What is anemia?
Anemia happens when your
blood doesn't have enough
hemoglobin
(he-mo-GLOBE-in).
Hemoglobin helps red blood
cells carry oxygen from
your lungs to all parts of
your body.
What causes anemia?
There are many types of
anemia, all with different
causes:
Iron deficiency anemia
(IDA). IDA is the most
common type of anemia. IDA
happens when you don't
have enough iron in your
body. You need iron to
make hemoglobin. This can
happen when you lose blood
from problems like heavy
periods, ulcers, colon
polyps, or colon cancer. A
diet that doesn't have
enough iron in it can also
cause IDA. Pregnancy can
also cause IDA if there's
not enough iron for the
mother and fetus. You can
get iron from foods like
ground beef, clams,
spinach, lentils, baked
potato with skin,
sunflower seeds, and
cashews.
Megaloblastic (or vitamin
deficiency) anemia. This
most often happens when
your body doesn't get
enough folic acid or
vitamin B-12. These
vitamins help your body
keep healthy blood and a
healthy nervous system.
With this type of anemia,
your body makes red blood
cells that can't deliver
oxygen right. Folic acid
supplements (pills) can
treat this type of anemia.
You can also get folic
acid in beans and legumes;
citrus fruits and juices;
wheat bran and other whole
grains; dark green leafy
vegetables; and poultry,
pork, shellfish, and
liver. Sometimes, with
this disease, your health
care provider may not
realize you're not getting
enough B-12. This usually
happens to someone with
pernicious anemia, a type
of autoimmune disease.
B-12 deficiency may also
be more common in people
with other autoimmune
diseases, like Crohn's
disease. Not getting
enough B-12 can cause
numbness in your legs and
feet, problems walking,
memory loss, and problems
seeing. The treatment
depends on the cause. But
you may need to get B-12
shots or take special B-12
pills.
Underlying diseases.
Certain diseases can hurt
the body's ability to make
red blood cells. For
example, people with
kidney disease, especially
those getting dialysis
(takes out wastes from
your blood if your kidneys
can't), are at higher risk
for developing anemia.
Their kidneys can't create
enough hormones to make
blood cells, and iron is
lost in dialysis.
Inherited blood disease.
If you have a blood
disease in your family,
there is a higher risk
that you will also have
this disease. One type of
inherited blood disease is
sickle cell anemia.
Instead of having normal
red blood cells that move
through blood vessels
easily, sickle cells are
hard and have a curved
edge. These cells cannot
squeeze through small
blood vessels and block
the organs from getting
blood. Your body destroys
sickle red cells quickly,
but it can't make new red
blood cells fast enough.
This causes anemia.
Another inherited blood
disease is thalassemia. It
happens when the body is
missing certain genes or
when variant (different
from normal) genes are
passed down from parents
that affect how the body
makes hemoglobin.
Aplastic anemia. This rare
problem happens when your
body doesn't make enough
red blood cells. Since
this affects the white
blood cells too, there is
a higher risk for
infections and bleeding
that can't be stopped.
This can be caused by many
things:
cancer treatments
(radiation or
chemotherapy)
exposure to toxic
chemicals (like those used
in some insecticides,
paint, and household
cleaners)
some drugs (like those
that treat rheumatoid
arthritis)
autoimmune diseases (like
lupus)
viral infection that
affects bone marrow o bone
marrow diseases
The treatment depends on
how serious the anemia is.
It can be treated with
blood transfusions,
medicines, or a bone
marrow transplant.
What are the signs of
anemia?
Anemia takes some time to
develop. In the beginning,
you may not have any signs
or they may be mild. But
as it gets worse, you may
have these symptoms:
fatigue
weakness
not doing well in work or
school
low body temperature
pale skin
rapid heartbeat
shortness of breath
chest pain
dizziness
irritability
numbness or coldness in
your hands and feet
headache
How do I find out if I
have anemia?
Anemia is diagnosed by a
blood test. If you have
anemia, your health care
provider (HCP) may want to
do other tests to find out
what's causing it, like
ulcers (sore on the lining
of the stomach or duodenum
[beginning of the small
intestine]) or polyps
(growths).
What's the treatment for
anemia?
