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Anemia is a condition in which you don't have enough healthy red blood

cells to carry adequate oxygen to your tissues. Having anemia may make
you feel tired and weak.There are many forms of anemia, each with its own
cause. Loss of blood is the most common cause of anemia. Anemia can be
temporary or long term, and it can range from mild to severe.Treatments for
anemia range from taking supplements to undergoing medical procedures.
You may be able to prevent some types of anemia by eating a healthy,
varied diet.
Anemia symptoms vary depending on the cause of your anemia but may
Pale skin
A fast or irregular heartbeat
Shortness of breath
Chest pain
Cognitive problems
Cold hands and feet
Anemia occurs when your blood doesn't have enough red blood cells. This
can happen if:
Your body doesn't make enough red blood cells
Bleeding causes you to lose red blood cells more quickly than they can be
Your body destroys red blood cells
What red blood cells do

Your body makes three types of blood cells white blood cells to fight
infection, platelets to help your blood clot and red blood cells to carry oxygen
throughout your body.
Red blood cells contain hemoglobin a red, iron-rich protein that gives
blood its red color. Hemoglobin enables red blood cells to carry oxygen from
your lungs to all parts of your body and to carry carbon dioxide from other
parts of the body to your lungs so that it can be exhaled.
Common types of anemia and their causes include:
Iron deficiency anemia. Iron deficiency anemia is caused by a shortage of
the element iron in your body. Your bone marrow needs iron to make
hemoglobin. Without adequate iron, your body can't produce enough
hemoglobin for red blood cells.
This type of anemia is often caused by blood loss, such as from heavy
menstrual bleeding, an ulcer, cancer, a polyp somewhere in your digestive
system, and prolonged use of aspirin or drugs known as nonsteroidal antiinflammatory drugs (NSAIDs).
Vitamin deficiency anemias. In addition to iron, your body needs folate
and vitamin B-12 to produce sufficient numbers of healthy red blood cells. A
diet lacking in these and other key nutrients can cause decreased red blood
cell production.
Additionally, some people may eat enough B-12, but their bodies aren't able
to process the vitamin. This can lead to vitamin deficiency anemia, also
known as pernicious anemia.
Aplastic anemia. This very rare life-threatening anemia is caused by a
decrease in the bone marrow's ability to produce red blood cells. Causes of
aplastic anemia include infections, drugs and autoimmune diseases.
Hemolytic anemias. This group of anemias develops when red blood cells
are destroyed faster than bone marrow can replace them. Certain blood
diseases can cause increased red blood cell destruction. You can inherit a
hemolytic anemia, or you can develop it later in life.
Sickle cell anemia. This inherited and sometimes serious anemia is caused
by a defective form of hemoglobin that forces red blood cells to assume an
abnormal crescent (sickle) shape. These irregular-shaped red blood cells die
prematurely, resulting in a chronic shortage of red blood cells.

Risk factors
These factors place you at increased risk of anemia:
Intestinal disorders. Having an intestinal disorder that affects the
absorption of nutrients in your small intestine such as Crohn's disease and
celiac disease puts you at risk of anemia. Surgical removal of or surgery to
the parts of your small intestine where nutrients are absorbed can lead to
nutrient deficiencies and anemia.
Menstruation. In general, women who haven't experienced menopause
have a greater risk of iron deficiency anemia than do men and
postmenopausal women. That's because menstruation causes the loss of red
blood cells.
Pregnancy. If you're pregnant, you're at an increased risk of iron deficiency
anemia because your iron stores have to serve your increased blood volume
as well as be a source of hemoglobin for your growing baby.
Chronic conditions. For example, if you have cancer, kidney or liver failure,
or another chronic condition, you may be at risk of anemia of chronic
disease. These conditions can lead to a shortage of red blood cells.
Family history. If your family has a history of an inherited anemia, such as
sickle cell anemia, you also may be at increased risk of the condition.
Left untreated, anemia can cause numerous complications, such as:
Severe fatigue. When anemia is severe enough, you may be so tired that
you can't complete everyday tasks. You may be too exhausted to work or
Heart problems. Anemia can lead to a rapid or irregular heartbeat an
arrhythmia. Your heart must pump more blood to compensate for the lack of
oxygen in the blood when you're anemic. This can even lead to congestive
heart failure.
Death. Some inherited anemias, such as sickle cell anemia, can be serious
and lead to life-threatening complications. Losing a lot of blood quickly
results in acute, severe anemia and can be fatal.
Tests and diagnosis

