NHLBI OSPEEC YourGuidetoAnemia Booklet RELEASE 508

YOUR
GUIDE TO
A NE MIA
P R E V E N T | T R E AT | C O N T R O L
CONTENTS
Your Guide to Anemia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1
Signs and Symptoms of Anemia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 3

Anemia Explained� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 3
What Your Blood Is Made Of � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 3
Recognizing the Signs and Symptoms of Anemia � � � � � � � � � � � � � � � � � � � � � � � 4
What Is the Difference Between Signs and Symptoms? � � � � � � � � � � � � � � � � � � � 4
The Leading Causes of Anemia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5

When Your Body Does Not Make Enough Red Blood Cells � � � � � � � � � � � � � � � � 5
When Your Body Destroys Too Many Red Blood Cells � � � � � � � � � � � � � � � � � � � � 5
When Your Body Loses Too Many Red Blood Cells � � � � � � � � � � � � � � � � � � � � � � 6
How Anemia Is Diagnosed � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 7

Medical and Family Histories � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 7
Physical Exam � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 7
Testing for Anemia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 7
How Anemia Is Treated � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 11

The Goals of Treatment � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 11
Your Anemia Healthcare Team � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 11
Different Types of Anemia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 13

Iron-Deficiency Anemia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 13
Causes � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 13
People Who Are More Likely To Develop Iron-Deficiency Anemia � � � � � � � � � 15
Signs and Symptoms of Iron-Deficiency Anemia � � � � � � � � � � � � � � � � � � � � � 16
How Iron-Deficiency Anemia Is Diagnosed � � � � � � � � � � � � � � � � � � � � � � � � � � 17
How Iron-Deficiency Anemia Is Treated � � � � � � � � � � � � � � � � � � � � � � � � � � � � 18
Pernicious Anemia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 19
Causes � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 19
Probable Outcomes � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 19
Other Names � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 19
People Who Are More Likely To Develop Pernicious Anemia � � � � � � � � � � � � 20
Signs and Symptoms � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 21
How Pernicious Anemia Is Diagnosed � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 21
How Pernicious Anemia Is Treated � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 22
YO U R G U I D E TO A N E M I A I
Aplastic Anemia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 22
Causes � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 22
People Who Are More Likely To Develop Aplastic Anemia � � � � � � � � � � � � � � 22
Signs and Symptoms � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 22
How Aplastic Anemia Is Diagnosed � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 23
How Aplastic Anemia Is Treated � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 24
Hemolytic Anemia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 24
Causes � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 24
People Who Are More Likely To Develop Hemolytic Anemia � � � � � � � � � � � � 27
Signs and Symptoms � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 27
The Spleen: Your Body’s Natural Filter � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 27
How Hemolytic Anemia Is Diagnosed � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 27
Blood Tests � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 28
Other Tests � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 28
How Hemolytic Anemia Is Treated � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 28
How To Prevent Anemia or Keep Your Anemia Under Control � � � � � � � � � � � � 31

Lead a Healthy Lifestyle � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 31
Work With Your Doctor or Anemia Healthcare Team� � � � � � � � � � � � � � � � � � � � � 32
Talking to Your Family and Friends � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 32
A Final Thought � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 32
Making Progress Against Anemia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 33

The Latest Research � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 33
Clinical Trials � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 33
Coping and Support � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 34
For Caregivers � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 34
In Times of Crisis � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 34
Definitions � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 35
II YO U R G U I D E TO A N E M I A
YOUR GUIDE TO
ANEMIA
Your Guide to Anemia is your first step to learning It also offers tips on what to do after an anemia
more about anemia—the most common blood diagnosis� For example, it recommends
disorder in the United States� adopting a heart-healthy lifestyle and talking with
Whether you’ve been diagnosed with anemia or your family members about their own risk for
have a family member or friend who is living with developing anemia�
it, or you simply want to learn more about this Because anemia can develop in people of all ages,
blood disorder, the National Heart, Lung, and races, and ethnicities, it is important that you speak
Blood Institute’s (NHLBI) Your Guide to Anemia to your doctor or healthcare professional if you think
gives reliable answers to your questions� The guide you are experiencing any of the signs or symptoms
provides information on the causes of anemia; the of the blood disorder�
signs and symptoms of anemia; how anemia can For more information about anemia, please visit
be prevented, diagnosed, and treated; and the www�nhlbi�nih�gov/health-topics/anemia�
different types of anemia�
YO U R G U I D E TO A N E M I A 1
The solid part of blood
contains three types of
blood cells:
• RED CELLS
• WHITE CELLS
• PLATELETS
2 YO U R G U I D E TO A N E M I A
SIGNS AND SYMPTOMS
OF ANEMIA
A N E M I A E X PL A I N E D W H AT YO U R B LO O D I S M A D E O F
Anemia is a condition that develops when your Blood is made of liquid and solids� The liquid part,
blood has a lower-than-normal amount of red called plasma, is mostly water� Plasma carries
blood cells or hemoglobin� Hemoglobin, an iron- essential nutrients, hormones, and proteins
rich protein, helps red blood cells carry oxygen throughout your body� Plasma also carries waste
from the lungs to the rest of the body� If you have products from cells to the kidneys and digestive
anemia, your body does not get enough oxygen- system to be removed from your body�
rich blood� This can cause you to feel tired or weak� The solid part of blood contains three types of
You may also have shortness of breath, dizziness, blood cells—red blood cells, white blood cells, and
headaches, or an irregular heartbeat� platelets� Here is a breakdown of each type:
There are many types and causes of anemia� While • Red blood cells are shaped like discs and
mild anemia is a common and treatable condition, are slightly indented in the center� They contain
anemia may also be a sign of a more serious hemoglobin, which is a protein that carries
condition� It may result from chronic (ongoing) oxygen from your lungs to all parts of your
bleeding in the stomach� Chronic inflammation from body� Your body depends on oxygen to carry
an infection, kidney disease, cancer, or autoimmune out its functions� Hemoglobin also carries
diseases also can cause the body to make fewer carbon dioxide (a waste product) from the body
red blood cells� to the lungs, which allow you to breathe it out�
Some people are at a higher risk for anemia, The hemoglobin in red blood cells gives blood
including women who are having their menstrual its red color�
periods or are pregnant, people who donate blood • White blood cells fight infection� They are
frequently, those who do not get enough iron or part of your body’s immune system� Your body
certain vitamins, and people who take certain makes five different types of white blood cells�
medicines or undergo particular treatments, such When you get an infection or other type of
as chemotherapy for cancer� illness, your body will make more of the specific
Your doctor will consider your medical history, type of white blood cells needed to fight
physical exam, and test results when diagnosing that illness�
and treating anemia� A simple blood test is often • Platelets are tiny oval-shaped blood cell
used to confirm that you have low amounts of red fragments that help your blood clot� If you begin
blood cells or hemoglobin� For some types of mild to bleed inside or on the surface of your body,
to moderate anemia, your doctor may recommend platelets gather at the spot and stick together
solutions that help your body produce more red to seal small cuts or breaks on blood vessel
blood cells� These options include over-the-counter walls� Then, proteins called clotting factors and
or prescription iron supplements, certain vitamins, red blood cells join the platelets to form a stable
or intravenous (IV) iron therapy� To prevent anemia clot that stops the bleeding�
in the future, your doctor may also suggest healthy
lifestyle changes� If you have severe anemia, your
doctor may recommend red blood cell transfusions�
Blood cells are made in your bone marrow, which As anemia gets worse, you may also experience
is the spongy tissue inside many of your bones� faintness or dizziness, increased thirst, sweating,
Blood cells live for various lengths of time� Red weak and rapid pulse, or fast breathing�
blood cells live about 120 days, and platelets live Severe anemia may cause lower leg cramps
about six days� White blood cells have various while exercising, shortness of breath, or brain
lifespans� Some types live about one day, while damage� A lack of red blood cells may also cause
others may live a long time� Your bone marrow is heart-related symptoms because your heart must
always making new blood cells to replace those work harder to carry oxygen-rich blood throughout
that have died or have been destroyed or lost� your body� These symptoms include arrhythmias
or abnormal heart rhythms, a heart murmur (an
RECOGNIZING THE SIGNS AND extra or unusual sound heard during a heartbeat),
SY M P TO M S O F A N E M I A an enlarged heart, or even heart failure�
The signs and symptoms of anemia can be mild
or severe� They depend on how severe the anemia W H AT I S T H E D I F F E R E N C E B E T W E E N
is and how quickly it develops� Generally, signs and S I G N S A N D SY M P TO M S ?
symptoms increase as anemia gets worse� Many A sign is evidence of a disease or condition that
of the signs and symptoms of anemia also occur someone else can see or measure (for example,
in other diseases and conditions� yellowish skin, a low hemoglobin level, or abnormal
Mild anemia may have no signs or symptoms� heart rhythms)�
If you do develop signs and symptoms, you may A symptom is a feeling that a person experiences
have tiredness, weakness, or pale or yellowish skin� with a disease or condition (for example, tiredness
These signs and symptoms also occur in more or chest pain)�
severe anemia and are far more noticeable or clear�
Red blood cells