It depends on the cause of
the anemia. For example,
treatment for sickle cell
anemia is different than
treatment for a diet low
in iron or folic acid.
Talk to your HCP about the
best treatment for the
cause of your anemia.
How do I prevent anemia?
Take these steps to help
prevent some types of
anemia:
Eat foods high in iron:
red meat
fish
chicken
liver o eggs
dried fruits, like
apricots, prunes, and
raisins
lentils and beans
green, leafy vegetables,
like spinach and broccoli
o tofu o cereal with iron
in it (iron-fortified)
For more sources of iron,
visit www.cc.nih.gov/ccc/supplements/iron.html.
Eat/drink foods that help
your body absorb iron,
like orange juice,
strawberries, broccoli, or
other fruits and
vegetables with vitamin C.
Don't drink coffee or tea
with meals. These drinks
make it harder for your
body to absorb iron.
Calcium can hurt your
absorption of iron. If you
have a hard time getting
enough iron, talk to your
health care provider about
the best way to get enough
calcium too.
Make sure you get enough
folic acid and vitamin
B-12 in your diet.
Talk to your HCP about
taking iron pills
(supplements). Do NOT take
these pills without
talking to your health
care provider first. These
pills come in two forms:
ferrous and ferric. The
ferrous form is better
absorbed by your body. But
taking iron pills can
cause side effects, like
nausea, vomiting,
constipation, and
diarrhea. Reduce these
side effects by taking
these steps:
Start with half of the
recommended dose.
Gradually increase to the
full dose.
Take the pill in divided
doses.
Take the pill with food.
If one type of iron pill
is causing problems, ask
your HCP for another
brand.
If you are a non-pregnant
woman of childbearing age,
get tested for anemia
every 5 to 10 years. This
can be done during a
regular health exam.
Testing should start in
adolescence.
If you are a non-pregnant
woman of childbearing age
with these risk factors
for iron deficiency, get
tested every year:
heavy periods
low iron intake
previous diagnosis of
anemia
How much iron do I need
every day?
Most people get enough
iron through a regular
healthy diet that has
iron-rich foods. But some
groups of people don't get
enough iron:
teenage girls/women of
childbearing age (who have
heavy menstrual losses,
who have had more than one
child, or use an
intrauterine device [IUD])
older infants and toddlers
pregnant women
These groups of people
should be screened
periodically for iron
deficiency. If the tests
show that the body isn't
getting enough iron, iron
supplements may be
prescribed. Many health
care providers prescribe
iron supplements during
pregnancy because many
pregnant women don't get
enough. They can help when
diet alone can't restore
the iron level back to
normal. Talk with your HCP
to find out if you are
getting enough iron
through your diet or if
you or your child needs to
be taking iron
supplements. Please see to
the chart below to see how
many milligrams (mg) of
iron you should take every
day
Age
Infants & Children Women
Pregnant Breastfeeding
7 to 12 months 11 mg
1 to 3 years 7 mg
4 to 8 years 10 mg
9 to13 years 8 mg 27 mg 10
mg
14 to18 years 15 mg 27 mg
10 mg
19 to 50 years 18 mg 27 mg
9 mg
51+ years 8 mg
Are there special iron
guidelines for pregnant
women?
Many pregnant women have a
hard time getting enough
iron. During pregnancy,
your body demands more
iron because of the
growing needs from the
fetus, the higher volume
of blood, and blood loss
during delivery. Not
getting enough iron can
cause preterm labor and
delivering a low-birthweight
baby. If you're pregnant,
follow these tips:
Make sure you get 27mg of
iron every day. Take an
iron supplement (pill). It
may be part of your
prenatal vitamin. Start
taking it at your first
prenatal visit.
Get tested for anemia at
your first prenatal visit.
I am taking hormone
therapy (HT). Does
that affect how much iron
I should take?
It might. If you are still
getting your period while
taking HT, you may need
more iron than women who
are postmenopausal and not
taking HT. Talk to your
health care provider.
Does birth control affect
my risk for anemia?
It could. Some women who
take birth control pills
have less bleeding during
their periods. This would
lower their risk for
anemia. But women who use
an intrauterine device
(IUD) may have more
bleeding and increase
their chances of getting
anemia. Talk to your
health care provider.
