Anemia

Overview

What is anemia?

Anemia is a condition that affects your red blood cells. Your red blood cells carry oxygen from
your lungs to the rest of your body. Hemoglobin is the protein in red blood cells that allows them
to carry oxygen. Your body needs iron in order to make hemoglobin.

People who have anemia dont have enough hemoglobin. The most common cause of anemia is
when your body doesnt make enough hemoglobin because it doesnt have enough iron. This is
called iron deficiency anemia.

Another common type of anemia is when your body doesnt have enough red blood cells, but the
red blood cells you do have are normal in size. This is called normocytic (say: normo-sit-tic)
anemia.

Symptoms

What are the symptoms of anemia?

Often, no symptoms = Seringkali, tidak ada gejala

Paleness = pucat
Feeling tired = Merasa lelah
Unusual shortness of breath during exercise = sesak napas biasa selama latihan
Unusual food cravings (known as pica) = mengidam makanan yang tidak biasa
(dikenal sebagai pica)
Fast heartbeat = Cepat detak jantung
Cold hands and feet = tangan dan kaki dingin
Brittle nails or hair loss = kuku rapuh atau rambut rontok
Headaches = Sakit kepala
Dizziness or lightheadedness = Pusing atau ringan

Causes & Risk Factors

What can cause low iron levels?

A number of things can cause low iron levels in your body:

 1. Diet. You may have low iron levels if you dont eat enough foods high in iron. This is
mostly a problem for children, young women who follow fad diets and people who
dont eat meat.
2. Inability to absorb iron. The iron in your food is absorbed by the body in the small
intestine. Diseases that affect your small intestines ability to absorb nutrients, such as
Crohns disease or celiac disease, may cause low iron levels in your body. Some foods or
medicines, including milk, antacids or stomach acid-lowering medicines, also can prevent
your body from absorbing iron.

Infants who drink cow's milk in the first year of life are at risk for iron deficiency anemia.
Its the most common dietary cause of iron deficiency in infants. Cows milk does not
have enough of the iron infants need to grow and develop. Do not give cow's milk to your
infant in the first year of life. Breastfed infants who do not eat iron-rich foods like iron-
fortified cereal or take an iron supplement after the fourth month of life are also at risk of
iron deficiency anemia.
3. Pregnancy. Women who are pregnant or who are breastfeeding need more iron than
women who are not pregnant or breastfeeding. That's why pregnant women often are
tested for anemia and why they need to eat more iron-rich foods or take a daily iron pill.

When you're pregnant, your body makes more blood to share with your baby. You may have up
to 30% more blood than when youre not pregnant. If you dont have enough iron, your body
can't make the red blood cells that it needs to make this extra blood.

The following may increase your risk of anemia during pregnancy:

Vomiting a lot from morning sickness

Not getting enough iron-rich foods
Having heavy periods before pregnancy
Having 2 pregnancies close together
Being pregnant with twins, triplets or more
Becoming pregnant as a teenager
Losing a lot of blood (for example, from an injury or during surgery).

If you are pregnant and are not getting enough iron, you are at risk of developing iron-deficiency
anemia.

4. Blood loss. Heavy periods may cause low iron levels in women. Internal bleeding, usually in
the digestive tract, also can cause blood loss. A stomach ulcer, ulcerative colitis, cancer, or taking
aspirin or similar medicine for a long time can cause bleeding in your stomach or intestines.

5. Genetic diseases. If you have sickle cell disease or thalassemia, your body has trouble
producing healthy red blood cells, which can lead to anemia. Youre also at risk of passing these
diseases on to your unborn baby. If you or someone in your family has one of these diseases, talk
to your doctor about how to prevent or treat anemia while youre pregnant.

What causes normocytic anemia?

Normocytic anemia can be a problem you were born with (called congenital) or it can be caused
by an infection or disease (called acquired).

The most common cause of the acquired form of normocytic anemia is a chronic (long-term)
disease. Chronic diseases that can cause normocytic anemia include kidney disease, cancer,
rheumatoid arthritis and thyroiditis. Some medicines can cause you to have normocytic anemia,
but this does not happen often.

Diagnosis & Tests

How is anemia diagnosed?

Talk to your doctor if you think you might have anemia. To diagnose anemia, your doctor will
probably test your blood. If you have anemia, your doctor may need to do other tests to find out
what's causing it.

Normocytic anemia is most often found by routine tests that are part of a physical exam. It
might be found by a blood test you get for some other reason. A complete blood count (also
called a CBC) can show if you have normocytic anemia.

If your CBC shows a low number of normal-sized red blood cells, your doctor might want you to
get more tests to see what is causing the anemia. If you were born with it, other family members
may also need to be tested.

Should I be tested for anemia if Im pregnant?

During your first prenatal visit, youll have a blood test to check for anemia. Even if you dont
have anemia during your early pregnancy, your doctor will probably want to check you again in
your second or third trimester.

Treatment

How is anemia treated?