Physical exam. During a physical exam, your doctor may listen to your
heart and your breathing. Your doctor may also place his or her hands on
your abdomen to feel the size of your liver and spleen.
Complete blood count (CBC). A CBC is used to count the number of blood
cells in a sample of your blood. For anemia, your doctor will be interested in
the levels of the red blood cells contained in the blood (hematocrit) and the
hemoglobin in your blood.
Normal adult hematocrit values vary from one medical practice to another
but are generally between 40 and 52 percent for men and 35 and 47 percent
for women. Normal adult hemoglobin values are generally 14 to 18 grams
per deciliter for men and 12 to 16 grams per deciliter for women.
Treatments and drugs
Anemia treatment depends on the cause.
Iron deficiency anemia. This form of anemia is treated with changes in
your diet and iron supplements.
If the underlying cause of iron deficiency is loss of blood other than from
menstruation the source of the bleeding must be located and stopped.
This may involve surgery.
Vitamin deficiency anemias. Folic acid and vitamin C deficiency anemias
are treated with dietary supplements and increasing these nutrients in your
diet. If your digestive system has trouble absorbing vitamin B-12 from the
food you eat, you may receive vitamin B-12 injections.
Anemia of chronic disease. There's no specific treatment for this type of
anemia. Doctors focus on treating the underlying disease. If symptoms
become severe, a blood transfusion or injections of synthetic erythropoietin,
a hormone normally produced by your kidneys, may help stimulate red blood
cell production and ease fatigue.
Aplastic anemia. Treatment for this anemia may include blood transfusions
to boost levels of red blood cells. You may need a bone marrow transplant if
your bone marrow is diseased and can't make healthy blood cells.
Anemias associated with bone marrow disease. Treatment of these
various diseases can include simple medication, chemotherapy or bone
marrow transplantation.
Hemolytic anemias. Managing hemolytic anemias includes avoiding
suspect medications, treating related infections and taking drugs that
suppress your immune system, which may be attacking your red blood cells.

Depending on the severity of your anemia, a blood transfusion or

plasmapheresis may be necessary. Plasmapheresis is a type of bloodfiltering procedure. In certain cases, removal of the spleen can be helpful.
Sickle cell anemia. Treatment for this anemia may include the
administration of oxygen, pain-relieving drugs, and oral and intravenous
fluids to reduce pain and prevent complications. Doctors also may
recommend blood transfusions, folic acid supplements and antibiotics.
Thalassemia. This anemia may be treated with blood transfusions, folic acid
supplements, removal of the spleen (splenectomy), a bone marrow
transplant or a another drug.
Iron. Iron-rich foods include beef and other meats, beans, lentils, ironfortified cereals, dark green leafy vegetables, and dried fruit.
Folate. This nutrient, and its synthetic form folic acid, can be found in citrus
fruits and juices, bananas, dark green leafy vegetables, legumes, and
fortified breads, cereals and pasta.
Vitamin B-12. This vitamin is found naturally in meat and dairy products.
It's also added to some cereals and soy products, such as soy milk.
Vitamin C. Foods containing vitamin C such as citrus fruits, melons and
berries help increase iron absorption.
Consider genetic counseling if you have a family history of anemia
If you have a family history of an inherited anemia, such as sickle cell
anemia or thalassemia, talk to your doctor and possibly a genetic counselor
about your risk and what risks you may pass on to your children.
Aplastic anemia is a condition that occurs when your body stops producing
enough new blood cells. Aplastic anemia leaves you feeling fatigued and with
a higher risk of infections and uncontrolled bleeding.
A rare and serious condition, aplastic anemia can develop at any age.
Aplastic anemia may occur suddenly, or it can occur slowly and get worse
over a long period of time. Treatment for aplastic anemia may include
medications, blood transfusions or a stem cell transplant.
Aplastic anemia symptoms may include:


Shortness of breath with exertion

Rapid or irregular heart rate

Pale skin

Frequent or prolonged infections

Unexplained or easy bruising

Nosebleeds and bleeding gums

Prolonged bleeding from cuts

Skin rash



Aplastic anemia develops when damage occurs to your bone marrow,
slowing or shutting down the production of new blood cells. Bone marrow is a
red, spongy material inside your bones that produces stem cells, which give
rise to other cells. Stem cells in the bone marrow produce blood cells red
cells, white cells and platelets. In aplastic anemia, the bone marrow is
described in medical terms as aplastic or hypoplastic meaning that it's
empty (aplastic) or contains very few blood cells (hypoplastic).
Factors that can temporarily or permanently injure bone marrow and affect
blood cell production include:

Radiation and chemotherapy treatments. While these cancerfighting therapies kill cancer cells, they can also damage healthy cells,
including stem cells in bone marrow. Aplastic anemia can be a temporary
side effect of these treatments.

Exposure to toxic chemicals. Exposure to toxic chemicals, such as

some used in pesticides and insecticides, may cause aplastic anemia.
Exposure to benzene an ingredient in gasoline also has been linked

to aplastic anemia. This type of anemia may get better on its own if you
avoid repeated exposure to the chemicals that caused your initial illness.

Use of certain drugs. Some medications, such as those used to treat

rheumatoid arthritis and some antibiotics, can cause aplastic anemia.

Autoimmune disorders. An autoimmune disorder, in which your

immune system begins attacking healthy cells, may involve stem cells in
your bone marrow.

A viral infection. Viral infections that affect bone marrow may play a
role in the development of aplastic anemia in some people. Viruses that
have been linked to the development of aplastic anemia include hepatitis,
Epstein-Barr, cytomegalovirus, parvovirus B19 and HIV.

Pregnancy. Aplastic anemia that occurs in pregnancy may be related

to an autoimmune problem your immune system may attack your bone
marrow during pregnancy.

