About anaemia

Red blood cells carry oxygen around the body. They do this using the protein ‘haemoglobin', or Hb for short.

Anaemia means a low level of haemoglobin in your blood.

Anaemia is caused by:

  • not having enough healthy red blood cells to carry oxygen
  • or having red blood cells that are unable to carry enough oxygen.

More about blood

Blood contains:

• red blood cells to carry oxygen. Red blood cells are made in our bone marrow. They last for around 120 days. So we must constantly make new ones.
• white blood cells to help fight infection
• platelets to help form clots when we bleed
• plasma, the liquid in blood that carries the blood cells around the body.

Symptoms of anaemia

The following can be features of anaemia:

  • tiredness
  • shortness of breath
  • dizziness
  • fast heartbeat or sensation of the heart beating in the chest (palpitations)
  • pounding or ‘ringing’ in your ears
  • headache
  • cold hands or feet
  • pale or yellow skin
  • chest pain
  • lack of concentration
  • sore tongue or mouth ulcers
  • irritability.

Different types of anaemia

There are many different types of anaemia. They need different treatments. The most common types are listed below.

Anaemia due to not enough red blood cells being produced

This can have different causes.

  • A shortage of iron or vitamins

    ‘Iron deficiency anaemia’ is common.

    A lack of iron might be due to:
    • not having enough iron in your diet
    • problems with absorbing iron from your food
    • iron being lost, for example, due to surgery or because of bleeding
    • during pregnancy when more oxygen is needed to support the baby’s development.
       
  • Not enough vitamin B12 or B9 (folate)
    This can be due to:
    • not eating enough food containing vitamin B12 or folate
    • the body not absorbing it. This can be due to conditions such as pernicious anaemia and coeliac disease.
       
  • Anaemia of chronic illness
    This is sometimes called ‘functional iron deficiency’.
    The body has enough iron, but inflammation caused by chronic illnesses or infections can block the body’s access to the iron. This means that the bone marrow cannot produce good quality red blood cells.
     
  • Anaemia of kidney disease
    Patients with kidney problems may be unable to produce enough of the hormone ‘erythropoietin’ which tells the bone marrow to produce more red blood cells.

Anaemia due to a problem in the bone marrow

Red blood cells are made in the bone marrow. Certain conditions can disrupt the cells being produced, such as:

  • certain cancers
  • some drugs, such as chemotherapy
  • bone marrow disease, such as myelodysplastic syndrome or aplastic anaemia.

Anaemia due to inherited disorders

Some inherited conditions can affect haemoglobin production. One example is the condition ‘thalassaemia’.

Anaemia due to increased destruction of red blood cells

‘Haemolysis’ is when the body destroys its own red blood cells. It has several causes, including inherited disorders like ‘sickle cell anaemia’, and rarely, as a reaction to medicines or infection.

Anaemia due to bleeding

Anaemia caused by bleeding can be severe and sudden, such as bleeding from a stomach ulcer or sudden injury. Or it can be slower, for example, due to heavy periods or hidden bleeding in the bowel.

When blood loss is slow, the anaemia develops gradually. It is often associated with low iron because the iron is lost from the red blood cells.

Who is at risk of anaemia

Anaemia can be caused in many ways. It is more common in young children and babies as they may not have built up iron stores. Anaemia is also seen in:

  • those who have a diet lacking in iron, essential vitamins and minerals.
  • those who suffer from diseases such as:
    • inflammatory bowel disease
    • bone marrow disorders
    • rheumatoid arthritis
    • heart disease
    • chronic liver diseases
    • recurrent infections.
  • those who are losing blood, for example:
    • you have bowel cancer
    • you have recently had major surgery.
  • girls and women having heavy periods.
  • pregnant women, as more red blood cells are needed to support the developing baby.

Tests for anaemia

Blood tests

  • Full blood count to check the number and size of red blood cells in your blood, and to measure the haemoglobin level.
  • Vitamin B12 and folate levels, to see if you have enough to help make red blood cells.
  • Ferritin to check the amount of iron.
  • Blood chemistry tests to check that organs such as the liver and kidneys are working well.

Bone marrow biopsy

  • This is rarely required. It will only be done if a problem with the bone marrow is suspected. It is carried out by a specialist in a hospital.

Other investigations

These may include tests to see if there is bleeding somewhere. For example:

  • bowel investigations, such as gastroscopy and colonoscopy (camera tests looking at the stomach and large bowel)
  • blood tests looking for coeliac disease
  • urine tests looking for evidence of blood in the urine
  • referral to hospital if symptoms do not improve following treatment from your GP.

Treatments

There are two general approaches to the treatment of anaemia.

Replacement therapy

Depending on the type of anaemia, there are several treatment options available:

  • oral or intravenous iron
  • vitamin B9 (folate) or vitamin B12 tablets
  • injections of vitamin B12
  • rarely, blood transfusion.

Treatment of the cause or disease

These treatments will be guided by the condition that you have. Your doctor will explain them so you can discuss the treatment options available to you.

What you can do to help

There are several things you can do to help yourself.

  • Eat a healthy balanced diet. This includes fruit, vegetables, eggs, fish or meat, and carbohydrates such as potatoes or pasta.
    For more information on iron in your diet, follow the link in the table below.
  • Talk to your doctor, nurse or midwife:
    • if you think you have any of the symptoms of anaemia listed above
    • if you have noticed blood in your poo or urine
    • if you have persistent heavy periods.
  • Talk to a healthcare professional before taking any alternative medicines, herbal preparations or over the counter treatments for anaemia. Some can react with prescribed medications.

More information

Contact information

Ask your GP or pharmacist for more on this