live about
120
D A Y S
Platelets
live about
6 D A Y S
THE LEADING CAUSES
OF ANEMIA
Anemia has three main causes: lack of red blood rheumatoid arthritis, chronic inflammatory diseases,
cell production, high rates of red blood cell and kidney disease�
destruction, and blood loss�
Reasons Your Body May Not Make Enough
Conditions that may lead to anemia include:
Red Blood Cells
• Heavy menstrual periods
• Pregnancy ACQUIRED CAUSES INHERITED CAUSES
• Ulcers • Folate or iron deficiency • Fanconi anemia
• Colon polyps or colon cancer from a poor diet • Shwachman-Diamond
• Inherited disorders • Demand for red blood syndrome
cells exceeds the supply • Dyskeratosis
• A diet that does not have enough iron, folic • Some cancers (for congenita
acid, or vitamin B12 example, leukemia, • Diamond-Blackfan
• Blood disorders such as sickle cell disease lymphoma, and anemia
multiple myeloma)
and thalassemia • Amegakaryocytic
• Toxins (for example, thrombocytopenia
• Cancer pesticides)
• Aplastic anemia, which is a condition that can • Radiation and
be inherited or acquired chemotherapy treatments
for cancer
• Glucose-6-phosphate dehydrogenase (G6PD)
• Some viral infections (for
deficiency, which is a metabolic disorder example, hepatitis and
Anemia can make you feel tired, cold, dizzy, Epstein-Barr)
and irritable� You may be short of breath or • Autoimmune disorders (for
example, lupus)
have a headache�
• Pregnancy
W H E N YO U R B O DY D O E S N OT M A K E
E N O U G H R E D B LO O D C E L L S W H E N YO U R B O DY D E S T R OYS TO O
M A N Y R E D B LO O D C E L L S
To make enough healthy hemoglobin and red
blood cells, your body needs iron, vitamin B12, Sometimes your body destroys red blood cells
folate (another B vitamin), small amounts of other before they reach the end of their natural lifespan
vitamins and minerals, and protein� You get these of about 120 days� This process, called hemolysis,
nutrients from the foods you eat� Your body also can be caused by an acquired or inherited
needs a proper balance of hormones—especially condition� Red blood cells may also be destroyed
erythropoietin, which is a hormone that boosts red in such large numbers that the bone marrow
blood cell production� cannot make enough new red blood cells to keep
up� Certain diseases or infections, such as lupus
Certain chronic diseases—those that go on for a or hepatitis, are examples of acquired conditions
long time and often don’t go away completely—can that may cause your body to destroy too many
harm the body’s ability to make enough red blood red blood cells�
cells� These are diseases such as cancer, HIV/AIDS,
What Can Cause Your Body To Destroy
Too Many Red Blood Cells
These are some reasons why
ACQUIRED CAUSES INHERITED CAUSES your body may lose too many
red blood cells over a long
• Immune hemolytic • Sickle cell disease
anemia (the immune • Thalassemias
period of time:
system makes
antibodies against red
• Hereditary • Heavy menstrual bleeding
spherocytosis
blood cells or medicines, • Heavy, frequent nosebleeds
leading to red blood • Hereditary
cell destruction) elliptocytosis • Bleeding in the digestive or
• G6PD deficiency
• Physical damage to urinary tract
red blood cells • Pyruvate kinase
• Paroxysmal nocturnal deficiency • Ulcers
hemoglobinuria • Some cancers (for example,
• Infection (for example,
malaria)
digestive tract, kidney,
and bladder)
These are some reasons your

W H E N YO U R B O DY LO S E S TO O M A N Y
R E D B LO O D C E L L S body may suddenly lose too
many red blood cells:
The third main way in which people develop anemia
is through blood loss� When you lose blood, you • Injuries
can lose a large number of red blood cells, and that • Childbirth
can cause anemia� The loss of those red blood cells
also leads to low levels of iron in your body� Without • Burst blood vessel
enough iron, your body will make fewer red blood • Heavy bleeding during surgery
cells than it needs, and the red blood cells it does
make will have less hemoglobin than normal� That,
too, can lead to anemia�
HOW ANEMIA IS
DIAGNOSED
M E D I CA L A N D FA M I LY H I S TO R I E S • Listen to your heart for a rapid or irregular

You can find out you have anemia in various ways� heartbeat and your lungs for rapid or
It may be detected when you are being tested for uneven breathing�
another condition� You also might find out that you • Feel your abdomen for an enlarged
have iron-deficiency anemia if you try to give blood liver or spleen, check for bone pain, or
and are turned down because you have a low conduct a pelvic or rectal exam to check for
hemoglobin level� internal bleeding�
Or you may have signs or symptoms and go to • Conduct a neurological exam to check how
your doctor, who discovers anemia through blood well your muscles, senses, and reflexes work,
tests� Your doctor will likely take a few first steps to as well as your mental status, coordination, and
determine whether your signs and symptoms are ability to walk�
the result of anemia or some other condition� The
most important thing to remember is that, with an T E S T I N G FO R A N E M I A
accurate diagnosis, many anemias are treatable� Based on your answers and the physical exam,
Here is some of the information your doctor will your doctor will recommend tests to determine the
need to help diagnose your condition: type of anemia you may have and its severity� Often,
the first test is a complete blood count (CBC), which
• Signs and symptoms and how long you
is a broad-scale test that provides a count of all
have had them
red blood cells, white blood cells, and platelets in
• Medical history, including how regular or heavy a sample of your blood� It also includes other tests
your menstrual periods are that provide useful information about your blood�
• Pregnancy history Your doctor can use this information to help
Your doctor may talk to you about the foods determine whether you have anemia, what type
you eat, the medicines you take, and your family you may have, and what underlying condition
health history� may be causing the anemia� Depending on the
results of the CBC, your doctor may recommend
PH YS I CA L E X A M further tests�
Here are some of the things your doctor may do The table on the next page summarizes the CBC
during a physical exam: and other common tests and procedures that your
doctor may recommend to diagnose anemia�
• Check your tongue, nails, or the inner lining
of your eyelids to see if they are pale�
• Check your fingernails to see whether
they are pale or brittle, and how quickly they
refill with blood�
Complete Blood Count Tests
TEST WHAT IT DOES WHAT IT REVEALS
Red blood cell, white Counts all red blood cells, white A lower-than-normal number of red blood cells
blood cell, and platelet blood cells, and platelets in a sample suggests anemia�
count of blood� Specific changes in number, size, or shape
Gives information about the size, point to the cause of anemia�
shape, and physical characteristics of
the blood cells�
White blood cells Identifies the five types of white blood A white blood cell’s differential can help identify
differential cells in a blood sample and the relative a condition that may be causing anemia�
percentage of each in the sample�
Hemoglobin Measures the amount of oxygen- Low hemoglobin levels point to diseases that
carrying protein in the blood� usually cause the body to make too few red
blood cells�
Hematocrit Measures how much space red blood A low hematocrit level points to anemia� An
cells take up in your blood� abnormal hematocrit level may also be a sign of
a blood or bone marrow disorder�
Mean corpuscular volume Measures the average size of the red Red blood cell size gives a clue to the type of
blood cells� anemia� Larger than normal red blood cells may
suggest pernicious anemia caused by vitamin
B12 or folate deficiency�
Smaller than normal red blood cells suggest
iron-deficiency anemia or thalassemia, which is
a rare, inherited anemia�
Mean corpuscular Calculates the average amount of Larger than normal red blood cells have
hemoglobin oxygen-carrying hemoglobin inside red more oxygen-carrying hemoglobin� Smaller
blood cells� than normal red blood cells often have less
hemoglobin�
Mean corpuscular Calculates the average concentration This test gives clues about the type of anemia
hemoglobin concentration of hemoglobin inside red blood cells� or other possible conditions when abnormal
values of hemoglobin are found�
Red cell distribution width Calculates the difference in the size of The body may be trying to make new red blood
red blood cells� cells to correct the anemia, or the test may
provide clues about the cause of the anemia�
Bone Marrow Test
Bone marrow aspiration Gives information about the marrow’s Abnormal results showing only a few cells in
and bone marrow biopsy ability to make enough healthy the bone marrow can point to aplastic anemia�
blood cells� (The doctor collects and Certain cancers may cause anemia, in
evaluates a sample of bone marrow�) particular leukemia, which is a cancer of the
bone marrow itself� The bone marrow sample
is a means to diagnose cancer affecting
the bone marrow that may be the source of
an anemia� Taking a bone marrow sample can
help diagnose cancer that may be affecting the
bone marrow and also causing an anemia�
Other Blood Tests
Blood smear Shows the size, shape, and number Possible causes for the anemia through the
of red blood cells, white blood cells, presence of abnormal or immature blood cells�
and platelets�
Reticulocyte count Measures the number of young red The possibility of hemolytic anemia because
blood cells in the blood� Shows of a markedly higher reticulocyte count, or
whether the bone marrow is making the possibility of iron-deficiency anemia,
enough red blood cells at the pernicious anemia, aplastic anemia, or other
correct rate or at a higher rate in an anemias because of a lower reticulocyte count�
appropriate response to the anemia�
Serum iron Measures the total amount of iron in Iron-deficiency anemia due to abnormal
the blood� amounts of transferrin (a protein that either
transports iron to the bone marrow, where
hemoglobin and red blood cells are made, or
it transports iron to body tissues for storage)�
Total iron-binding capacity Measures the total amount of iron that Iron-deficiency anemia due to abnormal
can be bound by transferrin� amounts of transferrin (a protein that either
Unsaturated iron-binding Determines the portion of transferrin Iron-deficiency anemia due to abnormal
capacity that is not yet saturated with iron� amounts of transferrin (a protein that either
Transferrin saturation Shows the percentage of transferrin Iron-deficiency anemia due to abnormal
that is saturated with iron� It is amounts of transferrin (a protein that either
calculated using the results of serum transports iron to the bone marrow, where
iron, total iron-binding capacity, hemoglobin and red blood cells are made, or
and unsaturated iron-bonding it transports iron to body tissues for storage)�
capacity tests�
Serum ferritin Reflects the amount of stored iron in Iron-deficiency anemia due to abnormal
your entire body� amounts of transferrin (a protein that transports
iron to the bone marrow, where hemoglobin
and red blood cells are made, or it transports
iron to body tissues for storage)�
Coombs test Looks for antibodies directed against A positive result points to the presence of
red blood cells� antibodies (proteins made by the immune
system)� These results can point to
hemolytic anemia�
G6PD test Measures the amount of glucose-6- Abnormal results can point to a G6PD
phosphate dehydrogenase (G6PD), deficiency, an inherited condition that can
an enzyme, in red blood cells� lead to hemolytic anemia�
HOW ANEMIA IS
TREATED
T H E G OA L S O F T R E AT M E N T generally treated through dietary changes and

