Brief overview
- Symptoms: dizziness, headaches, reduced performance, shortness of breath, ringing in the ears, pale skin and mucous membranes, smooth red tongue, sometimes brittle nails, inflamed corners of the mouth
- Causes: Impaired blood formation, e.g. due to a lack of iron, folic acid, vitamin B12, kidney weakness, inflammation, blood loss, increased breakdown of red blood cells, blood distribution disorder
- Treatment: Depending on the cause, e.g. supply of deficient trace elements, nutritional adjustment, hormone administration, blood transfusion if necessary, treatment of underlying diseases (e.g. inflammation or infection)
- Diagnosis: blood test, determination of the number of red blood cells, haemoglobin content, assessment of the appearance of the red blood cells, examination of bone marrow if necessary
- When to see a doctor? Always if anemia is suspected
- Prevention: Balanced diet, check-ups for chronic illnesses
What is anemia?
Haemoglobin is an iron-containing protein that transports oxygen from the lungs to the body’s cells. On the way back, it takes carbon dioxide (CO2), which is a waste product of cell metabolism, into the lungs. There, CO2 is released with the breath.
In the case of anemia, there is too little haemoglobin so that the body cells are no longer supplied with sufficient oxygen.
Forms of anemia
Doctors differentiate between different types of anemia depending on the shape and appearance of the red blood cells under the microscope and how much haemoglobin they contain:
- Microcytic, hypochromic anemia: The red blood cells are too small and contain too little hemoglobin. A typical example of this form of anemia is iron deficiency anemia.
- Normocytic, normochromic anemia: This form of anemia is caused by severe blood loss. The red blood cells are normal in size and contain normal amounts of hemoglobin.
Anemia can also be classified according to its causes. Doctors distinguish between the following forms:
- Anemia due to impaired hematopoiesis
- Anemia due to increased breakdown of red blood cells in the body
- Anemia due to loss of erythrocytes (bleeding)
- Anemia due to a distribution disorder of red blood cells in the body
Symptoms of anemia
Anemia not only has many causes, but is also associated with numerous symptoms that are not always clear. Typical for all anemias, however, are symptoms that result from an undersupply of oxygen to the body:
- dizziness
- headaches
- Reduced mental and physical performance
- Shortness of breath (dyspnea) on exertion, in advanced anemia also at rest
- Palpitations and ringing in the ears
- Pale skin, conjunctiva and mucous membranes
Depending on the type of anemia, other symptoms may also occur. Some examples:
- Iron deficiency anemia: Brittle hair and nails, pale face, inflamed corners of the mouth and mucous membranes
- Pernicious anemia/vitamin B12 deficiency anemia: memory problems, loss of appetite, burning tongue, digestive problems such as constipation or diarrhea, weight loss
- Haemolytic anemia: icterus (jaundice) with yellow discoloration of the skin and yellowish coloration of the originally white area in the eye
- Anemia due to internal bleeding: Black stool (tarry stool or melena) or red blood in the stool or urine, circulatory collapse, low blood pressure, high heart rate
Causes of anemia
It is often a secondary finding of chronic diseases. In addition, anemia occurs more frequently in old age as a result of slower regeneration processes.
Overall, anemia can be divided into the following groups according to the mechanism of origin:
Anemia due to disorders of hematopoiesis
Blood formation is a sensitive process, and certain factors disrupt it at various stages. Blood cells are formed in the bone marrow: different types of blood cells, including precursors of red blood cells, develop from so-called stem cells with the help of various messenger substances (hormones).
A lack of building blocks, hormones or vitamins as well as diseases of the bone marrow such as inflammation or leukemia (blood cancer) impair blood formation. This results in the formation of red blood cells that are not fully functional and do not ensure sufficient oxygen transport.
The most common forms of anemia are caused by this type of blood formation disorder:
Folic acid deficiency anemia: Folic acid is essential for cell division and blood formation. The vitamin is found in particular in various types of cabbage (such as broccoli), spinach, asparagus and leaf lettuce. Malnutrition therefore sometimes causes folic acid deficiency anemia. This form of anaemia also sometimes develops with severe alcohol abuse. This is a macrocytic, hyperchromic anemia.