Risk factors
Aplastic anemia is rare. Factors that may increase your risk include:

Treatment with high-dose radiation or chemotherapy for cancer

Exposure to toxic chemicals

The use of some prescription drugs such as chloramphenicol, which

is used to treat bacterial infections, and gold compounds used to treat
rheumatoid arthritis

Certain blood diseases, autoimmune disorders and serious infections

Pregnancy, rarely

Tests and diagnosis

Blood tests. Normally, red blood cell, white blood cell and platelet levels
stay within a certain range. Your doctor may suspect aplastic anemia when
all three of these blood cell levels are very low.
Bone marrow biopsy. To confirm a diagnosis, you'll need to undergo a bone
marrow biopsy. In this procedure, a doctor uses a needle to remove a small
sample of bone marrow from a large bone in your body, such as your
hipbone. The bone marrow sample is examined under a microscope to rule

out other blood-related diseases. In aplastic anemia, bone marrow contains

fewer blood cells than normal.
Once you've received a diagnosis of aplastic anemia, you may need
additional tests to determine an underlying cause.
Treatments and drugs
Treatments for aplastic anemia may include observation for mild cases, blood
transfusions and medications for more-serious cases, and in severe cases,
bone marrow transplantation. Severe aplastic anemia, in which your blood
cell counts are extremely low, is life-threatening and requires immediate
hospitalization for treatment.
Blood transfusions
Treatment for aplastic anemia usually involves blood transfusions to control
bleeding and relieve anemia symptoms. Blood transfusions aren't a cure for
aplastic anemia. But they do relieve signs and symptoms by providing blood
cells that your bone marrow isn't producing. A transfusion may include:
Red blood cells. Transfusions of red blood cells raise red blood cell counts.
This helps relieve anemia and fatigue.
Platelets. Transfusions of platelets help prevent excessive bleeding.
While there's generally no limit to the number of blood cell transfusions you
can have, complications can sometimes arise with multiple transfusions.
Transfused red blood cells contain iron that can accumulate in your body and
can damage vital organs if an iron overload isn't treated. Medications can
help your body get rid of excess iron. Another possible complication is that
over time, your body may develop antibodies to transfused blood cells,
making them less effective at relieving symptoms. However, the use of
immunosuppressant medication makes this complication less likely.
Stem cell transplant
A stem cell transplant to rebuild the bone marrow with stem cells from a
donor may offer the only successful treatment option for people with severe
aplastic anemia. A stem cell transplant, which is also called a bone marrow
transplant, is generally the treatment of choice for people who are younger
and have a matching donor most often a sibling.
A stem cell transplant carries risks. There's a chance that your body may
reject the transplant, leading to life-threatening complications. In addition,
not everyone is a candidate for transplantation or can find a suitable donor.

Immune-suppressing drugs can be very effective at treating aplastic anemia.

The downside is that these drugs further weaken your immune system. It's
also possible that after you stop taking these drugs, aplastic anemia may

Bone marrow stimulants

Certain drugs including colony-stimulating factors, such as sargramostim
(Leukine), filgrastim (Neupogen) and pegfilgrastim (Neulasta), and epoetin
alfa (Epogen, Procrit) may help stimulate the bone marrow to produce new
blood cells. Growth factors are often used in combination with immunesuppressing drugs.
Antibiotics, antivirals
Having aplastic anemia weakens your immune system. You have fewer white
blood cells in circulation to fight off germs. This leaves you susceptible to
At the first sign of infection, such as a fever, see your doctor. You don't want
the infection to get worse, because it could prove life-threatening. If you
have severe aplastic anemia, your doctor may give you antibiotics or
antiviral medications to help prevent infections.
Iron deficiency anemia is a common type of anemia a condition in
which blood lacks adequate healthy red blood cells. Red blood cells carry
oxygen to the body's tissues.
As the name implies, iron deficiency anemia is due to insufficient iron.
Without enough iron, your body can't produce enough of a substance in red
blood cells that enables them to carry oxygen (hemoglobin). As a result, iron
deficiency anemia may leave you tired and short of breath.
You can usually correct iron deficiency anemia with iron supplementation.
Sometimes additional tests or treatments for iron deficiency anemia are
necessary, especially if your doctor suspects that you're bleeding internally.
Initially, iron deficiency anemia can be so mild that it goes unnoticed. But as
the body becomes more deficient in iron and anemia worsens, the signs and
symptoms intensify.
Iron deficiency anemia symptoms may include:

Extreme fatigue
Pale skin
Shortness of breath
Chest pain
Frequent infections
Dizziness or lightheadedness
Cold hands and feet
Inflammation or soreness of your tongue
Brittle nails
Fast heartbeat
Unusual cravings for non-nutritive substances, such as ice, dirt or starch
Poor appetite, especially in infants and children with iron deficiency anemia
An uncomfortable tingling or crawling feeling in your legs (restless legs
Causes of iron deficiency anemia include:
Blood loss. Blood contains iron within red blood cells. So if you lose blood,
you lose some iron. Women with heavy periods are at risk of iron deficiency
anemia because they lose blood during menstruation. Slow, chronic blood
loss within the body such as from a peptic ulcer, a hiatal hernia, a colon
polyp or colorectal cancer can cause iron deficiency anemia.
Gastrointestinal bleeding can result from regular use of some over-thecounter pain relievers, especially aspirin.
A lack of iron in your diet. Your body regularly gets iron from the foods
you eat. If you consume too little iron, over time your body can become iron
deficient. Examples of iron-rich foods include meat, eggs, leafy green
vegetables and iron-fortified foods. For proper growth and development,
infants and children need iron from their diet, too.
An inability to absorb iron. Iron from food is absorbed into your
bloodstream in your small intestine. An intestinal disorder, such as celiac

ability to

which affects your intestine's ability to absorb nutrients from

food, can lead to iron deficiency anemia. If part of your small
has been bypassed or removed surgically, that may affect your
absorb iron and other nutrients.

