All about anemia and 10 easy tips to prevent it

What is the blood?


Blood is the fundamental fluid that sustains life in humans and animals. It circulates through the heart and blood vessels (arteries and veins), transporting all the body’s tissues the elements they need to perform their functions: nutrients, hormones, vitamins, antibodies, heat and oxygen.

Human blood is mainly made up of plasma and blood cells. Plasma represents 55% of the total volume and is in turn composed of water, proteins and inorganic salts.

The remaining 45% are made up of red blood cells (erythrocytes), white blood cells (leukocytes), which defend the body against bacterial and viral infections, and platelets, which prevent bleeding, promoting blood clotting.

The amount of blood in a person’s body depends on their sex, age, weight, and height. But generally speaking, an adult has between 4.5 and 6 liters of blood, 7% of its weight.

What are red blood cells and hemoglobin?

Red blood cells, or red blood cells, are blood cells that are made in the bone marrow. Its function is to transport oxygen from the lungs to the rest of the body, as well as to remove carbon dioxide from peripheral tissues and expel it through the lung. Both oxygen and carbon dioxide circulate in the blood attached to hemoglobin, a protein present in red blood cells.

What is anemia?

The term anemia designates a set of symptoms and signs that occur due to a decrease in the number of red blood cells in the blood or a decrease in hemoglobin levels. When the body produces fewer red blood cells or the hemoglobin level drops, it does not receive enough oxygen and the symptoms of anemia arise.

What types of anemia are there?

There are many kinds of anemia, as it can be the manifestation of a hematological disease or a symptom of many other pathologies. Many of these signs are mild, short-lived, and easy to treat, while others are severe, last longer, and, if left untreated, can be fatal.

Some of the types of anemia are:

  • Iron deficiency anemia: occurs when the body does not have enough iron to make healthy red blood cells and enough hemoglobin. In this case, the body begins to use its iron stores, which are quickly depleted. As a result, the body produces fewer red blood cells and, in addition, these are smaller, so they contain less hemoglobin than necessary.
  • Aplastic anemia: it is a pathology that can be inherited or acquired after birth and that prevents the production of enough red blood cells. Babies and children with it often require blood transfusions.
  • Those types of anemia in which, due to acquired or hereditary factors, the body destroys red blood cells with excessive speed. These include sickle cell anemia, thalassemias, and hemolytic anemia.
  • Folic acid deficiency anemia: Folic acid is necessary for the formation and growth of red blood cells, although the body is not able to store it in large quantities.

This type of anemia is more common in pregnant women, but it can also be due to other causes (alcoholism, not consuming fresh fruits and vegetables, or overcooking vegetables).

During pregnancy, the baby uses the mother’s meager folate stores to grow properly. If a folic acid supplement is not given to the pregnant mother, she can become anemic and the child suffer significant growth problems.

  • Pernicious anemia: Red blood cells decrease because the intestine cannot adequately absorb vitamin B12, necessary for its production, growth and function. This type of anemia appears when there are significant problems in the stomach or because our immune system affects the cells that produce intrinsic factor (essential to be able to absorb vitamin B12).
  • Sickle cell anemia: it is an anemia with an important hereditary component. Hemoglobin is different and this causes it to change the shape of red blood cells, which in turn causes them to be destroyed earlier and have their transport function altered.

Fanconi anemia: it is a rare disease, characteristic of childhood due to the appearance of anemia, infectious and hemorrhagic episodes that are usually persistent and severe. It is because it decreases at the same time the three series of blood cells: red blood cells, white blood cells and platelets.

Who is affected by anemia?

Anemia is a very common disease that can occur at any age. It is estimated that it affects 24.8% of the world’s population, according to WHO data.

Both men and women can suffer from it, but iron deficiency anemia is the most common, and occurs more in women of childbearing age. According to the Spanish Foundation for the Digestive System, approximately one in five women of childbearing age suffers from a deficiency in iron stores and up to 7% suffer from iron deficiency anemia related to blood loss during menstruation.

Causes of anemia?

There are three main causes of anemia:

  1. blood loss.
  2. a lack or insufficient production of red blood cells.
  3. an increase in the rate at which they are destroyed or lost.
  • Blood loss. It is the most common cause, especially in the case of iron deficiency anemia. This blood loss can be due to menstrual periods; regular intake of medications such as aspirin or ibuprofen; bleeding from the digestive or urinary tract; Surgery; trauma; and cancer.
  • Lack of red blood cell production. It can be caused by acquired situations such as a poor diet, abnormal levels of certain hormones (such as erythropoietin), pregnancy and some diseases such as kidney failure, cancer or AIDS. It can also occur in inherited diseases such as aplastic anemia.
  • Increase in the rate of destruction of red blood cells. An enlarged spleen or inherited diseases such as sickle cell anemia, thalassemias, and hemolytic anemia are some of the possible causes. In the specific case of iron deficiency anemia, the cause of the disease is iron deficiency which, in turn, can be caused by blood loss, pregnancy, a diet low in this mineral or diseases that prevent iron absorption, like celiac disease.

