heart
and lungs. There are other complications related to specific types of anaemia.

Prevention of anaemia
You can reduce your risk of developing anaemia by eating a healthy, balanced
diet. This supplies all the vitamins most people need. Only take supplements if
your GP recommends it.
The best sources of iron and vitamin B12 are red meat and fortified foods, such
as breakfast cereals and bread. Fortified means particular nutrients are added to
the food during their manufacture. Dark green vegetables, dried fruit such as
raisins, apricots and prunes, beans and lentils are all also good sources of iron.
Dairy products such as eggs are also a good source of vitamin B12.
The best sources of folate are green vegetables, such as broccoli, Brussels
sprouts, asparagus and peas. Chickpeas and brown rice are also good sources of
folate.
If you have a condition that affects how well you absorb nutrients, or if youre
pregnant, you may need to take supplements. It may benefit you to take iron
tablets if you're menstruating. Ask your GP for advice.

FAQs
Are there foods I shouldnt eat if I have anaemia?
Answer
If you have anaemia, there arent any particular foods you should cut out
altogether. However, try to limit your intake of tea, coffee and alcohol, where
possible.

Explanation
The main nutrients you need to make healthy red blood cells and the oxygencarrying substance haemoglobin are iron, vitamin B12 and folate. A healthy,
balanced diet can provide enough of these essential nutrients. However, there
are certain substances found in some foods that can interfere with the
absorption of iron. For example, phenols found in tea and coffee stop you from
absorbing iron, so where possible its best to limit your intake.
Vitamin C, on the other hand, helps your body to absorb more iron. Therefore
include foods that are rich in vitamin C in your diet to get as much iron out of
the food you eat. For example, drink fresh orange juice with your meal or have a
fruit dessert.
If you have an inherited condition called G6PD deficiency and eat fava beans, it
can cause sudden and severe anaemia. Fava beans cause your red blood cells to
break down rapidly, which results in severe anaemia and jaundice (yellowing of
the whites of your eyes). Therefore if you have this condition, check the
ingredients of foods to make sure they don't contain fava beans.

How do I know if I have anaemia?

Answer
Anaemia can often be difficult to recognise and diagnose by the symptoms
alone. You will probably need a blood test to confirm that you have anaemia.

Explanation
Symptoms of anaemia can be quite vague so it's possible to have the condition
for a long time without realising it.

The most common symptoms and signs of anaemia include feeling tired, looking
pale and feeling short of breath when you exert yourself. You may also have the
sensation of your heart racing or thumping (called palpitations).
Other symptoms that occur in certain types of anaemia include having:

brittle nails

mouth sores or ulcers

pins and needles in your hands or feet

a sore tongue

itchy skin

a ringing sound in your ears

These symptoms may be caused by problems other than anaemia. If you have
any of these symptoms, see your GP for advice.

I have anaemia and need a blood transfusion. What does

it involve and what are the risks?
Answer
A blood transfusion is when blood or some of its components are put straight
into your bloodstream. Its done through a small tube (cannula), which is put
into a vein, usually in your arm.

Explanation
Your doctor will usually only recommend you have a blood transfusion if youre
lacking blood or certain components of blood. The most common reason for
having a blood transfusion is to replace blood that is lost during major surgery or
an injury. Sometimes you may have a blood transfusion to treat severe anaemia.
The blood is given to you through a fine, plastic tube called a cannula. This is
put into a vein in your arm and connects to a drip that controls the flow of blood
into your body. It takes up to four hours for one bag of blood to transfuse.
However, you can have it more quickly if you need to.
During a blood transfusion, you may get a slight temperature, chills or a rash. If
this happens, a nurse may give you paracetamol and an antihistamine.
However, your healthcare team may need to slow down the rate at which the
blood is transfused or even stop the transfusion.