The good news is that anemia often is easily supplements� Other types of anemia are treated
treated� The treatment your doctor chooses will with medicines, procedures, surgery, or lifestyle
depend on the type of anemia you have, its cause, changes� Occasionally, a person may need blood
and how severe it is� transfusions, but this treatment is used only with
severe anemia� The “Different Types of Anemia”
These are the main goals of treatment: section on page 13 provides more details on the
• Increase your red blood cell count treatments used for specific anemias�
or hemoglobin level to improve the
oxygen-carrying capacity of your blood YO U R A N E M I A H E A LT H CA R E T E A M
• Treat the underlying condition Primary care providers—family doctors, internists,
causing your anemia pediatricians, and nurse practitioners—can treat
• Prevent complications from the anemia, such many anemias� Your healthcare provider may also
as heart or nerve damage want to work with one or more specialists to help
• Relieve symptoms and improve your treat your anemia� These specialists may include:
quality of life • A hematologist, a doctor who specializes in
People who have mild or moderate anemia with treating blood disorders
no symptoms, or people whose anemia is not • A gastroenterologist, a doctor who
getting worse, may not need treatment� Exceptions specializes in treating digestive system and
apply to those with nutritional anemias such as liver diseases and conditions
iron-deficiency anemia� In those cases, the low level • An obstetrician/gynecologist, a doctor
of iron in the body may have other harmful effects who specializes in medical and surgical
besides anemia, and treatment is needed� For more care for women and who focuses on
information, see “People Who Are More Likely to pregnancy, childbirth, and disorders of the
Develop Iron-Deficiency Anemia” on page 15� reproductive system
People who have severe anemia or anemia that is • A cardiologist, a doctor who specializes
getting worse need treatment� Some rare anemias, in treating heart and blood vessel diseases
such as severe aplastic anemia, can be fatal if it and conditions
goes untreated� The risk of death may increase • A neurologist, a doctor who specializes
dramatically if a person has low levels of other in treating nervous system disorders,
blood cells besides red blood cells, such as white including diseases of the brain, spinal cord,
blood cells or platelets� nerves, and muscles
Anemia treatments are evolving, and the kind • A registered dietitian, an accredited food
your doctor suggests for you is based on and nutrition expert
the type of anemia you have� For example,
iron-deficiency anemia and pernicious anemia are
DIFFERENT T YPES
OF ANEMIA
I RO N - D E FI C I E N CY A N E M I A CAU S E S
Iron-deficiency anemia is a common type of Iron-deficiency anemia usually develops over time
anemia that occurs when you do not have enough because your body’s intake of iron is too low� Low
iron in your body� People with mild or moderate levels of iron can occur because of blood loss, a
iron-deficiency anemia may not have any signs or daily iron intake that is less than the recommended
symptoms� More severe iron-deficiency anemia daily amount, and medical conditions that make
may cause fatigue or tiredness, shortness of breath, it hard for your body to absorb iron from the
or chest pain� gastrointestinal (GI) tract�
If your doctor diagnoses you with iron-deficiency When you lose blood, you lose iron� Certain
anemia, your treatment will depend on the conditions or medicines can cause blood loss
cause and severity of the condition� Your doctor and lead to iron-deficiency anemia� Common
may recommend healthy eating changes, iron causes of blood loss that lead to iron-deficiency
supplements, intravenous (IV) iron therapy for anemia include:
mild to moderate iron-deficiency anemia, or red • Bleeding in your GI tract (from an ulcer, colon
blood cell transfusions for severe iron-deficiency cancer, or regular use of medicines such as
anemia� You may need to address the cause of aspirin or nonsteroidal anti-inflammatory drugs
your iron deficiency, such as underlying bleeding� If [NSAIDS], such as ibuprofen and naproxen)
undiagnosed or untreated, iron-deficiency anemia
• Certain rare genetic conditions such as
can cause serious complications, including heart
hereditary hemorrhagic telangiectasia, which
failure and developmental delays in children�
causes bleeding in the bowels
• Frequent blood donation
• Frequent blood tests, especially in infants and
small children
• Heavy menstrual periods
• Injury or surgery
• Urinary tract bleeding
Iron-deficiency anemia can be caused by getting
less than the recommended daily amounts of
iron� The recommended daily amounts of iron will
depend on your age, sex, and whether you are
pregnant or breastfeeding�
Recommended daily amounts of iron, in milligrams (mg)
AGE MALE FEMALES PREGNANCY BREASTFEEDING
Birth to 6 months 0�27 mg 0�27 mg
7 to 12 months 11 mg 11 mg
1 to 3 years 7 mg 7 mg
14 to 18 years 11 mg 15 mg 27 mg 10 mg
19 to 50 years 8 mg 18 mg 27 mg 9 mg
51 or older 8 mg 8 mg
Recommended daily iron intake for Even if you consume the recommended daily
children and adults. The table above lists the amount of iron, your body may not be able to
recommended amounts of iron, in milligrams (mg) absorb the iron� Certain conditions or medicines
at different ages and stages of life� Until the teen can decrease your body’s ability to absorb
years, the recommended amount of iron is the iron and lead to iron-deficiency anemia� These
same for boys and girls� From birth to 6 months, conditions include:
babies need 0�27 mg of iron� This number goes • Intestinal and digestive conditions, such as
up to 11 mg for children ages 7 to 12 months, and celiac disease; inflammatory bowel diseases,
down to 7 mg for children ages 1 to 3� From ages including ulcerative colitis and Crohn’s disease;
4 to 8, children need 10 mg, and from ages 9 to and Helicobacter pylori infection�
13, 8 mg� From ages 14 to 18, boys need 11 mg,
while girls need 15 mg� From ages 19 to 50, men • A history of gastrointestinal surgery, such
need 8 mg and women need 18 mg� After age 51, as weight-loss surgery—especially gastric
both men and women need 8 mg� Pregnant women bypass—or gastrectomy�
need 27 mg� Breastfeeding girls under age 18 • Certain rare genetic conditions, such as
need 10 mg while breastfeeding women older than a TMRPSS6 gene mutation that causes a
18 need 9 mg� person’s body to make too much of a hormone
called hepcidin� Hepcidin blocks intestine from
taking up iron�
Other medical conditions that may lead to
iron-deficiency anemia include:
• End-stage kidney failure, where there is
blood loss during dialysis� People who have
chronic kidney disease also often take other
medicines—such as proton pump inhibitors,
anticoagulants, or blood thinners—that may
cause iron-deficiency anemia� Proton pump
inhibitors interfere with iron absorption, and
blood thinners increase the likelihood of
bleeding in the GI tract�
• Inflammation from heart failure or
obesity� These chronic conditions can
lead to inflammation that may cause
iron-deficiency anemia�
How does inflammation from chronic diseases cause
iron-deficiency anemia?
When there is inflammation in your body, your liver makes more of a hormone
called hepcidin. Hepcidin prevents iron from leaving cells where it is stored or from
being absorbed in the duodenum, the first part of the small intestine just beyond
the stomach.
• Even if you have enough iron in your body, inflammation may make it harder for your
body to absorb or use iron.
• Without enough available iron in your blood, your body cannot make as many
new red blood cells. The red blood cells it does make have less hemoglobin than
normal. Hemoglobin is a protein inside red blood cells that carries oxygen from the
lungs to tissues and organs in the body. Hemoglobin also carries carbon dioxide
back to the lungs.
PE O PL E W H O A R E M O R E L I K E LY TO People who are higher risk due to their family

