What Should You Do if You Suspect You Have Anemia?
Schedule an appointment with your healthcare provider for a complete blood count test. In the meantime, ensure your diet includes iron-rich foods like lean red meat, leafy greens, and fortified cereals. Do not start iron supplements without medical guidance, as too much iron can be harmful.
If you are experiencing persistent fatigue, weakness, or other symptoms suggestive of anemia, the most important first step is getting a blood test. A complete blood count measures your hemoglobin level, hematocrit, and red blood cell characteristics. The World Health Organization defines anemia as a hemoglobin level below 13 grams per deciliter in men and below 12 grams per deciliter in non-pregnant women. Your doctor will likely order additional tests to determine the underlying cause, including iron studies, vitamin B12 and folate levels, and a reticulocyte count.
While awaiting your appointment, focus on eating a nutrient-rich diet. Include both heme iron sources like beef, chicken, and fish, and non-heme sources like spinach, lentils, and fortified cereals. Pair iron-rich foods with vitamin C from citrus fruits, bell peppers, or tomatoes to enhance absorption. Avoid drinking tea or coffee with meals, as tannins can inhibit iron absorption by up to 60 percent. The National Heart, Lung, and Blood Institute recommends against self-treating with iron supplements without a confirmed diagnosis, as iron overload can damage organs.
The WHO defines anemia as hemoglobin below 13 g/dL in men and below 12 g/dL in non-pregnant women
What Is Anemia and What Are the Different Types?
Anemia is a condition in which your blood lacks enough healthy red blood cells or hemoglobin to carry adequate oxygen to your body's tissues. There are more than 400 types of anemia, but iron deficiency anemia, vitamin deficiency anemia, anemia of chronic disease, and hemolytic anemia are the most common forms.
Iron deficiency anemia is the most prevalent form worldwide, affecting an estimated 1.2 billion people according to the Global Burden of Disease Study. It occurs when your body lacks sufficient iron to produce hemoglobin, the protein in red blood cells that carries oxygen. Common causes include inadequate dietary iron intake, blood loss from menstruation or gastrointestinal bleeding, pregnancy, and conditions that impair iron absorption such as celiac disease or inflammatory bowel disease.
Vitamin deficiency anemias result from low levels of vitamin B12 or folate, both essential for red blood cell production. Pernicious anemia, an autoimmune condition that prevents vitamin B12 absorption, is a classic example. Anemia of chronic disease develops in people with ongoing inflammatory conditions like rheumatoid arthritis, cancer, kidney disease, or chronic infections. These conditions interfere with red blood cell production and iron utilization. Hemolytic anemias involve premature destruction of red blood cells and include inherited conditions like sickle cell disease and thalassemia.
What Are the Symptoms of Anemia?
The most common anemia symptoms are fatigue, weakness, pale or yellowish skin, irregular heartbeat, shortness of breath, dizziness, chest pain, cold hands and feet, and headaches. Symptoms develop gradually in chronic anemia and may go unnoticed until hemoglobin drops significantly.
Anemia symptoms result from reduced oxygen delivery to your tissues. Fatigue is the hallmark symptom, often described as an overwhelming tiredness that does not improve with rest. As anemia worsens, your heart compensates by pumping harder and faster, which can cause palpitations, a rapid heartbeat, and shortness of breath during activities that previously caused no difficulty. Pale skin and nail beds reflect decreased hemoglobin in the blood, while cold extremities result from the body directing blood flow to vital organs.
Some anemia types produce distinctive symptoms. Iron deficiency anemia may cause unusual cravings for non-food items like ice, dirt, or starch, a condition called pica. It can also cause restless legs syndrome, brittle nails, and a sore or swollen tongue. Vitamin B12 deficiency anemia may cause neurological symptoms including numbness and tingling in the hands and feet, difficulty walking, memory problems, and mood changes. The CDC notes that mild anemia often produces no symptoms and is discovered incidentally during routine blood work.