The biggest risk of having a blood transfusion is being given the wrong blood
type but this risk is small. Before you have a blood transfusion, you will have a
blood test to determine your blood type. This will be tested (cross-matched) with
a sample of suitable donated blood. Immediately before your blood transfusion,
your doctor or nurse will check your details and make sure you get the blood
that is intended for you.
The risk of getting an infectious disease from a blood transfusion is very low. All
blood donors are carefully selected to make sure the blood they donate is as
safe as possible. All donated blood is tested for infectious diseases such as
hepatitis B, hepatitis C and HIV before it's available for use.
There are a number of other possible risks of blood transfusion, which may
depend on your personal health. Ask your doctor for information to explain these
to you.

I'm a vegetarian is there anything I can do to help

prevent myself from developing anaemia?
Answer
You can help to reduce your risk of developing anaemia by eating a healthy,
balanced diet with enough iron, folic acid and vitamin B12.

Explanation
If youre vegetarian or vegan, you may miss out on some nutrients. These can
include iron and vitamin B12 that are in meat, fish, poultry and dairy products. If
you dont get enough of these nutrients, you may be more at risk of developing
anaemia.
Good non-meat sources of iron include:

beans

dried fruit and nuts

brown rice and wholegrain bread

fortified breakfast cereals

dark, green leafy vegetables

Good non-meat sources of vitamin B12 include:

eggs, milk and cheese

yeast extract

fortified breakfast cereals, soya milk, yoghurts and desserts

If you follow a vegan diet, you may need to take vitamin B12 supplements.
Its also important to have enough folate in your diet, which you can get from
green vegetables, such as broccoli, Brussels sprouts, asparagus and peas.
Chickpeas and brown rice are also good sources of folate.
For more information about healthy eating, speak to your GP.

Resources
Further information

NHS Blood and Transplant

0300 123 23 23
www.blood.co.uk
British Nutrition Foundation
020 7557 7930
www.nutrition.org.uk

Sources

Goddard AF, James MW, Mcintyre AS, et al. Guidelines for the
management of iron deficiency anaemia. Gut 2011; 60:130916.
doi:10.1136/gut.2010.228874.

Anemia. Medscape. www.emedicine.medscape.com, published 4

November 2011

Components of blood. NHS Blood and Transplant. www.blood.co.uk,

accessed 8 July 2013

Fernndez-Gaxiola AC, De-Regil LM. Intermittent iron

supplementation for reducing anaemia and its associated impairments in
menstruating women. Cochrane Database of Systematic Reviews 2011, Issue
12. doi: 10.1002/14651858.CD009218.pub2.

Anaemia of chronic disease. PatientPlus.

www.patient.co.uk/patientplus.asp, published 10 June 2013

Anaemia suspected. Map of Medicine. www.mapofmedicine.com,

published 21 January 2013

Anaemia iron deficiency. NICE Clinical Knowledge Summaries.

cks.nice.org.uk, published February 2013

Iron deficiency anemia. Medscape. www.emedicine.medscape.com,

published 23 September 2013

Anemia of chronic disease and renal failure. Medscape.

www.emedicine.medscape.com, published 28 October 2013

Hemolytic anemia. Medscape. www.emedicine.medscape.com,

published 21 February 2013

Iron. Food Standards Agency. www.eatwellscotland.org, accessed 9

July 2013

Vegetarian diets keeping a healthy balance. British Dietetic

Association. www.bda.uk.com, published August 2011

Vitamin B12 and folate deficiency. Map of Medicine.

www.mapofmedicine.com, published 28 March 2012

Will I need a blood transfusion? NHS Blood and Transplant.

www.hospital.blood.co.uk, published 31 July 2011

Blood transfusion FAQs. NHS Blood and Transplant.

www.blood.co.uk, accessed 9 July 2013

Vitamin B12. Food Standards Agency. www.eatwellscotland.org,

accessed 9 July 2013

Glucose-6-phosphate dehydrogenase deficiency. Medscape.

www.emedicine.medscape.com, published 10 January 2012

Favism. PatientPlus. www.patient.co.uk/patientplus.asp, published

22 June 2011

Jaundice. PatientPlus. www.patient.co.uk/patientplus.asp, published

22 June 2011

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