D E V E LO P I R O N - D E F I C I E N CY A N E M I A history and genetics include:
You may have an increased risk for iron-deficiency • Those who have inherited Von Willebrand
anemia because of your age, sex, family history disease, a bleeding disorder that affects the
and genetics, or lifestyle habits, or because of blood’s ability to clot� This makes it harder
unhealthy environments� to stop bleeding and can increase the risk of
People who are at higher risk because they are a iron-deficiency anemia from trauma, surgery, or
certain age include: heavy menstrual periods�
• Individuals with a gene for hemophilia,
• Infants between 6 and 12 months,
including symptomatic female carriers who
especially if they are fed only breast milk or are
have heavy menstrual periods�
fed formula that is not fortified with iron� The
iron that full-term infants have stored in their People who are at higher risk due to their lifestyle
bodies is used up in the first 4 to 6 months habits include:
of life� Babies born prematurely may be at • Those with vegetarian or vegan eating
an even higher risk, as most newborns’ iron patterns� Not eating enough iron-rich foods,
stores are developed during the third trimester such as meat and fish, may result in you
of pregnancy� getting less than the recommended daily
• Children between ages 1 and 2, especially amount of iron�
if they drink a lot of cow’s milk, which is • Individuals who donate blood often�
low in iron�
• Athletes, especially young females� Endurance
• Teens, who have an increased need for iron athletes lose iron through their GI tracts�
during growth spurts� They also lose iron through the breakdown
• Older adults, especially those over age 65� of red blood cells, called hemolysis� In
People who are at higher risk due to their this case, hemolysis is caused by strong
environment include: muscle contractions and the impact of feet
repeatedly striking the ground, such as with
• Children who have lead in their blood from marathon runners�
their environment or the water they drink�
Lead interferes with the body’s ability to
make hemoglobin�
People who are at higher risk because of their “Before my diagnosis I was always
gender include:
very, very tired� I thought my busy
• Girls and women between ages 14 and 50�
They tend to need more iron than boys and
lifestyle—a full-time job and part-time
men of the same age� school—was to blame� I didn’t think I
Women who are at higher risk include: had a medical condition� Some years
• Those who are experiencing menstruation, later, I had surgery for a different
especially if they have heavy periods�
health problem� At that time, doctors
• Those who are pregnant, who recently
gave birth, or who are breastfeeding� told me that my extreme tiredness was
These women may be consuming less than due to iron-deficiency anemia�
the recommended daily amount of iron� This
is because their need for iron increases during My doctor prescribed iron
these periods of growth and development,
and it may be hard to get the recommended supplements and advised
amount from food alone� Pregnant women me to adopt an overall
need more iron to support their unborn babies’
growth, so their bodies produce more blood�
healthy lifestyle that
With more red blood cells on hand, their includes good nutrition,
bodies can store iron to prepare for blood physical activity, and
loss during delivery�
better sleeping habits�”
S I G N S A N D SY M P TO M S O F
I R O N - D E F I C I E N CY A N E M I A Susan
Common signs of iron-deficiency anemia include:
• Brittle or spoon-shaped nails
• Cracks at the sides of the mouth
• Pale skin
• Swelling or soreness of the tongue
Common symptoms of iron-deficiency
anemia include:
• Chest pain
• Coldness in the hands and feet
• Difficulty concentrating
• Dizziness
• Fatigue, or feeling tired, which can make it hard
to find the energy to do normal activities*
• Headache
• Irregular heartbeat, which is a sign of more
serious iron-deficiency anemia
• Pica, which is an unusual craving for non-food
items, such as ice, dirt, paint, or starch
• Restless legs syndrome
• Shortness of breath
• Weakness
*This is the most common symptom�
H OW I R O N - D E F I C I E N CY A N E M I A Different tests help your doctor diagnose
I S D I AG N O S E D iron-deficiency anemia� In iron-deficiency
Your doctor will use the basic tests described anemia, blood levels of iron will be low, or less
earlier (see “How Anemia Is Diagnosed” on page 7) than 10 micromoles per liter (mmol/L) for both men
to diagnose iron-deficiency anemia� If your anemia and women� Normal levels are 10 to 30 mmol/L�
is mild, you may have no signs or symptoms at all� Levels of ferritin will also be low, or less than
Your doctor may discover the anemia while testing 10 micrograms per liter (mg/L) for both men and
you for something else� women� Normal levels are 40 to 300 for men and
20 to 200 for women�
If your doctor suspects iron-deficiency anemia,
he or she will likely recommend a complete blood If iron-deficiency anemia is confirmed and your
count� If this blood test confirms the diagnosis, your doctor thinks that it may be caused by internal
doctor may recommend other blood tests to find bleeding, you may have one or more of the
out what’s causing the anemia and how severe it is� following procedures to guide treatment:
These tests include a blood smear, a reticulocyte • Fecal occult blood test to check for blood
count, and blood iron tests (see “Testing for in the stool� Blood in the stool would suggest
Anemia” on page 7 for more details)� bleeding in the GI tract and may require
further testing�
Healthy and Low Iron Studies in Adults • Upper endoscopy to look for bleeding in
the esophagus, stomach, and the first part of
Iron, µmol/L Normal 10 to 30 the small intestine� A tube with a tiny camera
Iron-deficiency Less than 10 is inserted through your mouth down to your
anemia stomach and upper small intestine to view the
lining of your upper digestive tract�
Ferritin, µg/L Normal Men 40 to 300
Women 20 to 200
• Colonoscopy to look for bleeding or other
abnormalities, such as growths or cancer of the
Iron-deficiency Less than 10 lining of the colon� For this test, you are sedated
anemia while a small camera is inserted into the colon
to view it directly�
H OW I R O N - D E F I C I E N CY A N E M I A If iron supplements alone are not able to replenish
I S T R E AT E D the levels of iron in your body, your doctor may
Treatment for iron-deficiency anemia will depend recommend a procedure such as:
on its cause and severity� Treatments may include • Iron therapy, or intravenous (IV) iron. This
iron supplements, procedures, surgery, and dietary is sometimes used to deliver iron through a
changes� Severe iron-deficiency anemia may require blood vessel to increase iron levels in the blood�
intravenous iron therapy or a blood transfusion� One benefit of IV iron is that it often takes
Your doctor may recommend that you take iron only one or a few sessions to replenish the
supplements, also called iron pills or oral iron, by amount of iron in your body� People with severe
mouth once or several times a day to increase iron-deficiency anemia or who have chronic
the amount of iron in your body� This is the most conditions such as kidney disease or celiac
common treatment for iron deficiency� It generally disease may be more likely to receive IV iron�
takes three to six months to replenish your You may experience vomiting, headache, or
iron stores� other side effects right after the IV iron, but
these usually go away within a day or two�
Iron supplements are sometimes recommended by
• Red blood cell transfusion(s). These may
your doctor during pregnancy� If your condition is
be used for people with severe iron-deficiency
caused by certain rare genetic conditions, such as
anemia to quickly increase the amount of red
a TMRPSS6 gene mutation, you may not respond
blood cells and iron in the blood� Your doctor
to oral iron supplements�
may recommend this if you have serious
Iron supplements are generally not recommended complications of iron-deficiency anemia, such
for people who do not have iron-deficiency anemia� as chest pain�
This is because too much iron can damage • Surgery, upper endoscopy or colonoscopy, to
your organs� stop bleeding�
Do not stop taking your prescribed iron To help you meet your recommended daily intake of
supplements without first talking to your doctor� iron, your doctor may ask you to take these steps:
Talk to your doctor if you are experiencing side
effects such as a metallic taste, vomiting, diarrhea, • Adopt healthy lifestyle changes, such as
constipation, or an upset stomach� Your doctor may heart-healthy eating patterns�
be able to recommend options such as taking your • Increase your daily intake of iron-rich foods
supplements with food, lowering the dose, trying to help treat your iron-deficiency anemia� See
a different type of iron supplement, or receiving “Lead a Healthy Lifestyle” on page 31 to learn
intravenous iron� about foods that are high in iron� It is important
to know that increasing your intake of iron may
not be enough to replace the iron your body
normally stores but has used up�
SAFETY NOTE • Increase your intake of vitamin C to help your
Keep Iron Supplements Out of body absorb iron�
Reach of Children • Avoid drinking black tea, which reduces
The high doses of iron in these iron absorption�
supplements can quickly cause If you have chronic kidney disease and
life-threatening poisoning if your iron-deficiency anemia, your doctor may
child eats them. recommend erythropoiesis stimulating agents
This is particularly important for (ESA)� These medicines stimulate the bone marrow
pregnant women taking prenatal to make more red blood cells� ESAs are usually
vitamins. These vitamins are often used with iron therapy or intravenous iron, or when
brightly colored capsules that iron therapy alone is not enough�
could attract young children, who
may think that they are candy.
PE R N I C I O U S A N E M I A
Pernicious anemia is a condition that develops PROBABLE OUTCOMES
when the body does not have enough vitamin Pernicious anemia was often fatal in the past, before
B12� The body needs vitamin B12 to make healthy vitamin B12 treatments were available. Now, the condition
red blood cells and to keep its nervous system usually is easy to treat with vitamin B12 pills or shots.
working properly� With ongoing care and proper treatment, most people
who have pernicious anemia can recover, feel well, and
When your body does not have enough vitamin live normal lives. Without treatment, pernicious anemia
B12, the red blood cells don’t divide normally and can lead to serious problems with the heart, nerves,
are too large� They may have trouble getting out of digestive tract, and other parts of the body. It can also
cause neurological problems such as memory loss.
the bone marrow, a sponge-like tissue inside the
Some of these problems may be permanent. People who
bones where blood cells are made� have pernicious anemia may also be at higher risk for
Without enough red blood cells to carry oxygen weakened bone strength and stomach cancer.
to your body, you may feel tired and weak� Severe
OTHER NAMES
or long-lasting pernicious anemia can damage the
heart, brain, and other organs in the body� Pernicious anemia is one of two major types of
“macrocytic” or “megaloblastic” anemia. These terms
refer to anemia in which the red blood cells are larger
CAU S E S than normal. (The other major type of macrocytic anemia
is caused by folic acid deficiency.)
Pernicious anemia is caused by a lack of a protein
In rare cases, children are born with an inherited
called intrinsic factor, or other issues, such as disorder that prevents their bodies from making intrinsic
infections, surgery, medicines, or diet� factor. This disorder is called congenital pernicious
Lack of Intrinsic Factor anemia. Vitamin B12 deficiency also is called cobalamin
deficiency and combined systems disease.
People who have pernicious anemia cannot
absorb enough vitamin B12 from food� This is
because they lack intrinsic factor, a protein made
in the stomach� A lack of this protein leads to Malabsorption in the Small Intestine
vitamin B12 deficiency� Sometimes pernicious anemia occurs because the
body’s small intestine can’t properly absorb vitamin
In some people, an autoimmune response causes B12� This may be the result of:
a lack of intrinsic factor�
• Too many of the wrong kind of bacteria in the
An autoimmune response occurs if the body’s small intestine� This is a common cause of
immune system makes antibodies (proteins) pernicious anemia in older adults� The bacteria
that mistakenly attack and damage the body’s use up the available vitamin B12 before the
tissues or cells� small intestine can absorb it�
In pernicious anemia, the body makes antibodies • Diseases that interfere with vitamin B12
that attack and destroy the parietal cells� These absorption� One example is celiac disease�
cells line the stomach and make intrinsic factor� Why This is a genetic disorder that makes your
this autoimmune response occurs isn’t known, but body unable to tolerate a protein called
as a result of it, the stomach stops making intrinsic gluten� Another example is Crohn’s disease,
factor, and this leads to vitamin B12 deficiency� an inflammatory bowel disease� HIV also may
As a result of this attack, the stomach stops making interfere with vitamin B12 absorption�
intrinsic factor� This leads to vitamin B12 deficiency� • Certain medicines that alter bacterial
A lack of intrinsic factor also can occur if you’ve had growth or prevent the small intestine from
part or all of your stomach surgically removed� This properly absorbing vitamin B12� Examples
type of surgery reduces the number of parietal cells include antibiotics and certain diabetes and
available to make intrinsic factor� seizure medicines�
• Surgical removal of part or all of the
small intestine�
• A tapeworm infection� The tapeworm feeds
off of the vitamin B12� Eating undercooked,
infected fish may cause this type of infection�
Diet Lacking Vitamin B12 • Having had part or all of your small intestine
Some people get pernicious anemia because surgically removed� The small intestine is where
they don’t have enough vitamin B12 in their diets� vitamin B12 is absorbed�
This cause of pernicious anemia is less common • Having certain intestinal diseases or other
than other causes� Good food sources of vitamin disorders that may prevent your body from
B12 include: properly absorbing vitamin B12 (for example,
• Breakfast cereals with added vitamin B12 Crohn’s disease, intestinal infections, and HIV)�
• Meats such as beef, liver, poultry, and fish • Taking medicines that prevent your body from
• Eggs and dairy products such as milk, properly absorbing vitamin B12 – for example,
yogurt, and cheese antibiotics and certain seizure medicines�
• Foods fortified with vitamin B12, such as • Being a strict vegetarian who does not eat any
soy-based beverages and vegetarian burgers animal or dairy products and does not take
a vitamin B12 supplement, or having a poor
diet overall�
PE O PL E W H O A R E M O R E L I K E LY TO
D E V E LO P PE R N I C I O U S A N E M I A
Pernicious anemia is more common in people of
Northern European and African descent than in “I went to the doctor for some routine blood
other ethnic groups�
tests and found out I had vitamin B12
Older people also are at higher risk for the condition�
As people grow older, they tend to make less
deficiency, or pernicious anemia� I didn’t
stomach acid, which means less intrinsic factor is have any symptoms and didn’t know I
present as well� The lack of intrinsic factor prevents had a B12 deficiency until the
the small intestine from absorbing vitamin B12�
doctor told me� The doctor
Breastfed infants of strict vegetarian mothers also
are at risk for pernicious anemia� These infants can said that taking vitamin B12
develop anemia within months of being born� This shots would give me more
is because they haven’t had enough time to store
vitamin B12 in their bodies� Doctors treat these pep� He started me out with
infants with vitamin B12 supplements� vitamin B12 shots once a week
Other groups, such as people who have alcohol for 6 weeks� Now I only
use disorder, also may be at risk for pernicious
anemia� These people may not get the proper
need them once
nutrients in their diets� a month� I’ve always
Pernicious anemia also can occur in younger people eaten pretty healthy�
and other populations� Some of the reasons you
And while I’ve
may be at higher risk for pernicious anemia include:
slowed down a bit
• Having a family history of the condition�
• Having had part or all of your stomach since my diagnosis
surgically removed� The stomach makes of pernicious
intrinsic factor, which is a protein that helps
anemia, I still walk
your body absorb vitamin B12�
• Having an autoimmune disorder that involves 2 miles three or four
the endocrine glands, such as Addison’s times a week�”
disease, type 1 diabetes, Graves’ disease,
or vitiligo� Research suggests that a link may Sherman
exist between these autoimmune disorders
and pernicious anemia, which is caused by an
autoimmune response�
S I G N S A N D SY M P TO M S This information will give your doctor important
Some of the signs and symptoms of pernicious clues about whether you have pernicious anemia
anemia also show up in all types of anemia� Other and its possible cause�
