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photo of an anemia blood test and paperwork

The most common causes of anemia

By Jayne Morgan, M.D.
Executive director of Health and Community Education

I remember a family member of mine who used to chew crushed ice constantly when I was growing up. As soon as she arrived at my house, she would irritate me by switching the setting on the refrigerator door from “cubes” to “crushed,” filling up a glass with ice and munching on it for most of her visit. When she left, she would do so without returning the refrigerator settings back to cubes—my preference.

As a doctor, I later learned that what I witnessed growing up has a medical name. It is called pica and can be a sign of iron-deficiency anemia. You are probably asking yourself, “What is pica?”

Pica is the craving and chewing of substances with no nutritional value.  These commonly include ice, clay, dirt/soil, paper and erasers. 

The specific type of pica that involves chewing ice is actually called pagophagal pica and is often associated with iron-deficiency anemia. That’s right: My relative was likely not only anemic, but iron-deficient.

Symptoms of anemia

In medical school, as I studied various types of anemia, the memories of her visits came wafting back and I began to recall other seemingly innocuous details. She chewed her nails, complaining that they were always splitting, assuring me that she prayed I would not have nails like hers later in life. She also was prone to swooning at times, which we all chalked up to being a part of the overall drama that inevitably accompanied one of her visits.

However, what she was likely demonstrating were classic signs of iron-deficiency anemia. (Speaking of pica, in addition to iron-deficiency anemia, it can also be a sign of emotional problems, so antennas up).

Other common symptoms of iron-deficiency anemia include:

  • Fatigue

  • Rapid heart rate or palpitations

  • Weakness

  • Headache

  • Pallor

  • Shortness of breath

What causes anemia?

Anemia, in general, is caused by a decrease in red blood cells (or dysfunctional red blood cells) that then cause a reduction of oxygen in your body. Iron-deficiency anemia (just as the name states) is caused specifically by a lack of iron. Without enough iron, your body produces less hemoglobin (the substance that carries oxygen in your blood). So, you can end up tired and short of breath.

How is anemia treated?

Anemia is quite common and treatable by a physician or other medical professional. However, it requires a medical diagnosis and workup. The deficiency can usually be corrected with simple iron supplements, but additional testing may be necessary, especially if your doctor thinks you may be experiencing internal bleeding.

Something to remember about iron deficiency anemia is that it can be so mild that it often goes unnoticed. Over time, however, as the body becomes increasingly deficient, symptoms arise and continue to progress.

Something else to keep in mind is that although iron supplementation is often the treatment of choice, you should only do so under the supervision and direction of a physician. Overloading the body with iron supplements can be very dangerous, causing damage to your liver.

What are some other types of anemia?

One of the more common ones is vitamin-deficiency anemia, which is usually caused by low levels of vitamin B12 and folate. This can happen if you don’t eat enough foods containing these vitamins and, like iron-deficiency anemia, can take years to manifest with symptoms.

Many of the same symptoms of iron-deficiency anemia are also present in vitamin-deficiency anemia, with the addition of numbness or tingling in the hands and feet, muscle weakness and, less commonly, personality changes.

Who is at risk of anemia?

Vegans are greatly at risk of vitamin B12-deficiency because vitamin B12 is mainly found in meats (beef, liver, chicken and fish), eggs, cheese, yogurt and milk. So, people who don’t eat these types of food may need to discuss with their doctor or nutritionist whether they should take B12 supplements.

Also, those who are on kidney dialysis, have had gastric bypass surgery or have intestinal problems such as Crohn’s disease or celiac disease may also be at risk. Moreover, pregnancy creates an increased demand for folate in particular, and a lack of folate can cause birth defects. So, if you are pregnant or planning to become pregnant, discuss this with your OB/GYN.

Folate-containing foods include:

  • Dark green, leafy vegetables, including broccoli, spinach, asparagus and lima beans

  • Oranges

  • Lemons

  • Bananas

  • Strawberries

  • Melons

  • Peanuts

  • Liver

What is sickle cell anemia?

Is sickle cell anemia a true anemia? Yes, it is, and it is the only one that is an inherited or genetic anemia. It affects the shape of the red blood cells, changing the normal round shape of the cells to a sickle shape. This makes them less flexible, more rigid, and stickier as they move through the bloodstream. These stickier, sickled cells have shorter lifespans than normal cells and so the person is left with a shortage of red blood cells and, therefore, a shortage of oxygen.

Sickle cell anemia is characterized by:

  • Episodes of pain crises

  • Swelling of the hands and feet

  • Vision problems

  • Headaches

  • Delayed growth and puberty

  • Pulmonary hypertension

  • Stroke

In the United States, sickle cell anemia primarily affects people of African, Mediterranean, Caribbean and Middle Eastern descent. For a person to be affected, both the mother and the father must carry at least one copy of the gene that is then passed on to the offspring. Genetic counseling is important for anyone carrying the gene.

There are several other types of anemia, such as alpha and beta thalassemias, aplastic anemia, etc.  If you are curious or suspect that you may have symptoms of anemia, discuss directly with your doctor or other medical professional.

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