Vitamin B12 deficiency anemia: Vitamin B12 (cobalamin) is important for the formation of new cells and the metabolism of various protein building blocks (amino acids), among other things. A deficiency is usually caused by impaired absorption of the vitamin in the body, for example in chronic gastritis or coeliac disease. As with folic acid deficiency, this results in macrocytic, hyperchromic anemia.
Renal anemia: This form of anemia is caused by the kidneys producing too little erythropoietin due to a functional deficiency. This hormone stimulates the formation of red blood cells in the bone marrow, which is why a deficiency leads to anaemia. Renal insufficiency is the result of chronic kidney disease or kidney damage, for example. The resulting renal anemia is usually exacerbated by a shortened lifespan of the red blood cells and the blood washes (dialysis) often required by chronic kidney patients.
Aplastic anemia: In this case, the formation of all blood cells (red and white blood cells, platelets) is reduced. The reason is a functional disorder of the bone marrow, which is congenital (e.g. Fanconi anaemia) or acquired (e.g. through medication, toxins, ionizing radiation or certain infectious diseases).
Anemia due to other diseases: Anemia caused by inflammation, viral infections, cancer (such as leukemia), chemotherapy or autoimmune diseases is often underestimated. Chronic diseases in particular are among the most common causes of anaemia. Depending on their severity, they affect blood formation to varying degrees and lead to small cell anemia.
Anemia due to bleeding
Blood loss occurs when blood leaks from an external or internal wound. Sometimes the cause is an open injury as a result of an accident, but sometimes even small sources of bleeding lead to chronic blood loss, which over time develops into anemia.
This is the case, for example, with an undetected bleeding stomach ulcer or haemorrhoids.
Anemia due to acute or chronic bleeding is also known as bleeding anemia.
Anemia due to increased erythrocyte breakdown
The reason for this sometimes lies in the red blood cells themselves (corpuscular hemolytic anemia): The erythrocytes usually have a genetic defect and are therefore broken down prematurely.
This is the case with sickle cell anemia, for example: here the red blood cells are not – as is normally the case – disc-shaped and slightly dented on both sides, but sickle-shaped. They clump together easily and are increasingly broken down in the spleen. Another example is globular cell anemia with spherical erythrocytes.
In extracorpuscular hemolytic anemia, the cause lies outside the erythrocytes. For example, the red blood cells are destroyed mechanically, such as by artificial heart valves.
In other cases, chemicals, medication, immune reactions or infectious agents (such as malaria pathogens) are responsible for the excessive breakdown of red blood cells.
Anemia due to a distribution disorder
Anemia: Treatment
The treatment of anemia depends on the cause and severity of the anemia. Some examples:
- If there is a lack of iron, vitamin B12 or folic acid, the deficit is compensated for with appropriate medication, such as iron or folic acid tablets. However, you should only take such supplements if recommended by a doctor (especially iron supplements).
- If malnutrition plays a role (such as folic acid deficiency, iron deficiency) in the development of anemia, it is advisable to adjust your diet.
- If bleeding is the cause of the anemia, it must be stopped. For example, doctors will treat a bleeding stomach ulcer with an operation. If the blood loss is very severe, the patient receives infusions of red blood cell concentrate (“blood transfusion”).
- Patients with renal anemia receive erythropoietin to compensate for the lack of blood-forming hormone.
- In severe congenital forms of anemia such as sickle cell anemia, a stem cell transplant may be helpful.
Some people wonder what happens if anemia is not treated. As a result of reduced oxygen transport, untreated anemia is a major burden on the body. If a serious illness is the cause of the anemia and it remains untreated, life-threatening consequences are possible.
Whether someone is unable to work due to anemia depends on its severity and the triggering cause.
Anemia: When to see a doctor?
If you think you are suffering from anemia, it is advisable to see a doctor soon. This is especially true if you discover blood in your stool, urine or vomit. This is probably due to serious internal bleeding.
It is advisable for women with unusually heavy menstruation, very frequent or very prolonged periods to consult a gynecologist.