Pregnancy. Without iron supplementation, iron deficiency anemia occurs in

many pregnant women because their iron stores need to serve their own
increased blood volume as well as be a source of hemoglobin for the growing
Risk factors
These groups of people may have an increased risk of iron deficiency
Women. Because women lose blood during menstruation, women in general
are at greater risk of iron deficiency anemia.
Infants and children. Infants, especially those who were low birth weight
or born prematurely, who don't get enough iron from breast milk or formula
may be at risk of iron deficiency. Children need extra iron during growth
spurts. If your child isn't eating a healthy, varied diet, he or she may be at
risk of anemia.
Vegetarians. People who don't eat meat may have a greater risk of iron
deficiency anemia if they don't eat other iron-rich foods.
Frequent blood donors. People who routinely donate blood may have an
increased risk of iron deficiency anemia since blood donation can deplete
iron stores. Low hemoglobin related to blood donation may be a temporary
problem remedied by eating more iron-rich foods. If you're told that you can't
donate blood because of low hemoglobin, ask your doctor whether you
should be concerned.
Tests and diagnosis
To diagnose iron deficiency anemia, your doctor may run tests to look for:
Red blood cell size and color. With iron deficiency anemia, red blood cells
are smaller and paler in color than normal.
Hematocrit. This is the percentage of your blood volume made up by red
blood cells. Normal levels are generally between 34.9 and 44.5 percent for
adult women and 38.8 to 50 percent for adult men. These values may
change depending on your age.
Hemoglobin. Lower than normal hemoglobin levels indicate anemia. The
normal hemoglobin range is generally defined as 13.5 to 17.5 grams (g) of
hemoglobin per deciliter (dL) of blood for men and 12.0 to 15.5 g/dL for

women. The normal ranges for children vary depending on the child's age
and sex.
Ferritin. This protein helps store iron in your body, and a low level of ferritin
usually indicates a low level of stored iron.
Treatments and drugs
To treat iron deficiency anemia, your doctor may recommend you take iron
supplements. Your doctor will also treat the underlying cause of your iron
deficiency, if necessary.
Iron supplements
Your doctor may recommend over-the-counter iron tablets to replenish the
iron stores in your body. Your doctor will let you know the correct dose for
you. Iron is also available in liquid form for infants and children. To improve
the chances that your body will absorb the iron in the tablets, you may be
instructed to:
Take iron tablets on an empty stomach. If possible, take your iron tablets
when your stomach is empty. However, because iron tablets can upset your
stomach, you may need to take your iron tablets with meals.
Don't take iron with antacids. Medications that immediately relieve heartburn
symptoms can interfere with the absorption of iron. Take iron two hours
before or four hours after you take antacids.
Take iron tablets with vitamin C. Vitamin C improves the absorption of iron.
Your doctor might recommend taking your iron tablets with a glass of orange
juice or with a vitamin C supplement.
Iron supplements can cause constipation, so your doctor may also
recommend a stool softener. Iron may turn your stools black, which is a
harmless side effect.
Iron deficiency can't be corrected overnight. You may need to take iron
supplements for several months or longer to replenish your iron reserves.
Generally, you'll start to feel better after a week or so of treatment. Ask your
doctor when you need to return to have your blood rechecked to measure
your iron levels. To be sure that your iron reserves are replenished, you'll
probably need to take iron supplements for a year or more.
Medications, such as oral contraceptives to lighten heavy menstrual
Antibiotics and other medications to treat peptic ulcers
Surgery to remove a bleeding polyp, a tumor or a fibroid

If iron deficiency anemia is severe, you may need iron given intravenously or
you may need blood transfusions to help replace iron and hemoglobin
Sickle cell anemia is an inherited form of anemia a condition in which
there aren't enough healthy red blood cells to carry adequate oxygen
throughout your body.
Normally, your red blood cells are flexible and round, moving easily through
your blood vessels. In sickle cell anemia, the red blood cells become rigid
and sticky and are shaped like sickles or crescent moons. These irregularly
shaped cells can get stuck in small blood vessels, which can slow or block
blood flow and oxygen to parts of the body.
There's no cure for most people with sickle cell anemia. However, treatments
can relieve pain and help prevent further problems associated with sickle cell
Signs and symptoms of sickle cell anemia often don't appear until an infant is
at least 4 months old and may include:
Anemia. Sickle cells are fragile. They break apart easily and die, leaving
you without a good supply of red blood cells. Red blood cells usually live for
about 120 days before they die and need to be replaced. But sickle cells die
after an average of less than 20 days. This results in a lasting shortage of red
blood cells (anemia). Without enough red blood cells in circulation, your body
can't get the oxygen it needs to feel energized. That's why anemia causes
Episodes of pain. Periodic episodes of pain, called crises, are a major
symptom of sickle cell anemia. Pain develops when sickle-shaped red blood
cells block blood flow through tiny blood vessels to your chest, abdomen and
joints. Pain can also occur in your bones. The pain may vary in intensity and
can last for a few hours to a few weeks. Some people experience only a few
episodes of pain. Others experience a dozen or more crises a year. If a crisis
is severe enough, you may need to be hospitalized.
Hand-foot syndrome. Swollen hands and feet may be the first signs of
sickle cell anemia in babies. The swelling is caused by sickle-shaped red
blood cells blocking blood flow out of their hands and feet.
Frequent infections. Sickle cells can damage your spleen, an organ that
fights infection. This may make you more vulnerable to infections. Doctors
commonly give infants and children with sickle cell anemia vaccinations and

