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Anaemia - an overview
Published by Bupa's health information team, February 2010.
This factsheet is for people who have anaemia, or who would like information about it.
Anaemia is when there are too few red blood cells or not enough haemoglobin in the blood.
About anaemia
Your blood is made up of a watery fluid called plasma and cells and cell fragments, which are produced in your bone marrow.
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Red blood cells carry oxygen around your body in a substance called haemoglobin. Haemoglobin gives your blood its red colour. Iron is an important part of haemoglobin.
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White blood cells are larger than red blood cells. There are several different types of white blood cell and they are important in protecting your body against infection.
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Platelets are tiny fragments of cells that are involved in blood clotting.
If you don't have enough red blood cells, or enough of the oxygen-carrying substance haemoglobin, you have anaemia.
Types of anaemia
There are many types of anaemia, which are categorised according to their cause, including iron deficiency, vitamin B12-deficiency, folate-deficiency and sickle cell disease. For more information on specific types of anaemia please see Related topics.
Symptoms of anaemia
Symptoms depend on which type of anaemia you have, but those common to most types of anaemia include:
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feeling tired
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looking pale
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feeling breathless after little exercise
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a rapid pulse or palpitations (the sensation of feeling your heartbeat thumping in your chest)
These symptoms aren't always caused by anaemia but if you have them, visit your GP.
Other symptoms may depend on the underlying cause of anaemia.
Complications of anaemia
If anaemia isn't treated, there are a range of possible complications. For example, it can increase your risk of heart problems. There are different complications related to different types of anaemia.
Causes of anaemia
There are many possible causes of anaemia but they fall into the following three groups.
Loss of blood
You may develop anaemia if you lose a lot of blood, for example as a result of an injury or operation. Women who have heavy bleeding during their period can develop anaemia.
Not making enough red blood cells and/or haemoglobin
You may get anaemia if your bone marrow can't make enough good-quality red blood cells. This can happen if:
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there aren't enough essential vitamins such as vitamin B12 or folate in your body (these are needed to make red blood cells)
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you have a serious bone marrow disorder such as leukaemia or aplastic anaemia (a rare condition where your bone marrow fails to produce blood cells correctly)
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you have a chronic disease such as rheumatoid arthritis
Your kidneys produce a hormone called erythropoeitin, which tells your bone marrow to make red blood cells. If you have long-term kidney problems, you may have anaemia due to a lack of erythropoietin.
Red blood cells broken down too quickly
Red blood cells normally live for about 120 days before they are broken down and replaced.
Red blood cells can be broken down too soon if you have an inherited condition that affects your red blood cells or haemoglobin. These conditions are called haemolytic anaemias. Some medicines may be involved in causing haemolytic anaemia.
People with a condition called sickle cell anaemia have red blood cells that are broken down too soon. Sickle cell anaemia is an inherited condition where your red blood cells become crescent-shaped, rather than round, due to the presence of an abnormal type of haemoglobin called 'haemoglobin S'. These cells don't survive as well as normal red blood cells.
Diagnosis of anaemia
Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.
Your GP may ask you to have a blood test. A sample of your blood will be sent to a laboratory for testing, including a full blood count (FBC), which will give information about your haemoglobin levels and how many of each of the different types of blood cell you have. A FBC will also give information about the size of your red blood cells and the amount of haemoglobin each one contains.
The normal amount - or concentration - of haemoglobin is:
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at least 13g/dl (13 grams of haemoglobin per decilitre (100ml) of blood) for men
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at least 11.5g/dl for women
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at least 11g/dl for pregnant women
If your haemoglobin level is lower than the levels above, you may have anaemia.
The values for children vary by age - ask your GP for more advice.
You may need to have further tests, to help identify what has caused your anaemia. Further tests may include the following.
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Examination of your blood under a microscope (a blood film).
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Measurement of vitamin B12, iron and folate levels in your blood.
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A gastroscopy - a procedure used to look inside your oesophagus, stomach and the first part of your small bowel for evidence of bleeding.