What factors increase the risk of suffering from it?

As we have described previously, there are many types of anemia and each one has risk factors that increase the possibility of developing it. In general we can say that the general causes of anemia are malnutrition / malnutrition problems, pregnancy, hereditary factors, chronic diseases, autoimmune or treatment with certain drugs.

Factors such as following a diet low in iron, vitamins or minerals increase the risk of anemia ; blood loss caused by surgery or injury; and long-term or serious conditions such as kidney disease, cancer, diabetes, rheumatoid arthritis, or AIDS; inflammatory bowel conditions (including Crohn’s disease); liver disease; heart failure; and thyroid disease.

Likewise, prolonged infections and genetic factors such as a family history of hereditary anemia increase the chances of developing the disease. Women who are pregnant or have a heavy menstrual period, premature babies or those born with low birth weight, and children between 1 and 2 years old who do not follow a healthy diet and do not supplement it with iron supplements are also more likely to suffer anemia.

Also people who have excluded meat from their diet and do not eat other foods rich in iron, as well as frequent blood donors, are at higher risk. Finally, older people and adults who suffer internal bleeding from ailments such as ulcers, hemorrhoids or cancer, are more likely to suffer from this ailment.

What are the symptoms of anemia?

Symptoms of anemia vary depending on how quickly the disease appears, the severity of the disease and the body’s ability to respond, especially at the cardiovascular level. The main ones are:

  • Paleness: it is one of the most characteristic signs and occurs as a consequence of the closure of the blood vessels in the skin, hands, feet, … and due to the decrease in the concentration of hemoglobin in the blood.
  • Asthenia: feeling very tired is another symptom closely linked to this disease.
  • Dyspnea: it is the subjective feeling of shortness of breath.
  • Muscle fatigue: appears when making even small efforts.
  • Tachycardia and palpitations: these are constant in cases of moderate or severe anemia, while in chronic anemia of slow onset, the only noticeable sign may be light murmurs (noise that the blood makes when leaving the heart). If the anemia is very intense, very rapid breathing and even loss of consciousness are added.
  • Neurological disorders: they refer to alterations in vision or headaches. When anemia is very severe, signs of brain hypoxia (grogginess), dizziness, and even a coma may appear.
  • Neuromuscular manifestations: These consist of changes in behavior, headaches, dizziness, visual disturbances, insomnia, inability to concentrate, and sometimes disorientation.
  • Alterations in menstrual rhythm: the existence of abundant periods is the most common cause of anemia in young women, although it is usually moderate anemia. However, when anemia is more severe, a decrease in menstrual rhythm is usually seen. What happens is that, in the face of the drop in hemoglobin, the body reacts by reducing, or even canceling, the loss of blood.
  • Kidney disorders: there is a retention that can cause the appearance of edema or swelling in the legs.
  • Digestive disorders: These consist of poor appetite, nausea, and sometimes constipation.

What complications can it cause?

Severe or prolonged anemia can cause damage to the heart, brain, and other organs of the body, because the blood is not able to carry enough oxygen to the tissues. For example, this disease can cause arrhythmias that, over time, can damage the heart and lead to heart failure.

Anemia can also weaken people with cancer or HIV-infected people and make their treatment difficult. And in extreme cases, it can be lethal.

If left untreated, severe iron deficiency anemia can also lead to infections and growth problems in children and babies. During pregnancy, iron deficiency anemia is linked to premature deliveries and low-birth-weight babies, as long as they are not treated.

How is anemia diagnosed and treated?

Anemia is usually diagnosed with a medical examination and a blood test that includes complete blood counts, in order to determine, among other values, the levels of hemoglobin, hematocrit and red blood cells, as well as their color and average size. The medical and family history of the patient is also taken into account. Other additional tests may be endoscopy, colonoscopy, and ultrasound.

Once the disease is diagnosed, the doctor will prescribe the appropriate treatment, the objective of which will be to increase the number of red blood cells or the concentration of hemoglobin in the blood.

In the case of anemia due to vitamin or mineral deficiency, the doctor will prescribe the oral intake of iron supplements, vitamin B12 and folic acid. When it is due to significant blood loss, a transfusion will be performed. And in more specific cases (such as hereditary syndromes), bone marrow transplantation may be considered. In any case, it is necessary to consult with the primary care doctor or specialist (specialist in hematology) to indicate the most appropriate treatment of anemia for your case.

