Anemia

The most common form of anemia is iron deficiency anemia. Our body needs iron to function properly and make red cells. When we have low iron, it causes a decrease in healthy red blood cells and throws our whole system out of balance. Dr. Christopher Rokes, MD, a pediatric hematologist with UnityPoint Health, explains what causes anemia, symptoms of the condition and treatment options depending on the underlying cause. He also offers a precaution for parents transitioning their little ones to cow’s milk and how this toddler-favorite drink can impact iron absorption.

What is Anemia?

The primary job of red blood cells is to carry oxygen from our lungs to different parts of our body. Oxygen is then used by the cells to help produce energy. Hemoglobin is a protein inside our red blood cells that grabs on to the oxygen and helps transport it. As the red blood cells reach various parts of our body, the hemoglobin releases the oxygen to our cells and tissues. As a result, when you’re anemic due to a low red blood cell count, you can feel weak and have low energy.

What Causes Anemia?

Dr. Rokes says the body needs a good balance between the production and destruction of red blood cells — and explains the condition as a supply, demand or lack-of-materials issue.

“Here’s one way to think about it. To sustain the supply of any product in the market, you need a good amount of production to keep up with demand,” Dr. Rokes says.

“However, you also need a regular amount of destruction, so the product isn’t overloaded. For instance, producing too many cars crowds the streets. We need to get rid of cars every year to make space for more. Similarly, if your body doesn’t have enough of the right materials (like iron) to make hemoglobin, or if your body destroys more red blood cells than what it produces, you’ll have anemia.”

Anemia causes can be classified into two main categories:

Genetics

Anemia can be inherited within a family. Some examples of when genetics cause anemia include:

Sickle Cell Anemia: A genetic disorder where the usual disc shape of red blood cells changes to a “pointy shape,” leading to an increased breakdown and shortage of these cells. The abnormal shape of the cells leads to complications, such as pain and organ damage. All babies are tested for sickle cell anemia as part of their newborn screening, but these genes are more common in Black and Middle Eastern communities. Dr. Rokes says some subtypes of sickle cell anemia don’t require treatment but more severe types require a multidisciplinary approach from hematologists, pain management specialists and other healthcare professionals.
Thalassemia. A group of inherited blood disorders with reduced hemoglobin production, resulting in anemia.
Hereditary Spherocytosis or Elliptocytosis. Two other genetic disorders that affect the shape of red blood cells.

Acquired

Acquired anemia happens when a person is born with normal hemoglobin but later develops anemia due to various causes, like nutritional deficiencies, chronic diseases and environmental factors.

What is Iron Deficiency Anemia?

Iron deficiency anemia is the most common type of anemia.

Dr. Rokes says, “About one-third of the world’s population is iron deficient at any given time. What happens in these patients is that their iron, one of the main materials the body needs to make red blood cells and hemoglobin, is low. This causes a decrease in red blood cell production.”

What Causes Iron Deficiency Anemia?

The most common cause of low iron in developed countries is not having enough of the mineral in your diet. Blood loss from parasites is another culprit. Iron can be found in both animal and plant sources, such as red meat, eggs, poultry, fish, leafy green vegetables, beans, lentils and fortified cereals. Sometimes, even though you may be eating enough iron, your body may not properly absorb it because of excessive milk intake, or less likely, a disease that causes inflammation, such as Celiac.

Iron Deficiency Anemia in Children

“Babies are typically born with a good amount of iron, but they need more as they get older,” Dr. Rokes says.

While a good source of protein and calories, drinking too much cow’s milk is one of the more common reasons infants and young children don’t absorb iron properly. Cow’s milk contains calcium and casein, which can bind to iron and form insoluble complexes. These complexes aren’t easily absorbed in the small intestine. After children transition to cow’s milk, there’s a high association with iron deficiency around age two if they’re drinking more than 20 ounces a day. Dr. Rokes recommends a daily intake of 16 ounces or less to avoid iron deficiency.