antibiotics to







Delayed growth. Red blood cells provide your body with the oxygen and
nutrients you need for growth. A shortage of healthy red blood cells can slow
growth in infants and children and delay puberty in teenagers.
Vision problems. Some people with sickle cell anemia experience vision
problems. Tiny blood vessels that supply your eyes may become plugged
with sickle cells. This can damage the retina the portion of the eye that
processes visual images.
Sickle cell anemia is caused by a mutation in the gene that tells your body to
make hemoglobin the red, iron-rich compound that gives blood its red
color. Hemoglobin allows red blood cells to carry oxygen from your lungs to
all parts of your body. In sickle cell anemia, the abnormal hemoglobin causes
red blood cells to become rigid, sticky and
Risk factors
The risk of inheriting sickle cell anemia comes down to genetics. For a baby
to be born with sickle cell anemia, both parents must carry a sickle cell gene.
The gene is more common in families that come from Africa, India,
Mediterranean countries, Saudi Arabia, the Caribbean islands, and South and
Central America. In the United States, it most commonly affects blacks.
Sickle cell anemia can lead to a host of complications, including:
Stroke. A stroke can occur if sickle cells block blood flow to an area of your
brain. Signs of stroke include seizures, weakness or numbness of your arms
and legs, sudden speech difficulties, and loss of consciousness. If your baby
or child has any of these signs and symptoms, seek medical treatment
immediately. A stroke can be fatal.
Acute chest syndrome. This life-threatening complication of sickle cell
anemia causes chest pain, fever and difficulty breathing. Acute chest
syndrome can be caused by a lung infection or by sickle cells blocking blood
vessels in your lungs. It may require emergency medical treatment with
antibiotics and other treatments.
Pulmonary hypertension. People with sickle cell anemia can also develop
high blood pressure in their lungs (pulmonary hypertension). This
complication usually affects adults rather than children. Shortness of breath
and fatigue are common symptoms of this condition, which can be fatal.

Organ damage. Sickle cells can block blood flow through blood vessels,
immediately depriving an organ of blood and oxygen. In sickle cell anemia,
blood is also chronically low on oxygen. Chronic deprivation of oxygen-rich
blood can damage nerves and organs in your body, including your kidneys,
liver and spleen. Organ damage can be fatal.
Blindness. Tiny blood vessels that supply your eyes can get blocked by
sickle cells. Over time, this can damage the portion of the eye that processes
visual images (retina) and lead to blindness.
Skin ulcers. Sickle cell anemia can cause open sores, called ulcers, on your
Gallstones. The breakdown of red blood cells produces a substance called
bilirubin. A high level of bilirubin in your body can lead to gallstones.
Priapism. Men with sickle cell anemia may experience painful, long-lasting
erections, a condition called priapism. As occurs in other parts of the body,
sickle cells can block the blood vessels in the penis. This can damage the
penis and eventually lead to impotence.
Tests and diagnosis
A blood test can check for hemoglobin S the defective form of hemoglobin
that underlies sickle cell anemia. In the United States, this blood test is part
of routine newborn screening done at the hospital. But older children and
adults can be tested, too.
In adults, a blood sample is drawn from a vein in the arm. In young children
and babies, the blood sample is usually collected from a finger or heel. The
sample is then sent to a laboratory, where it's screened for hemoglobin S.
Treatments and drugs
Bone marrow transplant offers the only potential cure for sickle cell anemia.
But finding a donor is difficult and the procedure has serious risks associated
with it, including death.
As a result, treatment for sickle cell anemia is usually aimed at avoiding
crises, relieving symptoms and preventing complications. If you have sickle
cell anemia, you'll need to make regular visits to your doctor to check your
red blood cell count and monitor your health. Treatments may include
medications to reduce pain and prevent complications, blood transfusions
and supplemental oxygen, as well as a bone marrow transplant.
Medications used to treat sickle cell anemia include:

Antibiotics. Children with sickle cell anemia may begin taking the antibiotic
penicillin when they're about 2 months of age and continue taking it until
they're at least 5 years old. Doing so helps prevent infections, such as
pneumonia, which can be life-threatening to an infant or child with sickle cell
anemia. Antibiotics may also help adults with sickle cell anemia fight certain
Pain-relieving medications. To relieve pain during a sickle crisis, your
doctor may advise over-the-counter pain relievers and application of heat to
the affected area. You may also need stronger prescription pain medication.
Hydroxyurea (Droxia, Hydrea). When taken daily, hydroxyurea reduces
the frequency of painful crises and may reduce the need for blood
transfusions. Hydroxyurea seems to work by stimulating production of fetal
hemoglobin a type of hemoglobin found in newborns that helps prevent
the formation of sickle cells. Hydroxyurea increases your risk of infections,
and there is some concern that long-term use of this drug may cause tumors
or leukemia in certain people. However, this hasn't yet been seen in studies
of the drug.
Hydroxyurea was initially used just for adults with severe sickle cell
anemia. Studies on children have shown that the drug may prevent some of
the serious complications associated with sickle cell anemia. But the longterm effects of the drug on children are still unknown. Your doctor can help
you determine if this drug may be beneficial for you or your child.
Blood transfusions
In a red blood cell transfusion, red blood cells are removed from a supply of
donated blood. These donated cells are then given intravenously to a person
with sickle cell anemia.
Blood transfusions increase the number of normal red blood cells in
circulation, helping to relieve anemia. In children with sickle cell anemia at
high risk of stroke, regular blood transfusions can decrease their risk of
Supplemental oxygen
Breathing supplemental oxygen through a breathing mask adds oxygen to
your blood and helps you breathe easier. It may be helpful if you have acute
chest syndrome or a sickle cell crisis.
Stem cell transplant
A stem cell transplant, also called a bone marrow transplant, involves
replacing bone marrow affected by sickle cell anemia with healthy bone
marrow from a donor. Because of the risks associated with a stem cell