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A colonoscopy - a test that allows a doctor to look inside your large bowel, again to check for any bleeding.
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A faecal occult blood (FOB) test, which will help to identify if you have any blood loss from your stomach or bowel. You will be asked to give a sample of faeces (stool sample), which will be sent to a laboratory for testing.
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A bone marrow biopsy - a sample of your bone marrow will be taken for testing.
Your GP may refer you to a haematologist - a doctor who specialises in treating blood disorders - for some of these tests.
Treatment of anaemia
Treatment of anaemia depends on its underlying cause. You may need to improve your diet or your doctor may recommend that you take supplements of iron, folic acid or vitamin B12.
If you're severely anaemic because of a serious underlying health condition, you may need a blood transfusion.
If you have a condition such as chronic kidney disease, you may need to have injections of the hormone erythropoietin.
Prevention of anaemia
You can lower your chance of developing anaemia by eating a healthy, balanced diet. For most people, this will provide enough essential nutrients without the need to take supplements.
The main nutrients you need to make healthy red blood cells are listed below.
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Iron. Good sources of iron include meat (liver is a particularly good source), green vegetables, dried fruit, pulses (e.g. chick peas and lentils) and foods fortified with iron, such as some breakfast cereals and bread (fortified means that iron has been added during manufacturing).
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Vitamin B12. Good sources of vitamin B12 include meat, milk, cheese, eggs and fortified foods (it's not found in vegetables).
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Folate, which is found in liver, yeast extract, green leafy vegetables (such as peas and spinach), oranges, milk and fortified foods.
If you follow a vegan diet and don't eat animal products, or have a condition that affects how well you can absorb nutrients (e.g. coeliac disease), you may need to take nutrient supplements. Ask your GP or a dietitian for advice.
If you're pregnant, you're more likely to develop iron-deficiency anaemia. You will have regular blood tests at your antenatal appointments to check your haemoglobin levels. Your doctor or midwife will prescribe iron supplements if you need them.
Anaemia - an overview Q&As
See our answers to common questions about anaemia, including:
Related topics
Further information
Sources
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Parker S. The human body. London: Dorling Kindersley Limited, 2007
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Anaemia - Clinical features. GP Notebook. www.gpnotebook.co.uk, accessed 22 September 2009
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Anaemia - vitamin B12 and folate deficiency. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 23 September 2009
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Anaemia - iron deficiency. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 22 September 2009
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Etiology of anemia. Merck Manuals Online Medical Library. www.merck.com, accessed 22 September 2009
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Anaemia management in chronic kidney disease: full guideline. National Institute for Health and Clinical Excellence (NICE), 2006. Clinical guidelines CG39. www.nice.org.uk
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Evaluation of anemia. Merck Manuals Online Medical Library. www.merck.com, accessed 22 September 2009
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Ferritin test. Lab Tests Online UK. www.labtestsonline.org.uk, accessed 22 September 2009
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Guidelines for the management of iron deficiency anaemia. British Society of Gastroenterology, 2005. www.bsg.org.uk
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Treatment of anemia. Merck Manuals Online Medical Library. www.merck.com, accessed 22 September 2009
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Iron deficiency. Food Standards Agency. www.eatwell.gov.uk, accessed 22 September 2009
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Vitamin B12. Food Standards Agency. www.eatwell.gov.uk, accessed 22 September 2009
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Folic acid. Food Standards Agency. www.eatwell.gov.uk, accessed 22 September 2009
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Iron deficiency anaemia - assessment, prevention and control: a guide for programme managers. World Health Organization, 2001, www.who.int
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The pregnancy book. Department of Health, 2007. www.dh.gov.uk
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Blood transfusion. The National Blood Service. www.blood.co.uk, accessed 22 September 2009
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Vegetarian and vegan diets. British Nutrition Foundation. www.nutrition.org.uk, accessed 22 September 2009
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Bone marrow test. Cancer Research UK. www.cancerhelp.org.uk, accessed 26 September 2009
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: February 2010.