Anemia: examinations and diagnosis
If anemia is suspected, the doctor will take a blood sample to have it examined in the laboratory. During this blood test, the doctor will pay particular attention to the following parameters:
- Haematocrit: The haematocrit value indicates the ratio of solid cells to the liquid part of the blood. In healthy people, the cells make up around 40 to 50 percent of the blood. In anemia, however, the hematocrit value is reduced.
- Erythrocyte count: If the number of red blood cells is reduced, this may be due to a blood formation disorder.
- Haemoglobin: In anaemia, the haemoglobin (Hb) value is too low.
- MCH (mean corpuscular haemoglobin): It indicates the average hemoglobin content of a red blood cell. If the erythrocyte has too little hemoglobin, this is referred to as hypochromic anemia. If the hemoglobin content is increased, this indicates hyperchromic anemia. If anemia is present although the MCH values are normal, this is referred to as normochromic anemia.
- Serum ferritin: This is the most important laboratory value for assessing iron stores. If it is low, there is an iron deficiency.
- Reticulocytes: These are the young precursor cells of red blood cells. If their number is increased, this indicates anemia that has existed for some time, anemia due to impaired blood formation or increased erythrocyte breakdown.
If the cause of the anemia is unclear, the doctor will carry out additional diagnostic tests:
- Occult blood test: This detects traces of blood in the stool that are not visible to the naked eye. Occult blood indicates small bleedings in the digestive tract.
- Endoscopy: By means of gastroscopy and colonoscopy, sources of bleeding in the digestive tract can be detected and stopped at the same time.
- Bone marrow diagnostics: This enables the doctor to detect serious anaemia with bone marrow disorders (such as aplastic anaemia). Certain forms of leukemia, which are often associated with anemia, can also be detected by analyzing the bone marrow cells.
Anemia: Prevention
Foods containing vitamin B12 should also be a regular part of your diet. These include fish, meat, eggs and dairy products.
An adequate intake of iron is particularly important for women: Some of this important trace element is regularly lost during menstruation. Women with heavy, prolonged periods (menorrhagia) in particular often develop iron deficiency anemia.
However, athletes are also susceptible to iron deficiency as they excrete more iron with their sweat. Iron-rich foods such as liver, red meat, parsley, wholegrain cereals, pulses, sesame seeds and nuts help to cover iron requirements.
Frequently asked questions about anemia
What is anemia?
Anemia is a lack of healthy red blood cells in the body. As these blood cells are responsible for transporting oxygen, the deficiency can cause symptoms such as tiredness, weakness, shortness of breath or dizziness. Possible causes of anemia include internal or external bleeding, iron or vitamin deficiency, chronic diseases such as cancer and genetic disorders.
What to do if you have anemia?
You should have possible signs of anemia checked by a doctor. If anemia is actually present, treatment will depend on its cause and severity. This may include, for example, the administration of iron, vitamin B12 or folic acid, a blood transfusion and/or a change in diet (e.g. in the case of iron deficiency).
What should you eat if you have anemia?
What are the blood values for anemia?
In anemia, the blood values for haemoglobin, haematocrit and erythrocytes (red blood cells) are reduced. In the case of iron deficiency anemia, serum ferritin is also reduced and transferrin is increased. Depending on the type of anemia, other blood values may be increased or decreased (e.g. MCV, MCH).
Where does anemia come from?
Anemia occurs when the body does not produce enough red blood cells, they are broken down too quickly or are lost in large quantities. Possible causes include a lack of iron, vitamin B12 or folic acid, chronic kidney disease, cancer, inflammation, infections, genetic disorders, acute or chronic bleeding (e.g. in the case of a stomach ulcer) and certain medications.
What are the symptoms of anemia?
When is anemia dangerous?
Untreated severe or chronic anemia can be dangerous as it leads to a lack of oxygen in the organs. This can cause heart problems or brain damage, among other things. In pregnant women, anemia increases the risk of premature birth and low birth weight of the child.
Can anemia be cured?
Anemia is curable in most cases. Depending on the cause, treatment includes, for example, iron or folic acid supplements, medication to stimulate blood formation or blood transfusions. In chronic cases, long-term treatment may be necessary.