transplant, the procedure is recommended only for people who have

significant symptoms and problems from sickle cell anemia.
Vitamin deficiency anemia is a lack of healthy red blood cells caused by
lower than normal amounts of certain vitamins. Vitamins linked to vitamin
deficiency anemia include folate, vitamin B-12 and vitamin C.
Vitamin deficiency anemia can occur if you don't eat enough folate, vitamin
B-12 or vitamin C. Or vitamin deficiency anemia can occur if your body has
trouble absorbing or processing these vitamins.
Not all anemias are caused by a vitamin deficiency. Other causes include iron
deficiency and certain blood diseases. That's why it's important to have your
doctor diagnose and treat your anemia. Vitamin deficiency anemia can
usually be corrected with vitamin supplements and changes to your diet.
Signs and symptoms of vitamin deficiency anemia include:
Shortness of breath
Pale or yellowish skin
Irregular heartbeats
Weight loss
Numbness or tingling in your hands and feet
Muscle weakness
Personality changes
Unsteady movements
Mental confusion or forgetfulness
Causes of vitamin deficiency anemias, also known as megaloblastic anemias,
Folate deficiency anemia. Folate, also known as vitamin B-9, is a nutrient
found mainly in fruits and leafy green vegetables. A diet consistently lacking
in these foods can lead to a deficiency.

An inability to absorb folate from food can also lead to a deficiency. Most
nutrients from food are absorbed in your small intestine. People with
diseases of the small intestine, such celiac disease, or those who have had a
large part of the small intestine surgically removed or bypassed may have
difficulty absorbing folate or its synthetic form, folic acid. Alcohol decreases
absorption of folate, so drinking alcohol to excess may lead to a deficiency.
Pregnant women and women who are breast-feeding have an increased
demand for folate, as do people undergoing hemodialysis for kidney disease.
Failure to meet this increased demand can result in a deficiency.
Vitamin B-12 deficiency anemia (pernicious anemia). Vitamin B-12
deficiency can result from a diet lacking in vitamin B-12, which is found
mainly in meat, eggs and milk. Vitamin B-12 deficiency anemia can also
occur if your small intestine can't absorb vitamin B-12. This may be due to
surgery to your stomach or small intestine (such as gastric bypass surgery),
abnormal bacterial growth in your small intestine, or an intestinal disease,
such as Crohn's disease or celiac disease, that interferes with absorption of
the vitamin. Vitamin B-12 deficiency can also be caused by a tapeworm
ingested from contaminated fish because the tapeworm saps nutrients from
your body. However, a vitamin B-12 deficiency is most often due to a lack of
a substance called intrinsic factor.
Vitamin C deficiency anemia. Vitamin C deficiency can develop if you
don't get enough vitamin C from the foods you eat. Vitamin C deficiency is
also possible if something impairs your ability to absorb vitamin C from food.
For instance, smoking impairs your body's ability to absorb vitamin C.
Risk factors
Risk factors for vitamin deficiency anemia vary by type of vitamin deficiency.
Folate deficiency anemia
Your risk of folate deficiency anemia may be increased if:
You're pregnant, and you aren't taking a multivitamin containing folic acid.
You have intestinal problems that interfere with absorption of folate.
You abuse alcohol because alcohol interferes with the absorption of folate.
You take certain prescription medications, such as some anti-seizure drugs,
that can block absorption of folate.
You're undergoing hemodialysis for kidney failure. Ask your doctor whether
you need supplemental folic acid to prevent a deficiency.
You're undergoing cancer treatment. Some drugs used to treat cancer can
interfere with the metabolism of folate.

You don't eat many fruits and vegetables. If your diet is greatly lacking in
fresh fruits and vegetables, or you consistently overcook your food, you may
be at risk of folate deficiency anemia.
Vitamin B-12 deficiency anemia (pernicious anemia)
Your risk of vitamin B-12 deficiency anemia may be increased if:
You don't eat meat and dairy products, foods that contain a lot of vitamin B12. Vegetarians who don't eat dairy products and vegans, who don't eat any
foods from animals, may fall into this category.
You have an intestinal disease or abnormal bacterial growth in your stomach
or have had surgery to your intestines or stomach that interferes with the
absorption of vitamin B-12.
Vitamin C deficiency anemia
Your risk of vitamin C deficiency anemia may be increased if:
You're malnourished and you're not getting the nutrients and vitamins you
You smoke. Smoking can lead to vitamin C deficiency because it decreases
the absorption of this vitamin.
You abuse alcohol. People who drink heavily don't absorb vitamin C as
effectively, putting them at risk of vitamin C deficiency anemia.
You have a chronic illness. Certain chronic illnesses, such as cancer or
chronic kidney disease, increase your risk of vitamin D deficiency anemia by
affecting the absorption of vitamin C.