Another goal of treatment may be to alleviate the underlying disease or underlying cause of the anemia. For example, the specialist may prescribe medications such as oral contraceptives to lighten menstrual flow, antibiotics to treat ulcers, or surgery to remove polyps or tumors.

Why is iron important for health?

Iron is an essential micromineral for the body, as it is involved in the formation of hemoglobin and red blood cells, as well as certain enzymes. Our body accumulates iron deposits in the liver, spleen and bone marrow.

Nutrition experts recommend consuming at least 8 milligrams of iron per day for postmenopausal men and women, and 18 milligrams of iron per day for premenopausal women. Vegetarian men and women should practically double these amounts, since the body absorbs iron of plant origin to a lesser extent than that present in animal tissues.

10 tips to prevent and cope with anemia

Hereditary anemias cannot be prevented, but those caused by a deficiency of iron or vitamins can be avoided, if a series of simple recommendations are followed:

  1. Eat a varied diet with a little of everything.
    A balanced diet from all the food groups ensures that we have a sufficient amount of iron, because not all the iron present in food is absorbed in the same way. In fact, it is estimated that only 10-15% of dietary iron is absorbed by the intestine. Thus, approximately 30% of the iron in foods of animal origin (pork, chicken, red meat, seafood and molluscs, eggs and liver) is absorbed, while that of plant foods (spinach, chard and peas) is absorbed with more difficulty. In addition, there are some foods that it is preferable not to take after we have eaten others that are rich in iron: milk, egg yolk, certain legumes or whole grains, coffee, tea, cocoa or soy protein. A) Yes,
  2. Eat foods with iron daily.
    Iron is found in many foods, such as lean red meats (veal, beef); shell shellfish (cockles, clams and mussels); dried fruits (walnuts, pistachios, toasted almonds); liver; sesame, green leafy vegetables (watercress, chard, spinach); legumes (lentils, chickpeas, peas, lentil sprouts); or whole grain products: wheat, bread, rice, oat bread).
  3. Incorporate citrus foods into your diet.
    A good option is orange or tangerine juices, and also broccoli, kiwi and melon, which are appropriate not so much for vitamin C but for citric acid. These foods improve iron absorption.
  4. Don’t forget vitamin B12.
    The deficiency of this vitamin can cause pernicious anemia, so we must also ensure that it is present in our diet. We can find it in beef, poultry and fish, eggs and dairy and any food enriched with it, such as vegetarian burgers.
  5. Redouble your efforts if you don’t eat meat.
    Vegetarians should be aware that the body does not absorb iron of plant origin as easily as that contained in meat. Therefore, they should consume almost twice the iron in their day to day and incorporate foods such as whole grains, green leafy vegetables, beans and lentils, tofu and nuts.
  6. Take precautions if you are pregnant and bet on breast milk.
    The nutritional needs of iron are doubled in pregnancy, so women in this state should eat a diet rich in iron, vitamin C and folic acid. In these cases, the doctor usually prescribes prenatal vitamins in which iron and folic acid are mainly included. After giving birth, it is advisable to feed the baby exclusively with breast milk during the first six months of life, as its iron is better absorbed by children than that of cow’s milk. If this is not possible, an alternative to prevent anemia in babies is milk enriched with iron.
  7. Sport yes, but without lowering your guard.
    Physical exercise is always recommended, but if you practice it intensely, you should follow a balanced diet rich in iron more than ever. Long-distance runners, who sometimes suffer from so-called runner’s anemia, should be especially vigilant.
  8. Avoid self-diagnosis and go to the doctor.
    Even if we feel weak and think we have anemia, we should go to the doctor instead of starting to take food supplements or vitamins for anemia or on our own, because we risk iron poisoning and because, if there is anemia, it can be caused for a serious problem that requires a different treatment.
  9. Caution with the consumption of anti-inflammatories.
    Nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen should not be abused as they can irritate the stomach lining and cause a bleeding ulcer. Remember that internal bleeding reduces the concentration of red blood cells and hemoglobin in the blood
  10. Follow medical advice when taking nutritional supplements.
    When the specialist prescribes iron or vitamin supplements, we must carefully respect the administration and dosage guidelines indicated to us. Although we begin to feel better, we should not abandon the treatment halfway. Only 8% of iron taken orally is absorbed into the bloodstream, so it takes the body at least 3-6 months to increase its stores.

Dr. Ashwani Kumar is highly skilled and experienced in treating major and minor general medicine diseases.