- Fatigue and weakness that persists despite adequate rest
- Pale or yellowish skin, especially noticeable in nail beds and inner eyelids
- Shortness of breath during normal activities like climbing stairs
- Dizziness or lightheadedness, especially when standing up quickly
- Rapid or irregular heartbeat (palpitations)
- Cold hands and feet
- Headaches, particularly with exertion
- Chest pain (in severe cases — seek immediate medical attention)
How Is Anemia Diagnosed?
Anemia is diagnosed primarily through a complete blood count that measures hemoglobin, hematocrit, and red blood cell indices. Additional tests including iron studies, vitamin B12 and folate levels, reticulocyte count, and peripheral blood smear help identify the specific type and underlying cause.
The complete blood count is the cornerstone of anemia diagnosis. Key values include hemoglobin concentration, hematocrit (percentage of blood volume occupied by red blood cells), mean corpuscular volume (MCV, the average size of red blood cells), and red blood cell distribution width (RDW). The MCV is particularly useful for classification: microcytic anemia with small red blood cells suggests iron deficiency or thalassemia, normocytic anemia with normal-sized cells suggests chronic disease or acute blood loss, and macrocytic anemia with large cells suggests vitamin B12 or folate deficiency.
Iron studies measure serum iron, ferritin (the storage form of iron), total iron-binding capacity (TIBC), and transferrin saturation. A ferritin level below 30 nanograms per milliliter strongly suggests iron deficiency, according to guidelines from the American Society of Hematology. If iron deficiency is confirmed, further evaluation may be needed to identify the source of iron loss, including testing for occult gastrointestinal bleeding through a fecal occult blood test or endoscopy in older adults.
The American Society of Hematology guidelines identify ferritin below 30 ng/mL as a strong indicator of iron deficiency
What Are the Treatment Options for Anemia?
Treatment depends on the anemia type and severity. Iron deficiency anemia is treated with oral or intravenous iron supplements. Vitamin B12 deficiency requires B12 injections or high-dose oral supplements. Anemia of chronic disease improves when the underlying condition is managed. Severe anemia may require blood transfusions.
For iron deficiency anemia, oral iron supplements are the standard first-line treatment. Ferrous sulfate 325 mg taken one to three times daily on an empty stomach provides the most efficient absorption. Taking iron with vitamin C and avoiding calcium supplements, antacids, and tea or coffee within two hours of the dose improves absorption. Common side effects include nausea, constipation, and dark stools. If oral iron is poorly tolerated or ineffective, intravenous iron formulations like ferric carboxymaltose (Injectafer) can replenish iron stores more rapidly.
Vitamin B12 deficiency anemia caused by pernicious anemia or malabsorption requires intramuscular B12 injections, typically starting with daily doses for one week, then weekly for a month, then monthly for life. High-dose oral B12 supplements (1,000 to 2,000 micrograms daily) can be effective for dietary deficiency. Folate deficiency is treated with oral folic acid supplements. For anemia of chronic disease, treating the underlying condition is the primary approach, with erythropoiesis-stimulating agents reserved for specific situations like chronic kidney disease-related anemia.
When Should You See a Doctor for Anemia Symptoms?
See a doctor promptly if you experience persistent fatigue, shortness of breath with normal activities, rapid heartbeat, dizziness, or pale skin. Seek emergency care for chest pain, severe shortness of breath at rest, fainting, or signs of active bleeding such as blood in stools or heavy menstrual bleeding.
Many people dismiss anemia symptoms as normal tiredness or stress. However, untreated anemia can worsen progressively and lead to serious complications. The American Society of Hematology recommends evaluation if fatigue persists for more than two weeks despite adequate sleep and nutrition, if you notice your skin becoming noticeably pale, or if previously easy physical activities now leave you breathless. Pregnant women should be especially vigilant, as untreated anemia increases risks of preterm delivery and low birth weight.
Certain situations require urgent medical attention. Chest pain or shortness of breath at rest may indicate that anemia is straining your heart. Rapid or irregular heartbeat could signal that your heart is compensating for severely reduced oxygen-carrying capacity. Visible blood in your stool, very dark or tarry stools, or unusually heavy menstrual periods suggest active blood loss that needs immediate evaluation. If you have a known chronic condition and develop new or worsening fatigue, inform your healthcare team promptly.