signs and symptoms are specific to a lack of During the physical exam, your doctor may check
vitamin B12� for pale or yellowish skin and an enlarged liver� He
Signs and Symptoms of Vitamin B12 Deficiency or she may listen to your heart for rapid or irregular
Vitamin B12 deficiency can lead to nerve damage, heartbeats or a heart murmur�
which can cause tingling and numbness in your Your doctor may also check for signs of nerve
hands and feet, muscle weakness, and loss damage� He or she may want to see how well your
of reflexes� You may also feel unsteady, lose your muscles, eyes, senses, and reflexes work� Your
balance, and have trouble walking� Vitamin B12 doctor may ask questions or do tests to check your
deficiency can cause weakened bones and may mental status, coordination, and ability to walk�
lead to hip fractures� Your doctor may recommend tests to help diagnose
Severe vitamin B12 deficiency can cause pernicious anemia and find out what is causing it�
neurological problems, such as confusion, Often, the first test used to diagnose anemia is a
dementia, depression, and memory loss� complete blood count� This test measures many
Other symptoms of vitamin B12 deficiency parts of your blood and looks at the number and
involve the digestive tract� These symptoms appearance of your blood cells� With pernicious
include nausea (feeling sick to your stomach) and anemia, the red blood cells are larger than normal�
vomiting, heartburn, abdominal bloating and gas, (For more information about the complete blood
constipation or diarrhea, loss of appetite, and count, see “Testing for Anemia” on page 7�)
weight loss� An enlarged liver is another symptom� If your complete blood count shows that you
A smooth, thick, red tongue also is a sign of vitamin have anemia, your doctor may recommend other
B12 deficiency and pernicious anemia� tests, including:
Infants who have vitamin B12 deficiency may have • A reticulocyte count� This test measures the
poor reflexes or unusual movements, such as face number of young red blood cells in your blood�
tremors� They may have trouble feeding due to The results tell your doctor whether your bone
tongue and throat problems� They may also be marrow is making enough healthy red blood
irritable� If vitamin B12 deficiency isn’t treated, these cells� People who have pernicious anemia have
infants may have permanent growth problems� low reticulocyte counts�
• Tests for the blood levels of vitamins� These
H OW PE R N I C I O U S A N E M I A tests measure the levels of vitamin B12, folate,
I S D I AG N O S E D and vitamin C in your blood�
Pernicious anemia is diagnosed based on your • Tests for homocysteine and methylmalonic
medical and family histories, a physical exam, and acid levels� People who have pernicious
the results from tests� Your doctor may ask about anemia have higher-than-normal levels of these
your signs and symptoms, your diet, and any substances in their blood�
medicines you may take� He or she may also ask • An antibody test� This test measures whether
whether you have or have had the following: your body is making antibodies to attack the
stomach cells that make intrinsic factor� The
• Any stomach or intestinal surgeries�
results of this test will reveal the cause of your
• Any digestive disorders, such as celiac disease pernicious anemia�
or Crohn’s disease�
• Bone marrow tests� These tests indicate
• A family history of anemia or pernicious anemia� whether your bone marrow is healthy and
• A family history of autoimmune disorders—such making enough healthy red blood cells� People
as Addison’s disease, type 1 diabetes, Graves’ who have pernicious anemia have larger than
disease, or vitiligo� Research suggests that normal bone marrow cells�
a link may exist between these autoimmune
disorders and the kind of pernicious anemia
that is caused by an autoimmune response�
H OW PE R N I C I O U S A N E M I A CAU S E S
I S T R E AT E D Aplastic anemia occurs because of damage to stem
Doctors treat pernicious anemia by replacing the cells inside bone marrow, which is the sponge-
missing vitamin B12 in the body� People who have like tissue within your bones� Many diseases and
pernicious anemia may need lifelong treatment� conditions can damage the stem cells in bone
The goals of treating pernicious anemia include: marrow� As a result, the bone marrow makes fewer
red blood cells, white blood cells, and platelets�
• Preventing or treating the anemia and its signs
and symptoms The most common cause of bone marrow damage
is from your immune system attacking and
• Preventing or managing complications, such as destroying the stem cells in your bone marrow,
heart and nerve damage which is a kind of autoimmune disorder� The genes
• Treating the cause of the pernicious anemia you inherit from your parents, some medicines, and
(if a cause can be found) certain toxins in the environment may also cause
Specific Types of Treatment aplastic anemia�
Pernicious anemia usually is easy to treat with
vitamin B12 shots or pills� PE O PL E W H O A R E M O R E L I K E LY TO
D E V E LO P A PL A S T I C A N E M I A
If you have severe pernicious anemia, your doctor
may recommend shots first� Shots usually are given People of all ages can develop aplastic anemia�
in a muscle every day or every week until the level Those at increased risk may include:
of vitamin B12 in your blood increases� After your • People undergoing high-dose radiation or
vitamin B12 blood level returns to normal, you may chemotherapy for cancer
get a shot only once a month�
• People exposed to certain environmental toxins,
For less severe pernicious anemia, your doctor such as pesticides, arsenic, and benzene
may recommend large doses of vitamin B12 pills� A • People taking certain medicines, such as those
vitamin B12 nose gel and spray also are available� used to treat rheumatoid arthritis and some
These products may be useful for people who have types of antibiotics
trouble swallowing pills, such as older people who
have had strokes� • People with certain infectious diseases,
autoimmune disorders, or inherited conditions
Your signs and symptoms may begin to improve that can damage the bone marrow
within a few days after you start treatment� Your
doctor may advise you to limit your physical activity S I G N S A N D SY M P TO M S
until your condition improves�
Lower-than-normal numbers of red blood cells,
If your pernicious anemia is caused by something white blood cells, and platelets cause the signs
other than a lack of intrinsic factor, you may get and symptoms of aplastic anemia� While signs and
treatment for the cause—if a cause can be found� symptoms can be mild, moderate, or severe, severe
For example, your doctor may prescribe medicines aplastic anemia can be life-threatening�
to treat a condition that prevents your body from
absorbing vitamin B12� A lower-than-normal number of red blood cells can
cause fatigue; weakness; shortness of breath; pale
If medicines are the cause of your pernicious anemia, skin, gums, and nail beds; dizziness; headaches;
your doctor may change the type or dose of medicine cold hands and feet; and chest pain� A lower-than-
you take� Infants of strict vegetarian mothers may be normal number of white blood cells can cause fever,
given vitamin B12 supplements from birth� frequent or severe infections, and lingering flu-like
symptoms� A lower-than-normal number of platelets
A PL AS TI C A N E M I A can cause easy bleeding or bruising, petechiae
Aplastic anemia is a rare but serious blood disorder (pinpoint red spots on the skin), nosebleeds,
that occurs when your bone marrow cannot bleeding gums, blood in the stool, and heavy
make enough new blood cells for your body to menstrual periods�
work normally� Other signs and symptoms of aplastic anemia can
include nausea and skin rashes�
People who have another blood disorder called “I found out I had aplastic anemia in an
paroxysmal nocturnal hemoglobinuria (PNH)
and aplastic anemia may have other signs and
odd way� The day after a scuba diving trip,
symptoms, including blood in the urine, swelling I was covered with bruises that I could
or pain in the abdomen, swelling in the legs, not explain� I went to the doctor and was
headaches, and jaundice (a medical condition
marked by a yellowing of the skin or the whites immediately hospitalized and given a
of the eyes)� blood transfusion� The doctors told me
H OW A PL A S T I C A N E M I A
I almost didn’t have enough blood in my
I S D I AG N O S E D body� They diagnosed me with aplastic
To diagnose aplastic anemia, your doctor will order anemia, a blood disorder where your
tests to determine whether you have low numbers body has trouble making new blood cells�
of cells in your bone marrow and blood�
Looking back, there were little signs that
Your doctor will use your medical and family
histories, a physical exam, and other tests to I ignored—previous
determine possible causes of aplastic anemia� bruising and
• Medical and family histories. Your doctor tiredness—and
will ask about your symptoms and how long
you have had them� He or she also will want to I now know
know whether you’ve had any viral infections, that I should
been exposed to toxins, or had cancer
treatments� Another important diagnostic
have seen a
clue is whether you or anyone in your family doctor much
has had anemia� earlier than
• Physical exam. During the physical exam,
your doctor will look at your skin and check
I did�”
for signs of bleeding or infection� He or she
may also listen to your heart and lungs for any Shirah
abnormal sounds and feel your abdomen and
legs to determine whether they feel normal� The
physical exam findings will help your doctor
determine the severity of your condition and
what may be causing it�
• Other tests. In addition to the bone marrow
test, your doctor may recommend a chest
x-ray, a computed tomography (CT) scan,
ultrasound imaging, liver tests, tests for viral
infections, tests for vitamin B12 and folate
levels in your blood, and/or a specialized test
for PNH� These tests can help your doctor
determine the severity of your anemia, what
is causing it, and whether you have PNH� The
signs and symptoms of aplastic anemia are
similar to those of other conditions and other
types of anemia�
These tests can help your doctor rule out certain
conditions as the cause of your anemia�
H OW A PL A S T I C A N E M I A I S T R E AT E D treatment� This type of transplant works best in
Treatments may include medicines to suppress your children and young adults who are in good health
immune system, blood transfusions, or a blood and and have donors with closely matching cell types�
bone marrow transplant� A blood and bone marrow Other Treatments and Lifestyle Changes
transplant may cure the disorder in some people� Aplastic anemia also is treated in other ways� For
Removing a known cause of aplastic anemia, such example, removing a known cause of aplastic
as exposure to a toxin, may also cure the condition� anemia may cure the condition� Examples of
Because people who have aplastic anemia are known causes include high-dose radiation
more likely to develop blood disorders, your doctor or chemotherapy treatment, exposure to
will monitor your condition and screen you for blood environmental toxins, and certain medicines�
disorders regularly� If you take medicine to suppress Lifestyle changes also can help protect you from
your immune system, you also will need to take problems linked to aplastic anemia� For example,
steps to prevent infection and the flu, including because your red blood cell count is low, you may
taking medicine and getting vaccines such as an feel tired or short of breath� Conserve your energy
annual flu shot� and do not overdo physical activity� Because your
Medicines platelet count is low, you’re at risk of bleeding� Avoid
Your doctor may recommend medications to treat activities in which you might cut or injure yourself�
the cause of your anemia or help prevent or treat Because your white blood cell count is low, your
complications� For example, your doctor may body is less able to fight infections� Protect yourself
prescribe medicines to suppress your immune by washing your hands often and avoiding crowds
system or stimulate your bone marrow to make and people who are sick� See your doctor if you
red blood cells� One example of a medicine that develop a fever, which is a sign that you may have
can stimulate your bone marrow is erythropoietin an infection� Talk to your doctor about other lifestyle
therapy� Your doctor may also prescribe medicines changes that can protect you from problems linked
to prevent or treat an infection that may occur to aplastic anemia�
because your white blood cell count is low�
Blood Transfusions H E M O LY TI C A N E M I A
This is a common procedure in which you receive This blood disorder occurs when your red
blood through an IV line inserted in one of your blood cells are destroyed faster than they can
blood vessels� The blood you receive is carefully be replaced�
matched to your own blood type� Transfusions can
help increase your blood cell counts up to a normal CAU S E S
level� They help relieve symptoms but are not a
permanent treatment� This form of anemia develops when your bone
marrow cannot make enough new red blood cells
Blood and Marrow Stem Cell Transplants to replace the ones that have been destroyed
These procedures are implemented to replace too soon� There are many types of hemolytic
damaged stem cells in your bone marrow with anemia and many causes� Hemolytic anemia can
healthy cells� For this procedure, high doses of be acquired or inherited� Sometimes, the cause
chemotherapy and possibly radiation are used is not known�
to destroy your faulty stem cells� Then, donor
stem cells are put into a blood vessel through an Doctors diagnose hemolytic anemia based on the
intravenous tube placed in your chest� These cells underlying cause of your anemia� Certain conditions
are carefully matched to your own cell type� Once can cause hemolysis to happen too fast or too
the stem cells are in your body, they travel to your often� Conditions that may lead to hemolytic anemia
bone marrow and begin making new red blood include inherited blood disorders such as sickle
cells, white blood cells, and platelets� cell disease or thalassemia, autoimmune disorders,
bone marrow failure, or infections� Some medicines
Blood and marrow stem cell transplants generally or side effects from blood transfusions may cause
are the best treatment option for people who have hemolytic anemia�
severe aplastic anemia and are eligible for this
Types of Hemolytic Anemia
TYPE CHARACTERISTIC
Immune hemolytic anemia The immune system destroys red blood cells� These are the three types of immune
hemolytic anemia:
• Autoimmune hemolytic anemia (AIHA)� AIHA is the main cause of hemolytic
anemia� The immune system makes antibodies (proteins) that attack the red blood
cells� AIHA can develop very suddenly� Certain diseases or infections can raise the
risk for AIHA (for example, lupus, chronic lymphocytic leukemia, non-Hodgkin’s
lymphoma, other blood cancers, Epstein-Barr virus, cytomegalovirus, mycoplasma
pneumonia, hepatitis, and HIV)� Some AIHA antibodies become active only in
warm temperatures, others only in cold temperatures�
• Alloimmune hemolytic anemia� With this hemolytic anemia, a person’s immune
system makes antibodies against blood that is a different type from his or her own
blood� This may occur in a blood transfusion from a donor who has a different
blood type� It also can occur during pregnancy if the fetus has a different blood
type than the mother (this condition is called Rh incompatibility)�
• Drug-induced hemolytic anemia� Some medicines (for example, penicillin,
acetaminophen, antimalaria medicines, and levodopa) may cause an immune
reaction that destroys red blood cells�
Mechanical hemolytic anemia • Hemolytic anemia develops because red blood cells are physically damaged� This
damage may result from a heart-lung bypass machine (used during open-heart
surgery), an artificial heart valve that is not working well, an increase in body
temperature due to exposure to extreme heat or extensive burns, or preeclampsia
(very high blood pressure during pregnancy)�
Paroxysmal nocturnal • Abnormal stem cells in the bone marrow make blood cells with a faulty outer
hemoglobinuria membrane� This causes the body to destroy its red blood cells and make too few
white blood cells and platelets�
Other causes of acquired • Some infections and toxic substances can damage or destroy red blood cells,
hemolytic anemia leading to hemolytic anemia� Examples include malaria, blackwater fever,
tick-borne diseases, snake venom, and toxic chemicals�
Autoimmune
hemolytic anemia is
the main cause of
hemolytic anemia�
Types of Inherited Hemolytic Anemia
TYPE CHARACTERISTIC
Sickle cell disease • The body makes abnormal hemoglobin that causes red blood cells to have a
sickle, or C, shape� These sickle cells are sticky and do not travel easily through
blood vessels�
• Sickle cells live only about 10–20 days, and the bone marrow cannot make new
red blood cells fast enough to replace the dying ones�
• In the United States, sickle cell anemia mainly affects people of African and
Hispanic descent�
• All states require sickle cell disease screening for newborn babies�
Thalassemias • The body does not make enough of certain types of hemoglobin, which prevents it
from making enough healthy red blood cells�
• Thalassemias often affect people of Southeast Asian, Indian, Chinese, Filipino,