Tests and diagnosis

Doctors diagnose vitamin deficiency anemias through blood tests that check:
The number and appearance of red blood cells. People with anemia have
fewer red blood cells than normal. In vitamin deficiency anemias related to a
lack of vitamin B-12 and folate, the red blood cells appear large and
underdeveloped. In advanced deficiencies, the numbers of white blood cells
and platelets also might be decreased and look abnormal under a

The amount of folate, vitamin B-12 and vitamin C in your blood. Folate and
vitamin B-12 levels are measured at the same time because these
deficiencies can cause similar signs and symptoms.
Treatments and drugs
Treatment for vitamin deficiency anemia includes supplements and changes
in diet.
Folate deficiency anemia. Treatment involves eating a healthy diet and
taking folic acid supplements as prescribed by your doctor. In most cases,
folic acid supplements are taken orally. Once your body's level of folate
increases to normal, you may be able to stop taking the supplements. But if
the cause of your folate deficiency can't be corrected, you may need to take
folic acid supplements indefinitely.
Vitamin B-12 deficiency anemia (pernicious anemia). For milder cases
of vitamin B-12 deficiency, treatment may involve changes to your diet and
vitamin B-12 supplements in pill form or as a nasal spray. Your doctor may
suggest vitamin B-12 injections, particularly if your vitamin B-12 deficiency is
severe. At first, you may receive the shots as often as every other day.
Eventually, you'll need injections just once a month, which may continue for
life, depending on your situation.
Vitamin C deficiency anemia. Treatment for anemia related to vitamin C
deficiency is with vitamin C tablets. Additionally, you increase your intake of
foods and beverages that contain vitamin C
Thalassemia (thal-uh-SEE-me-uh) is an inherited blood disorder
characterized by less hemoglobin and fewer red blood cells in your body than
normal. Several types of thalassemia exist, including alpha-thalassemia,
beta-thalassemia intermedia, Cooley's anemia and Mediterranean anemia.
Hemoglobin is the substance in your red blood cells that allows them to
carry oxygen. The low hemoglobin and fewer red blood cells of thalassemia
may cause anemia, leaving you fatigued.
Thalassemia symptoms include:
Pale appearance
Yellow discoloration of skin (jaundice)

Facial bone deformities

Slow growth
Abdominal swelling
Dark urine
Thalassemia is caused by mutations in the DNA of cells that make
hemoglobin the substance in your red blood cells that carries oxygen
throughout your body. The mutations associated with thalassemia are passed
from parents to children.
The mutations that cause thalassemia disrupt the normal production of
hemoglobin and cause low hemoglobin levels and a high rate of red blood
cell destruction, causing anemia. When you're anemic, your blood doesn't
have enough red blood cells to carry oxygen to your tissues leaving you
Types of thalassemia
The type of thalassemia you have depends on the number of gene mutations
you inherit from your parents and which part of the hemoglobin molecule is
affected by the mutations. The more mutated genes, the more severe your
thalassemia. Hemoglobin molecules are made of alpha and beta parts that
can be affected by mutations.
Four genes are involved in making the alpha hemoglobin chain. You get two
from each of your parents. If you inherit:One mutated gene, you'll have no
signs or symptoms of thalassemia. But, you are a carrier of the disease and
can pass it on to your children.
Two mutated genes, your thalassemia signs and symptoms will be mild. This
condition may be called alpha-thalassemia minor, or you may be told you
have an alpha-thalassemia trait.
Two genes are involved in making the beta hemoglobin chain. You get one
from each of your parents. If you inherit:One mutated gene, you'll have mild
signs and symptoms. This condition is called beta-thalassemia minor or
referred to as a beta-thalassemia trait.
Risk factors
Factors that increase your risk of thalassemia include:

Family history of thalassemia. Thalassemia is passed from parents to children

through mutated hemoglobin genes. If you have a family history of
thalassemia, you may have an increased risk of the condition.
Certain ancestry. Thalassemia occurs most often in people of Italian, Greek,
Middle Eastern, Asian and African ancestry.
Tests and diagnosis
Prenatal testing
Testing can be done before a baby is born to find out if it has thalassemia
and determine how severe it may be. Tests used to diagnose thalassemia in
fetuses include:
Chorionic villus sampling. This test is usually done around the 11th week
of pregnancy and involves removing a tiny piece of the placenta for
Amniocentesis. This test is usually done around the 16th week of
pregnancy and involves taking a sample of the fluid that surrounds the fetus.
Treatments and drugs
Treatment for thalassemia depends on which type you have and how severe
it is.
Treatments for mild thalassemia
Signs and symptoms are usually mild with thalassemia minor and little, if
any, treatment is needed. Occasionally, you may need a blood transfusion,
particularly after surgery, after having a baby or to help manage thalassemia
Some people with beta-thalassemia intermedia may need treatment for iron
overload. Although most people with this condition don't need the blood
transfusions that often cause iron overload, people with beta-thalassemia
intermedia may have increased digestive absorption of iron, leading to an
excess of iron. An oral medication called deferasirox (Exjade) can help
remove the excess iron.
Treatments for moderate to severe thalassemia
Treatments for moderate to severe thalassemia may include:
Frequent blood transfusions. More-severe forms of thalassemia often
require frequent blood transfusions, possibly every few weeks. Over time,
blood transfusions cause a buildup of iron in your blood, which can damage
your heart, liver and other organs. To help your body get rid of the extra iron,
you may need to take medications that rid your body of extra iron.

