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How Do I Know If I Have It?

To diagnose anemia, your doctor will likely take your medical history, perform a physical exam, and order laboratory tests. You can help by providing detailed answers about your symptoms, family medical history, diet, medications you take, alcohol intake and ethnic background. Your doctor will look for symptoms of anemia and other physical clues that might point to a cause.

Blood tests will not only confirm the diagnosis of anemia but also help point to the underlying condition. One of the most basic tests is a complete blood count (CBC), which determines the number, size, volume, and hemoglobin content of red blood cells.

If initial studies point to iron deficiency, your doctor may check your blood iron level and your serum ferritin level, the best indicator of your body's total iron stores. Your doctor may also measure your blood levels of vitamin B-12 and folate. Only in rare cases will a doctor need to remove a sample of bone marrow to determine the cause of your anemia.

Special blood tests can detect rare causes of anemia, such as an immune attack on your red blood cells, red blood cell fragility, and defects of enzymes, hemoglobin and clotting.

If your doctor suspects hemolytic anemia, tests can identify the breakdown products of red blood cells in your blood and urine.

What Are the Treatments?

Your doctor will not treat your anemia until the underlying cause has been established. The treatment for one type of anemia may be both inappropriate and dangerous for another type of anemia.

Anemia caused by blood loss. If you suddenly lose a large volume of blood, you may be treated with fluids, blood transfusion, oxygen, and possibly iron to help your body build new red blood cells. Chronic blood loss is treated by identifying the source of bleeding, stopping the bleeding, and, if necessary, giving treatment for iron-deficiency anemia.

Anemia caused by decreased red blood cell production. With iron deficiency anemia your doctor will probably recommend iron supplements that contain the ferrous form of iron, which your body can absorb easily. Timed-release iron supplements are not a good choice for most people because iron is primarily absorbed in the upper part of the digestive tract.

CAUTION: Always consult with your doctor before taking iron supplements. Excess iron intake can be harmful. Symptoms of iron overload include fatigue, vomiting, diarrhea, headache, irritability and joint problems.

CAUTION: Iron supplements — like all supplements and any medication — should be kept out of the reach of children. Iron poisoning is the most common cause of accidental poisoning in young children. Very few tablets can prove fatal in a matter of hours. Symptoms of poisoning in a child include dizziness, confusion, nausea, vomiting, and diarrhea. Seek medical help immediately.

Side Effects: You may need to continue taking iron supplements for up to one year. Taking iron supplements with food can help prevent common side effects, which may include nausea, diarrhea, constipation and stomach pain. Let your doctor know if you continue to have side effects. Different formulations are available.

Iron supplements can also interact with other medications you may take, so be certain to tell your doctor if you are being treated for another condition. Calcium supplements interfere with iron absorption so it is best to take them at different times of the day.

Your doctor may also recommend that you increase the amount of iron in your diet. Good dietary sources of iron include red meat, beans, egg yolk, whole-grain products, nuts and seafood.

Your doctor will monitor your red blood cell counts including hematocrit, hemoglobin, and ferritin levels during treatment. If your anemia doesn't improve with iron supplements, your doctor will look for some other underlying cause. In rare cases, your doctor may prescribe iron injections or give you iron intravenously (through a needle in the vein). In extremely rare cases of life-threatening iron-deficiency anemia, treatment may involve blood transfusion.

Vitamin B-12 and folate deficiency anemia. If your body stores are depleted of vitamin B-12, your doctor will most likely prescribe vitamin B-12 injections and may also recommend high doses of B-12 supplements or a B-12 nasal spray. There is a good chance that many of the symptoms of deficiency will improve once the body is provided with the needed B-12.

Most people with vitamin B-12 deficiency have a permanent inability to absorb vitamin B-12 and will need injections every one to three months or pills daily for the rest of their lives.

Your doctor may also recommend that you increase the amount of vitamin B-12 in your diet. Good dietary sources of vitamin B-12 are meat, liver, and kidney; fish, oyster, and clams; and milk, cheese and eggs.

If you have a folate deficiency, your doctor will prescribe folate supplements and may recommend you increase the amount of folate in your diet. Good dietary sources of folate include fresh fruits, green leafy vegetables, cruciferous vegetables (cauliflower, broccoli and brussel sprouts), liver and kidney, dairy products, and whole grain cereals. Vegetables should be eaten raw or lightly cooked.

Anemia caused by problems of the bone marrow and stem cells. Anemia that originates in the bone marrow and stem cells tend to be more persistent and difficult to treat. The treatments for hereditary anemias, such as thalassemia, vary widely and depend on the specific condition and the severity of symptoms. Some anemias will not require any treatment while others may require repeated transfusion and other aggressive measures. Although aplastic anemia will occasionally go into spontaneous remission, people with this disorder generally require bone marrow transplantation.

Lead poisoning is treated by discontinuing exposure to lead and administering a drug that binds and draws lead out of the body.

For people with anemia as a result of chronic disease, the best way to alleviate the anemia is often to treat the underlying condition. Shots of Epogen, a hormone that stimulates the production of red blood cells, may also help in some instances. People who have anemia as a result of kidney failure will require adequate dialysis, take Epogen, and possibly have a kidney transplant.

Anemia caused by increased red blood cell destruction. The treatment of hemolytic anemia will be tailored to the underlying cause. Mild cases of hemolytic anemia may not require any treatment at all. If an offending environmental agent can be identified — a chemical, for example — exposure to this agent should stop immediately. People with hemolytic anemia may need surgery to replace faulty heart valves, remove a tumor, or repair abnormal blood vessels.

Supportive treatment — like intravenous fluids and pain medication — will often be administered. Blood transfusion may be necessary in some cases. Steroids can halt the body's immune attack on its own red blood cells. Certain damaging factors can be removed from the blood by a treatment called plasmapheresis.

If hemolytic anemia persists despite treatment, your doctor may recommend splenectomy — surgical removal of the spleen — as a last resort. Most people can lead a normal life without their spleen.
Gallbladder surgery may also be required if you have longstanding hemolytic anemia and symptoms of gallstones. Hemolytic anemia that damages the kidneys may make dialysis necessary. In extremely rare cases, bone marrow transplantation may be the only solution for certain types of hemolytic anemia.

While there is no cure for sickle cell anemia, drugs can help ease the pain. And a drug called hydroxyurea appears to stimulate the formation of an alternate form of hemoglobin that isn't susceptible to the sickling.

How Can I Prevent It?

You can prevent iron-deficiency anemia by eating a well-balanced diet that includes good sources of iron, vitamin B-12, and folate.

• If you are a vegetarian, talk to your doctor or a nutritionist about your diet and any possible need for supplements.
• Ask your doctor or nutritionist if you should take vitamin C. Vitamin C makes the stomach more acidic and can improve the absorption of iron in your diet.
• Decrease your consumption of caffeinated products and tea. These substances can decrease iron absorption. Other offenders include the preservative EDTA, fiber, large amounts of calcium, and the phytates found in some vegetables.
• Select iron-fortified cereals and breads.
• Carefully follow safety guidelines if your occupation involves work with lead-containing materials such as batteries, petroleum, and paint.
• Ask your doctor or local public-health authorities about lead-testing the pottery you use for food or beverage preparation.

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