Mediterranean, or African descent�
Hereditary spherocytosis • A defect in the red blood cells’ outer membranes causes them to have a spherical,
or ball-like, shape�
• The ball-shaped red blood cells have a shorter-than-normal lifespan�
• Hereditary spherocytosis is the most common cause of hemolytic anemia among

people of Northern European descent�
Hereditary elliptocytosis • A defect in the red blood cells’ outer membranes makes them oval-shaped and
(ovalocytosis) less flexible than normal� They have a shorter than normal lifespan�
G6PD • The red blood cells are missing an enzyme called G6PD� (Enzymes are proteins
(Glucose-6-phosphate that drive chemical reactions in the body�) The missing enzyme makes the red
dehydrogenase deficiency) blood cells fragile and more likely to break down�
• If the red blood cells come in contact with certain substances in the bloodstream,
they rupture and die�
• Many factors, including certain medicines, foods (like fava beans), and infections,
can trigger the breakdown of the red blood cells
• G6PD deficiency mostly affects men of African or Mediterranean descent�
• Most states require G6PD deficiency screening for newborn babies�
Pyruvate kinase deficiency • The red blood cells are missing an enzyme called pyruvate kinase� This causes
them to break down easily�
• Pyruvate kinase deficiency is more common among the Amish�
PE O PL E W H O A R E M O R E L I K E LY TO H OW H E M O LY T I C A N E M I A
D E V E LO P H E M O LY T I C A N E M I A I S D I AG N O S E D
Hemolytic anemia affects people of all ages and Like other types of anemia, hemolytic anemia is
races and both sexes� The different types of diagnosed based on your personal and family
hemolytic anemia affect various populations� medical histories, a physical exam, and the
Some types of acquired hemolytic anemia also results of tests�
affect certain populations� For example, alloimmune First, your doctor may ask about your symptoms
hemolytic anemia can occur in pregnant women and how long you have had them� He or she also
and their fetuses� Mechanical hemolytic anemia will review your medical history, as well as your
may occur in people who have artificial heart valves family’s, and may ask questions such as these:
or who use a heart-lung bypass machine during • Do any of your relatives have inherited anemia,
open-heart surgery� such as sickle cell anemia, thalassemia, or
G6PD deficiency?
S I G N S A N D SY M P TO M S
• Have any of your family members had jaundice?
These signs and symptoms vary widely and depend • Have you recently had any illnesses or other
on the type and severity of the hemolytic anemia� medical conditions?
Some signs and symptoms are common to all
types of anemia, such as: • Do you take medicines? Which ones?
• Have you been exposed to any chemicals or
• Fatigue and weakness
toxic substances?
• Pale skin, gums, and nail beds
• Do you have an artificial heart valve?
• Dizziness
Your answers to these questions will help determine
• Shortness of breath whether you have hemolytic anemia and provide
• Headaches clues about the cause and severity of the condition�
• Cold hands and feet During the physical exam, your doctor will check for
• Chest pain signs of anemia, such as pale skin and fingernails,
Other signs and symptoms that are specific to fast breathing, and rapid heartbeats� He or she may
hemolytic anemia include: also feel your abdomen to determine whether you
have an enlarged spleen�
• Jaundice (a medical condition marked by
a yellow color of the skin or the whites of Many tests are used to confirm a diagnosis of
the eyes)� This sign often is very severe in hemolytic anemia and determine the specific
hemolytic anemia� type of this anemia� Often, the first test used to
diagnose anemia is a complete blood count� This
• Pain in the upper abdomen or back test measures many parts of your blood and looks
• An enlarged spleen (see “The Spleen: Your at the number and appearance of your blood cells�
Body’s Natural Filter” immediately below for (For more information about the test, see “Testing
more information) for Anemia” on page 7�) If the complete blood count
• Chills confirms that you have anemia, your doctor may
recommend additional blood and other tests�
T H E S PL E E N : YO U R B O DY ’ S
N AT U R A L F I LT E R
The spleen is a small organ that lies behind the
stomach on the left side of the abdomen� This
organ filters blood and helps fight infections� One
of the spleen’s jobs is to remove red blood cells
when they come to the end of their lifespans� If
large numbers of red blood cells are destroyed
during a short period, they will become trapped in
the spleen� Over time, this can cause the spleen to
become larger than normal�
B LO O D T E S T S H OW H E M O LY T I C A N E M I A I S T R E AT E D
• Reticulocyte count. This test measures Treatment for hemolytic anemia depends on the
the number of young red blood cells in your type of hemolytic anemia you have and its severity�
blood� The results tell your doctor whether your Your doctor will consider your age, medical history,
bone marrow is making enough healthy red and overall health when planning your treatment�
blood cells� You may not need treatment if your anemia is mild
• Blood smear. This test shows the shape of and is not getting worse� Severe hemolytic anemia
your red blood cells� An abnormal shape is a generally needs ongoing treatment and can be fatal
sign of inherited hemolytic anemia; the exact if not treated properly�
shape indicates the type of inherited hemolytic Treatment depends on the type and cause of the
anemia� For example, sphere-shaped red blood hemolytic anemia�
cells indicate hereditary spherocytosis�
• During emergencies, a blood transfusion may
• Coombs’ test. This test determines whether be necessary�
your immune system is making antibodies to
• Medicines that suppress the immune system
destroy your red blood cells�
may be used when the anemia is caused by an
• Haptoglobin and bilirubin tests. When immune system response�
red blood cells break down, they release
• When blood cells are being destroyed at a fast
hemoglobin into your bloodstream� Hemoglobin
pace, the body may need extra folic acid and
combines with a chemical called haptoglobin�
iron supplements to replace what is being lost�
A low level of haptoglobin in the blood
indicates hemolytic anemia� Hemoglobin • In rare cases, surgery is needed to remove
also breaks down into a compound called the spleen� This is because the spleen
bilirubin� High levels of bilirubin may suggest acts as a filter that removes abnormal cells
hemolytic anemia� from the blood�
• Hemoglobin electrophoresis. This test If your hemolytic anemia is caused by medicines
shows the different types of hemoglobin in or another health condition, your doctor may
your blood; it also can help identify the type change your treatment to control or stop the
of anemia you may have� hemolytic anemia�
• Test for paroxysmal nocturnal
hemoglobinuria. This test indicates whether
red blood cells lack a particular protein� “I have an inherited genetic type of
• Osmotic fragility. This test shows whether hemolytic anemia—G6PD deficiency�
your red blood cells are more fragile than My Italian heritage was an important clue
normal� It also can point to the type of anemia
you may have� to figuring out my illness, because it is
• Test for G6PD deficiency. A lack of G6PD an inherited illness that is common
enzymes in your red blood cells indicates that in Sicily, where my family came
you have G6PD deficiency�
from� Since being diagnosed, my
OT H E R T E S T S whole life has changed� I follow a
If the results of the blood tests do not clearly show healthy diet, avoiding triggers
that you have hemolytic anemia, your doctor may
recommend bone marrow tests� These tests show
like fava beans and certain
whether your bone marrow is making enough medications� Staying healthy
healthy blood cells� and avoiding the foods and
other triggers can almost
totally prevent the symptoms�”
Linda
Treatments for Acquired Hemolytic Anemia
TYPE POSSIBLE TREATMENTS
Immune hemolytic anemia • Corticosteroids and other medicines to suppress the immune system
• Removal of the spleen
• Plasmapheresis (a procedure to remove antibodies from the blood)
• Avoidance of cold temperatures (for example, wear gloves, a hat, and a scarf; dress
warmly in air conditioning; keep your car warm when driving in cold weather)
• Intravenous gamma globulin, a medicine that may increase the lifespan of red blood
cells and possibly reduce the number of antibodies produced
Mechanical hemolytic • Folic acid supplements