Stem cell transplant. Also called a bone marrow transplant, a stem cell
transplant may be used to treat severe thalassemia in select cases. Prior to a
stem cell transplant, you receive very high doses of drugs or radiation to
destroy your diseased bone marrow. Then you receive infusions of stem cells
from a compatible donor. However, because these procedures have serious
risks, including death, they're generally reserved for people with the most
severe disease who have a well-matched donor available usually a sibling.
Intensive antepartum management of SCD patients, with visits at bi-monthly
intervals for the first 20 weeks and then weekly until delivery, appears to be
the best method of preventing decompensation and crisis. During each visit
a thorough search should be made for infection and historical and physical
evidence of sickling; also, a nutritional survey should be made and diet
counseling should be provided. Vigilance for crisis is important, and the
patient should be hospitalized if pain, fever, infection, or other signs of
sickling are noted. Hematocrit and hemoglobin determinations should be
performed on each visit, since rapid reductions in these indices may occur
even in the asymptomatic patient. The RC, blood film, and serum bilirubin
determination may also be important in assessing the patient's hematologic
risk for crisis. Methods for assessment of fetal well being, such as
ultrasonography, oxytocin challenge test, nonstress test, and biophysical
profile, are also used to detect fetal jeopardy in these patients.

During labor and delivery, segmental epidural block appears to be the best
method of analgesia if performed by the obstetric anesthesiologist or skilled
perinatologist; hypotension and resultant hypoxia greatly increase the risk of
sickling. Alternatively, small amounts of meperidine or other analgesic
agents may be used with pudendal or spinal anesthesia for delivery. Oxygen
is administered at 4 L/min with the patient laboring in the semi-Fowler,
lateral recumbent position. Patients may be followed by blood smears to
detect sickling, and the fetus is assessed by continuous electronic
monitoring. Delivery is usually spontaneous at term, and cesarean sections
are performed only for obstetric indications. Oxytocin has not been found
harmful in the patient with SCD and is used when indicated.


Postpartum SCD patients are scrutinized for excess blood loss, infection, or
thrombophlebitis. Antithrombotic stockings, if properly applied, and early
ambulation are encouraged; prophylactic antibiotics are usually not
employed. Frequent visits (bi-weekly) to the clinic assure normality through
the 6-week postpartum adjustment phase. The infant should be tested using
cord blood for electrophoresis to detect heterozygotes and to identify those
with SCD so that counseling and education of the parents can effect a more
favorable outlook for the child.

Laboratory norms for the nonpregnant and pregnant patient




1315 g/dL

11.512.5 g/dL

Packed cell volume



RBC count



Mean corpuscular volume

80100 m3/cell

7090 m3/cell

General assessment


corpuscular 2734 pg/cell

2331 pg/cell

corpuscular 3136 g/dL
hemoglobin concentration


Reticulocyte count



50110 g/dL

40100 g/dL

Specific diagnostic tests

Serum iron


binding 250300 g/dL

Transferrin saturation


280400 g/dL

Serum ferritin

75100 g/L


erythrocyte 25 g/L

5570 g/L
35 g/L

sedimentation 015 mm/h

4050 mm/h

Serum folate (fasting)

6.519.6 ng/ml

510 ng/ml

Serum B12

150450 pg/ml


The laboratory assessment of anemia is more difficult during pregnancy. In

general, iron-sufficient, disease-free women with relative anemia during
pregnancy have a hemoglobin level above 11 g/dL and a PCV (or hematocrit)
above 35%. The average hemoglobin levels during pregnancy are between
11.5 and 12.5 g/dL instead of the normal 1315 g/dL found in the
nonpregnant state (see Table 1). The hemoglobin content during pregnancy
tends to be further reduced, since the derivative actually measured by most
laboratory techniques (cyanmethemoglobin) is slightly lower during
gestation. The PCV or hematocrit likewise is lower in pregnancy, averaging
3338% compared with the 3747% range associated with the normal
nonpregnant female. Since the relationship of hemoglobin level to PCV is
more erratic in pregnancy, the measurements of RBC mass and other indices
(i.e., mean corpuscular volume, MCV; mean corpuscular hemoglobin, MCH;
and mean corpuscular hemoglobin concentration, MCHC) may not be as
helpful as during the nonpregnant state. Of these, the MCV appears to be a
good discriminator of the various types of hypoproliferative anemias (Fig. 3).
All indices reflect average cell values and do not detect abnormalities in
mixed cell populations. A patient with an IDA and concomitant megaloblastic
process may reveal normal indices rather than the classic presentation of
either disease.
Iron compartments*
Iron content (mg)



Total body iron


Hemoglobin iron




Storage iron




Myoglobin iron




Labile pool




Other tissue iron


Transport iron