I am a vegetarian. What
steps should I take to
make sure I get enough
iron?
It depends on your diet.
Since it's easier to get
iron from meat than from
plant-derived foods, some
vegetarians may need to
take a higher amount of
iron each day than what is
recommended for other
people. Follow the tips
above to prevent anemia,
and try to take vitamin C
with other iron-rich
foods.
What happens if I take too
much iron?
Iron overload happens when
the body absorbs too much
iron over many years.
Excess iron builds up in
organs, like the heart and
liver. Many problems can
cause iron overload. It
can happen from years of
taking too much iron or
from repeated blood
transfusions. But the most
common form of iron
overload in the United
States is an inherited
condition (runs in
families) called
hereditary hemochromatosis
(he-mo-kro-ma-toe-sis).
Signs of early
hemochromatosis may
include:
fatigue
weakness
weight loss
abdominal pain
joint pain
As iron accumulation
progresses, patients may
have these symptoms:
arthritis
amenorrhea
early menopause
loss of sex drive
impotence (repeated
inability to get or keep
an erection firm enough
for sexual intercourse)
shortness of breath
Signs of advanced stages
of hemochromatosis
include:
arthritis
liver disease, including
an enlarged liver,
cirrhosis, cancer, and
liver failure
damage to the pancreas,
possibly causing diabetes
chronic (ongoing)
abdominal pain
severe fatigue
weakening of the heart
muscle
problems with your heart
rate or rhythms
heart failure
abnormal skin color,
making it look gray or
bronze
Treatment depends on how
severe the iron overload
is. The first step is to
get rid of the extra iron
in the body. The process
is called phlebotomy (fle-bot-o-me),
which means removing
blood. It is simple and
safe. A pint of blood will
be taken once or twice a
week for several months to
a year, and sometimes
longer. Once iron levels
go back to normal, you
will give a pint of blood
every 2 to 4 months for
life. Although treatment
cannot cure the problems
caused by hemochromatosis,
it will help most of them.
Arthritis is the only
problem that does not
improve after excess iron
is removed.
If I have hemochromatosis,
what can I do to stay
healthy?
There is a lot you can do
to make your life as
healthy as possible:
Get check ups. Have the
amount of iron in your
blood tested regularly.
Get your blood removed.
Make sure to get
phlebotomies when you need
them.
Watch the food you eat.
Don't eat raw fish or raw
shellfish.
Limit your alcohol intake.
If you choose to drink
alcohol, drink very
little. Women should have
no more than one drink a
day. Men should have no
more than two a day. But
if you have liver damage,
do NOT drink any alcohol.
Don't take iron pills.
Don't take iron pills,
supplements, or
multivitamin supplements
that have iron in them.
But eating foods that
contain iron is fine.
Watch your vitamin C
intake. Vitamin C
increases the amount of
iron your body absorbs. So
don't take pills with more
than 500mg of vitamin C
per day. Eating foods with
vitamin C is fine.
Exercise. You can exercise
as much as you want. Try
to get 30 minutes of
exercise every day to stay
fit and healthy.
For more information...
For more information on
anemia, contact the
National Women's Health
Information Center at
800-994-9662 or the
following organizations:
Division of Nutrition
and Physical Activity,
NCCDPHP, CDC, HHS
Phone: (770) 488-5820
or (888) 232-4674
Internet Address:
http://www.cdc.gov/nccdphp/dnpa/
National Heart, Lung,
and Blood Institute
Information Center, NHLBI,
NIH, HHS
Phone: (301) 592-8573
Internet Address:
http://www.nhlbi.nih.gov/health/infoctr
American Dietetic
Association
Phone: (312) 899-0040
or (800) 366-1655
(Consumer Nutrition
Hotline)
Internet Address:
http://www.eatright.org
Aplastic Anemia & MDS
International Foundation,
Inc.
Phone: (800) 747-2820
Internet Address:
http://www.aamds.org
Iron Disorders
Institute
Phone: (864) 241-0111
or (864) 244-2104
Internet Address:
http://www.irondisorders.org
This FAQ was reviewed by
the National, Heart, Lung
and Blood Institute at the
National Institutes of
Health.