anemia
• Blood transfusions
Paroxysmal nocturnal • Iron and folic acid supplements

hemoglobinuria
• Eculizumab, an antibody that blocks the destruction of red blood cells in this form
of anemia
Treatments for Inherited Hemolytic Anemia
TYPE POSSIBLE TREATMENTS
Hemoglobin disorders For sickle cell disease:

(sickle cell disease and Folic acid supplements (made from the synthetic form of folate), antibiotics to prevent
thalassemias) infection, medicine to reduce the number of faulty red blood cells in the blood,
and a medicine called hydroxyurea, which may help the body make more healthy
hemoglobin and reduce the amount of faulty hemoglobin that leads to sickle cells
For thalassemias:
Blood transfusions to replace destroyed red blood cells, and blood and marrow stem
cell transplants
• Folic acid supplements
Disorders of the red blood • Blood transfusions

cell outer membrane
(hereditary spherocytosis • Removal of the spleen (rarely)
and hereditary elliptocytosis)
For G6PD deficiency:
Avoidance of substances that trigger the condition, such as fava beans, naphthalene
(a substance in mothballs), and certain medicines
Enzyme deficiencies For pyruvate kinase deficiency:

Folic acid supplements and blood transfusions�
HOW TO PREVENT
ANEMIA OR KEEP YOUR
ANEMIA UNDER CONTROL
Many types of anemia can be mild, short term, or Help your family make healthy choices
even prevented� Other types may last a lifetime but together. Infants, young children, and teens
are easily treated� Still other anemias are severe, grow rapidly� A healthy diet supports growth and
life-threatening conditions that need prompt and development and can help prevent anemia� Keep
intense treatment� healthy foods at home, and help your children learn
You can take action to prevent, treat, and control how to make healthy choices when they are away
anemia� These actions can give you greater energy, from home� Also, help your older relatives enjoy a
improve your quality of life, and help you live healthy, nutrient-rich diet� Anemia is common in
a long time� older adults because of chronic (ongoing) diseases,
lack of iron, and poor diet�
L E A D A H E A LT H Y L I F E S T Y L E Making healthy lifestyle choices, such as adopting
a nutritious, iron-rich diet, can help prevent
Make healthy food choices. Eating healthy
common types of anemia� That way, you can have
means following a healthy eating pattern that
more energy and feel your best�
includes a variety of nutritious foods and drinks� It
also means getting the number of calories that’s Avoid substances that can cause or trigger
right for you (not eating too much or too little)� anemia. For example, exposure to chemicals or
toxins in the environment can cause some types
To eat healthy, try to follow these tips:
of anemia� Other types of anemia are triggered by
• Choose nutrient-dense foods and beverages� certain foods or cold temperatures� If you have one
Eat vegetables, fruits, whole grains, fat-free or of these types of anemia, avoid these triggers if
low-fat dairy products, and a variety of foods you can� If you have hemolytic anemia, reduce your
with protein, such as seafood, lean meats and chances of getting an infection by washing your
poultry, eggs, beans, peas, nuts, seeds, and hands often, avoiding people who have colds, and
soy products� staying away from crowds�
• Limit certain nutrients and ingredients, such
as salt, added sugars, saturated fats, and
refined grains�
• Stay at a healthy weight by balancing
the calories you eat and drink with the
calories you burn�
• Clean, handle, cook, and chill food properly to
prevent foodborne illnesses�
WO R K W I T H YO U R D O C TO R O R “My main lifestyle change has
A N E M I A H E A LT H CA R E T E A M
been to commit to regular
Visit your doctor if you develop signs or symptoms
of anemia� If you are diagnosed with anemia, follow
physical activity� My physical
your doctor’s advice about diet, supplements, therapist gave me an exercise
medicines, and other treatment methods� plan that I try to stick to every day�
Visit your doctor regularly for checkups and
The key to living with a chronic
ongoing care, and tell him or her about any new or
changing symptoms� illness is to not let it limit you� I
Older children and teens who have severe anemia can’t always do something I used
may have an increased risk of injury or infection� to do, but I still look for new ways
Talk with your doctor about ways to keep them
as healthy as possible and discuss whether they to enjoy life� I’m grateful for the
need to avoid certain activities� emotional support I get from my
Girls and women who have heavy menstrual husband and family in helping
periods may need regular screenings and
follow-up care with their doctors to prevent me manage my
or control iron-deficiency anemia� condition�”
TA L K I N G TO YO U R FA M I LY Shirah
AND FRIENDS
Some types of anemia—such as pernicious anemia,
Fanconi anemia, or thalassemia—can be inherited�
If you have been diagnosed with one of these types
of anemia, talk to your family members� Suggest
they visit their doctors for a checkup to see whether
they might have anemia�
If you have children or teens who have anemia, talk
to them about how they can take an active role in
their own care by learning about their condition and
making decisions with their doctor� This can help
young people feel more in control and have a more
positive outlook regarding their health�
A FINAL THOUGHT
You can do a lot to keep yourself and your family
healthy� The tips above can help you prevent or
cope with anemia and improve your overall health
and well-being� Make healthy choices today for
a brighter tomorrow�
MAKING PROGRESS
AGAINST ANEMIA
THE LATEST RESEARCH that receives the new treatment being tested�
Other groups may receive a different treatment
For many years, the National Heart, Lung, and
or a placebo (an inactive substance resembling a
Blood Institute (NHLBI) has supported research
drug being tested)� Comparing the results from the
aimed at finding the causes of blood disorders
groups gives researchers confidence that changes
and ways to prevent and treat them� Researchers
in the test group are due to the new treatment and
have learned a lot about anemia and other blood
not to other factors�
disorders through these studies� That knowledge
has led to improvements in prevention and care� Other types of clinical trials are done to discover
the factors, including environmental, behavioral,
Common types of anemias are generally
or genetic factors, that cause or worsen various
straightforward and easily treated� As a result, the
disorders� Researchers may follow a group of
NHLBI’s clinical research on anemias is focused
people over time to learn which factors contribute to
on specific types, including sickle cell disease and
becoming sick� For example, these types of studies
thalassemia� Research on these and other blood
gave us the important information that smoking is a
disorders continues to be an important priority
risk factor for both heart disease and lung cancer�
for the NHLBI�
Clinical trials may be relatively brief, or they may
The success of these efforts depends on the
last for years and require many visits to the study
willingness of volunteers to participate in clinical
sites� These sites usually are university hospitals or
research� If you would like to help researchers
research centers; however, they can include private
gather information about your disorder and possible
doctors’ offices and community hospitals�
treatments, talk to your doctor�
If you participate in a clinical trial, the process will
CLINICAL TRIALS be explained to you in detail� You will be given a
chance to ask questions, and you will be asked to
To fully understand a disorder and how best to
provide written permission� You may not directly
diagnose and treat it, researchers need to do
benefit from the results of the clinical trial in which
clinical research with people who have the disorder�
you participate; however, the information gathered
Clinical research is often conducted in clinical
will help others and will add to scientific knowledge�
settings, such as hospitals or doctors’ offices�
Taking part in clinical trials has other benefits,
Clinical trials test new ways to prevent, detect, or
as well� You will learn more about your disorder,
treat various disorders� For example, treatments—
you will have the support of a team of healthcare
such as medicines, medical devices, surgery, or
providers, and your health will likely be monitored
other procedures—need to be tested in people who
closely� However, participation also can have risks,
have the disorder� A trial helps determine whether
which you should discuss with your doctor� No
a treatment is safe and effective in humans before
matter what you decide, your regular medical care
it is made available for public use� In a clinical trial,
will not be affected�
participants are randomly assigned to a group
If you are thinking about participating in a clinical FO R CA R E G I V E R S
trial, you may have questions about the purpose of It would be short-sighted to look at this condition
the study, the types of tests and treatment involved, from the viewpoint of just the patient� Caregivers
how participation will affect your daily life, and are affected by anemia as well� Very often they take
whether any costs are involved� Your doctor may on the physical, emotional, and logistical needs of
be able to answer some of your questions and help a loved one�
you find clinical trials in which you can participate�
You also can visit the following websites to find If you are a caregiver, here are two valuable tips:
clinical trials related to your disorder and to learn • Make sure you have support so you can better
about being in a study: support your loved one�
• ClinicalTrials�gov • Ask for help� Waiting until you’re overwhelmed
• NHLBI clinical trials page will only result in added stress� Look to others
in your circle to pitch in so you can have time
C O PI N G A N D S U PP O R T for self-care�
Support in managing your anemia is vital� Here’s IN TIMES OF CRISIS