Treatment depends on what's causing your anemia. For example, if anemia results from losing
too much blood, your doctor will need to treat the cause of your blood loss. If anemia results
from your diet being too low in iron, your doctor may recommend a change in your diet or iron
pills.
Tips on taking iron pills

Take the pills with food.

Start slowly. Try taking 1 pill a day for 3 to 5 days, then 2 pills a day until you aren't
bothered by that amount. Increase the number of pills until you're taking the amount your
doctor recommended.
Increase the fiber in your diet if you have constipation. This is worth trying, even though
fiber may get in the way of how well your body can absorb iron. You'll still be able to
absorb some iron, and it's better than not taking any iron if you need it.
Don't take iron pills at bedtime if they upset your stomach.
If one type of iron pill causes problems, talk to your doctor about trying a different
formula or brand.

How is normocytic anemia treated?

Managing the condition that is causing the anemia is the most important part of treating it. This
might mean you would stop taking a particular medicine, or your doctor might treat a chronic
illness or look for something that is causing you to lose blood cells.

If your normocytic anemia is very bad, you might get shots of erythropoietin. Erythropoietin
(say: air-rith-ro-po-et-in) helps your bone marrow make more red blood cells.

How is anemia treated in children?

If your child is breastfed, talk to your doctor about adding some form of iron, such as
iron-fortified cereal or vitamin drops with iron, to your child's diet starting at 4 to 6 months of
age.

Complications

What problems can iron deficiency anemia cause in my child?

Iron deficiency anemia can cause your infant or toddler to have mental, motor or behavior
problems. These problems can be long lasting even after treatment fixes the anemia.

What problems does anemia cause during pregnancy?

If anemia isnt treated, it can increase your risk of having your baby too early or having a baby
who doesnt weigh enough. Youll also be at risk of needing a blood transfusion if you lose a lot
of blood during delivery. Anemia may also be associated with postpartum depression (depression
after delivery) in new mothers.

Rarely, mothers who have severe iron-deficiency anemia may pass along problems associated
with low iron to their babies. This can lead to growth problems and mental delays. However,
developing babies usually take as much iron as they need from their mothers. Getting treatment
for your iron-deficiency anemia can almost always prevent these problems.

Can iron pills cause problems?

Iron pills can cause stomach upset, heartburn and constipation. Be sure to talk to your doctor
before you take extra iron pills or vitamins. Lack of iron in your diet may not be the cause of
your anemia and too much iron is not good for you. If your doctor prescribes iron supplements,
be sure to tell your doctor about any discomfort you notice.

Prevention

Can anemia be prevented?

Some types of anemia can be prevented, such as those caused by diet. You can help prevent this
type of anemia by increasing the amount of iron in your diet.

How can I increase the iron in my diet?

Eat more foods that are high in iron. Your body best absorbs iron that comes from meat. Eating a
small amount of meat along with other sources of iron, such as certain vegetables, can help you
get even more iron out of these foods. Taking vitamin C pills or eating foods high in vitamin C,
such as citrus fruits or juice, at the same time you eat iron-rich foods or take your iron pill can
also help your body absorb the iron.

Some foods prevent your body from absorbing iron, including coffee, tea, egg whites, milk, fiber
and soy protein. Try to avoid these foods when you're eating food high in iron.

Foods high in iron

Liver
Red meat
Seafood
Dried fruits such as apricots, prunes and raisins
Beans, especially lima beans
Green leafy vegetables, such as spinach and broccoli
Iron-fortified foods like many breads and cereals (check the label)

How can I prevent iron-deficiency anemia during pregnancy?

You cant always prevent anemia during pregnancy, but eating foods rich in iron can help.
Doctors recommend that pregnant women eat at least 27 mg of iron daily. Most doctors also
recommend that pregnant women take a supplement that contains 30 mg of iron each day. (Most
prenatal vitamins contain at least this amount.)

Foods with vitamin Csuch as strawberries and citrus fruitshelp your body absorb iron. Eat
these foods with foods that are high in iron to help with absorption. For example, if youre taking
an iron pill, take it with orange juice or another food high in vitamin C. Some foods can block
iron absorption. These include milk, soy protein, egg yolks, coffee and tea. Avoid these foods
when eating iron-rich foods. Antacids and some other medicines that contain calcium also block
iron absorption. Your doctor can tell you more about which medicines to avoid if youre trying to
boost your iron levels.

How do I prevent iron-deficiency anemia in my child?

If you use iron-fortified formula, do not give your child vitamin drops with iron. This
combination provides too much iron and is not healthy. If you decide to stop breastfeeding before
your infant is 12 months of age, use iron-fortified formula. Do not use low-iron formula.

After your child is 12 months old, if you stop breastfeeding or using iron-fortified formula, you
should feed your toddler meat, chicken, fish, whole grains, enriched bread and cereal, dark green
vegetables, and beans. Vitamin C is also important because it helps the body absorb iron. You
should limit your child to less than 24 oz of cow's milk per day. (That's 3 cups of milk.) You
might try giving your child yogurt and cheese. Ask your doctor if you should continue to give
your child vitamins with iron.

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