In older children, iron deficiency is likely caused by blood loss. For young females, it can be due to heavy periods.

Iron Deficiency Anemia in Adults

In addition to having a diet that’s too low in iron and heavy menstrual cycles, iron deficiency anemia has other causes, including:

Poor absorption in the gut from conditions like Celiac Disease or inflammatory bowel diseases.
Blood loss from bleeding in the digestive tract due to peptic ulcers, colorectal polyps or tumors.
Pregnant individuals have higher iron requirements for themselves and baby, which can create an increased risk for iron deficiency anemia.
Frequent blood donations or surgeries that result in significant blood loss if the iron in your body isn’t adequately replaced.

Symptoms of Anemia

Symptoms of anemia in children:

Craving non-food items, like dirt or paper (called pica)
Fatigue, such as falling asleep in school
Not playing well with others
Picky eating
Poor sleep

In addition to the above, symptoms of anemia in adults can include:

Brittle nails
Cold hands and feet
Craving chewing ice
Dizziness or lightheadedness
Hair loss
Headaches
Pale skin, particularly in the face and lining of the lower eyelids
Poor appetite
Poor concentration
Ringing in the ears (tinnitus)
Generally feeling unwell

Generally speaking, there are three stages of anemia: mild, moderate and severe. The following blood panel results indicate how severe anemia is.

Mild: Hemoglobin level between 10 and 10.9 grams per deciliter
Moderate: Hemoglobin level between 7 and 10 grams per deciliter
Severe: Hemoglobin level less than 7 grams per deciliter

Dr. Rokes says it’s important to look at the all the numbers in a complete blood count (CBC) as well as symptoms when making a diagnosis.

How to Treat Iron Deficiency Anemia

Eating more iron-rich foods isn’t enough to treat deficiency anemia. Dr. Rokes suggests supplementing with iron tablets, too, that are over the counter or prescribed by your healthcare provider.

“With a good iron replacement, your iron deficiency should be corrected in three months,” he says.

“However, you also have to treat the factors causing your anemia. If you’re bleeding from your colon because of an inflammatory bowel disease, you have to control the disease for your iron to improve. If you have heavy periods, talk to your doctor about ways to ease the bleeding. Otherwise, the iron you’re eating and supplementing is less likely to increase your iron stores and hemoglobin.”

Treatment for severe anemia may involve blood transfusions, medication or other care techniques to address underlying causes and control the condition.

How Much Iron Should You Have Per Day?

General recommendations for a woman between the ages of 19-50 is 18 milligrams of iron per day. For men 19 and older, the recommended dietary allowance is 8 milligrams per day. This may change depending on other medications (like antiacids) or dietary factors for each patient. For women and men with iron deficiency anemia, your dosage depends on the severity of your anemia. Talk to your doctor about what's best.

Can Anemia be Cured?

Dr. Rokes says when anemia is acquired, and even if it’s severe, it’s more likely to be cured as long as the problem that’s causing the anemia is controlled.

“If you have a mild form of familial (genetic) anemia, like thalassemia, but are otherwise feeling well, it doesn’t need to be treated.”

It’s important to always discuss the need for any treatment or supplements with your doctor.

Can You Die from Anemia?

It’s possible to die from anemia, but Dr. Rokes says it’s not common. “In this situation, it would be if your anemia is completely uncontrolled, and you’re not receiving the appropriate medical care,” he explains.

When to Call Your Doctor about Iron Deficiency Anemia

If you suspect you’re experiencing symptoms of iron deficiency anemia, call your healthcare provider right away. Symptoms such as persistent fatigue, weakness or shortness of breath can signal the state of iron levels in your body. Additionally, if you’ve been diagnosed with anemia in the past or have a medical condition affecting iron absorption, talk to your doctor. Recognizing and getting care for iron deficiency anemia early can improve your overall health and prevent severe symptoms.