why� Going at anything alone can sometimes cause
more harm than good� In short, you are more Due to your blood condition, your needs have
able and better enabled when you have a stable changed� That means you should be prepared
support system� for an emergency that might affect your health�
Here are a few simple but valuable things to
This support does not have to be limited to have on hand in case traditional support may
family or friends� Support groups and community not be available:
organizations are available and will make
dealing with your condition easier� Within these • Prescriptions: Two weeks of
organizations you will find empathy, acceptance, prescription medicine
and wisdom so you don’t go at it alone� • Medical supplies: Two weeks of food,
water, and general medications
• Documents: Your electronic medical
records, along with your insurance card
and emergency contact card
DEFINITIONS
Arrhythmia (a-rhyth-mi-a): A problem with Gastrointestinal tract (GAS-troh-in-TES-tih-

the rate or rhythm of the heartbeat� During an nul trakt): The stomach and intestines� The
arrhythmia, the heart can beat too fast, too slowly, gastrointestinal tract is part of the digestive system,
or with an irregular rhythm� which also includes the salivary glands, mouth,
esophagus, liver, pancreas, gallbladder, and rectum�
Blood donation (bluhd do-na-shen): A safe and
simple procedure that involves a donor giving one Genetic (jeh-NEH-tik): Having to do with genes�
of the following blood products: whole blood, red Most genes are sequences of DNA that contain
blood cells, plasma, or platelets� information for making specific proteins or
molecules of RNA that perform important functions
in a cell� The information in genes is passed from
Blood transfusion (bluhd trans-fyoo-zhuhn): A
parents to children�
common, safe medical procedure in which healthy
blood is given to you through an intravenous (IV) line
that has been inserted in one of your blood vessels� Heart failure (hAHRt fAY-lyuhr): A condition that
develops when your heart doesn’t pump enough
blood for your body’s needs� This can happen
Blood type (bluhd tipe): The classification of
if your heart can’t fill up with enough blood� It
human blood based on certain markers found on
can also happen when your heart is too weak to
red blood cells� The four main blood types are
pump properly�
A, B, O, and AB�
Heart murmur (mUHR-muhr): An unusual sound

Bone marrow tests (bohn mar-oh tests): Tests
heard between heartbeats�
that check whether your bone marrow is healthy
and making normal amounts of blood cells�
Hemoglobin (HEE-moh-GLOH-bin): A
protein in red blood cells that carries oxygen
Chronic (KRAH-nik): Describes a condition,
throughout the body�
disease, sign, or symptom that lasts persistently,
recurs frequently, or worsens progressively over
a long time� Hemolysis (hee-MAH-lih-sis): The breakdown
of red blood cells� Red blood cells normally live
for up to 120 days� After that, they naturally break
Erythropoiesis stimulating agent (ESA)
down and are most often removed from the blood
(eh-RITH-roh-poy-EE-sis-STIM-yoo-LAY-ting
by the spleen�
AY-jent): A substance that stimulates the bone
marrow to make more red blood cells� ESAs are
used to treat anemia caused by chronic kidney Hormone (HOR-moan): A substance made
failure, some anticancer drugs, and certain in glands throughout the body� Hormones are
treatments for HIV� They may also be used to lower released into the blood to travel throughout the
the number of blood transfusions needed during body to control other body functions�
and after certain major surgeries�
Inflammation (IN-fluh-MAY-shun): The body’s Obesity (oh-bee-si-tee): A serious medical
response to infection or injury� It can affect many condition that can cause complications such
areas of the body and is a cause of many major as metabolic syndrome, high blood pressure,
diseases, including cancer, ischemic heart disease, atherosclerosis, heart disease, diabetes,
and autoimmune diseases� high cholesterol, cancers and sleep disorders�
Inherited (in-HAYR-ih-ted): The passing of Pica (PI-ka): A pattern of unusual cravings for
genetic information from a parent to a child nonfood items or food with no nutritional value,
through genes� such as ice, dirt, paint, or starch�
Mutation (myoo-TAY-shun): Any change in Red blood cell (red bluhd sel): A type of blood
a nucleic acid sequence, such as DNA or RNA� cell that carries oxygen to all parts of the body;
also known as an erythrocyte�
FOR MORE INFORMATION
For more information on anemia, visit the
NHLBI website at www�nhlbi�nih�gov/health-topics/anemia
or contact the NHLBI Center for Health Information:
P�O� Box 30105
Bethesda, MD 20824–0105
1-877-NHLBI4U (1-877-645-2448)
TRS: 7–1–1
Email: nhlbiinfo@nhlbi�nih�gov
NIH Publication No. 21-HL-7629
September 2021

NHLBI OSPEEC YourGuidetoAnemia Booklet RELEASE 508

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Signs and Symptoms of Anemia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 3

The Leading Causes of Anemia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5

How Anemia Is Diagnosed � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 7

How Anemia Is Treated � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 11

Different Types of Anemia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 13

How To Prevent Anemia or Keep Your Anemia Under Control � � � � � � � � � � � � 31

Making Progress Against Anemia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 33

Red blood cells

These are some reasons your

M E D I CA L A N D FA M I LY H I S TO R I E S • Listen to your heart for a rapid or irregular

TEST WHAT IT DOES WHAT IT REVEALS

Bone Marrow Test

TEST WHAT IT DOES WHAT IT REVEALS

TEST WHAT IT DOES WHAT IT REVEALS

T H E G OA L S O F T R E AT M E N T generally treated through dietary changes and

AGE MALE FEMALES PREGNANCY BREASTFEEDING

Birth to 6 months 0�27 mg 0�27 mg

PE O PL E W H O A R E M O R E L I K E LY TO People who are higher risk due to their family

• Thalassemias often affect people of Southeast Asian, Indian, Chinese, Filipino,

• The ball-shaped red blood cells have a shorter-than-normal lifespan�

• Hereditary spherocytosis is the most common cause of hemolytic anemia among

• Pyruvate kinase deficiency is more common among the Amish�

TYPE POSSIBLE TREATMENTS

• Removal of the spleen

• Plasmapheresis (a procedure to remove antibodies from the blood)

Mechanical hemolytic • Folic acid supplements

Paroxysmal nocturnal • Iron and folic acid supplements

Treatments for Inherited Hemolytic Anemia

TYPE POSSIBLE TREATMENTS

Hemoglobin disorders For sickle cell disease:

• Folic acid supplements

Disorders of the red blood • Blood transfusions

Enzyme deficiencies For pyruvate kinase deficiency:

Support in managing your anemia is vital� Here’s IN TIMES OF CRISIS

Arrhythmia (a-rhyth-mi-a): A problem with Gastrointestinal tract (GAS-troh-in-TES-tih-

Heart murmur (mUHR-muhr): An unusual sound

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