- Pale skin, a rapid heartbeat, yellowing of the skin or eyes, or abdominal swelling may signal a more serious cause of anemia.
- Blood in the stool, bloody diarrhea, unusual bleeding, or purple spots on the skin should be evaluated promptly.
- Severe fatigue, weakness, or symptoms that start early in life may be warning signs that need medical attention.
Anemia occurs when the body lacks enough healthy red blood cells or sufficient hemoglobin to transport oxygen efficiently. Common causes include low iron, low vitamin B12, and low folic acid, but it can also be linked to conditions such as bone marrow aplasia, inflammatory bowel disease, and colon cancer.
Common symptoms include weakness, rapid heartbeat, and pale skin. Depending on the underlying cause, anemia may also be accompanied by diarrhea, bleeding, yellowing of the skin and eyes, or abdominal pain.
If anemia is suspected, it is important to see your primary care provider or schedule a consult with a hematologist. Depending on the underlying condition, treatment may involve iron or vitamin supplementation, blood transfusions, a bone marrow transplant, or surgery.
Main causes
The main causes of anemia are:
1. Iron deficiency
Also called iron-deficiency anemia, this type of anemia can cause symptoms such as tiredness, hair loss, headache, pale skin, and cravings for ice, sand, or clay.
Iron deficiency most often occurs due to blood loss, such as from heavy menstrual bleeding or hemorrhoids, an inadequate dietary intake of iron, or difficulty absorbing the mineral.
According to the World Health Organization, iron deficiency is the most common nutritional deficiency leading to anemia, and deficiencies in folate and vitamin B12 are also important causes.
What to do: If iron deficiency is suspected, it is important to see your primary care provider. Treatment usually involves iron supplements and eating more iron-rich foods, such as lentils, parsley, beans, and red meat.
2. Vitamin B12 deficiency
Anemia caused by vitamin B12 deficiency is more common in people who do not eat meat, drink a lot of alcohol, or use antacids. It usually causes symptoms such as weakness, tingling throughout the body, and tiredness.
What to do: If a vitamin B12 deficiency is suspected, it is advisable to consult a primary care provider or a hematologist. Once the diagnosis is confirmed, treatment typically involves vitamin B12 supplementation, either in oral form or through B12 injections.
3. Folic acid deficiency
Folic acid deficiency can cause anemia and lead to symptoms such as weakness, tiredness, and a fast heartbeat. It is also more common in people who eat too few vegetables, drink too much alcohol, or use medications such as lithium and phenytoin.
What to do: It is important to improve the diet by eating more foods rich in folic acid, particularly dark green vegetables such as arugula and spinach, as well as beans and lentils.
However, a hematologist or primary care provider should be consulted to confirm the diagnosis and begin the most appropriate treatment, which typically involves folic acid supplementation in tablet or injection form.
4. Thalassemia
Thalassemia is a problem with hemoglobin production that affects how it works. In addition to anemia, it can cause symptoms such as pale skin, tiredness, short stature, yellowing of the skin and eyes, and abdominal swelling.
In more severe cases, anemia can be profound from the first days of life and may pose a risk to the baby’s life.
What to do: If thalassemia is suspected, it is advisable to consult a hematologist to confirm the diagnosis and determine the most appropriate treatment.
Treatment is not always necessary, especially in mild cases, but when required, it is often managed with blood transfusions.
5. Bone marrow aplasia
Bone marrow aplasia is a condition in which the bone marrow fails to produce enough blood cells, which can lead to anemia. It may also cause symptoms such as bleeding, purple spots on the skin, and increased susceptibility to infections like colds or gastroenteritis.
What to do: If bone marrow aplasia is suspected, it is important to consult a hematologist. Treatment varies depending on the underlying cause and may include medications such as antibiotics, blood transfusions, or a bone marrow transplant.
6. Inflammatory bowel disease
Inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, can also cause anemia because of inflammation, blood loss, and poor nutrient absorption.
Other symptoms are also common, such as bloody diarrhea, abdominal pain, and weight loss.
What to do: If inflammatory bowel disease is suspected, it is advisable to consult a gastroenterologist or your primary care provider. Anemia typically improves as the underlying condition is treated, which may involve the use of immunomodulating medications or, in some cases, surgery.
7. Colon cancer
Although uncommon, colon cancer can cause anemia and other symptoms such as blood in the stool, abdominal pain, constipation or diarrhea, and weight loss, especially in more advanced stages.
What to do: It is important to consult a gastroenterologist for a thorough evaluation and to confirm the diagnosis. Anemia often improves once the tumor is properly treated, which may involve surgery, chemotherapy, or both.
Confirming a diagnosis
Anemia may cause symptoms such as fatigue, drowsiness, pale skin, and weakness. You can use the test below to check your symptoms and estimate the likelihood of anemia:
To confirm anemia and identify its cause, it is important to consult a doctor for blood tests such as a complete blood count (CBC) and measurements of ferritin or vitamin B12 levels.
According to the National Heart, Lung, and Blood Institute, these tests help diagnose anemia by assessing red blood cell and hemoglobin levels and can also provide clues about its underlying cause.