Anaemia
Evaluation and treatment of low haemoglobin after identifying the underlying cause
What is anaemia?
Haemoglobin is the protein in red cells that carries oxygen. When there is too little of it, every tissue gets less oxygen than it needs, which is why the tiredness is not the sort that sleep fixes.
The commonest cause by far is a shortage of iron, from blood loss or from a diet that does not supply enough. Vitamin B12 and folate deficiency, long-term illness of the kidneys or the gut, and inherited conditions such as thalassaemia trait account for most of the rest.
What you might notice
- Looking pale and tired all the time
- Tired however much you sleep
- No strength for the work you usually do
- Craving ice, mud or chalk
- Getting out of breath on stairs
- Dizzy spells or near-blackouts
How it is diagnosed
Your doctor examines the inner eyelids, the palms and the tongue for pallor, and looks for a rapid pulse and a flow murmur, which are what the heart does to compensate.
The blood count gives both the haemoglobin and the size of the red cells, and cell size points at the cause: small cells suggest iron, large cells suggest B12 or folate. Iron studies, B12 and folate levels follow. In an adult man or a woman past the menopause, iron deficiency prompts a search for where the blood is being lost.
Recovery
On iron tablets the haemoglobin starts to rise within two to three weeks and reaches normal in about two months, but treatment carries on for three months beyond that to refill the stores.
You will usually feel better before the numbers look better. Iron blackens the stool, which is harmless, and it commonly causes constipation or nausea, which is worth reporting since the dose and the preparation can be changed.
If it is left untreated
The heart compensates for low haemoglobin by beating faster and harder, and over months that strain can tip someone with existing heart disease into failure.
The more important risk is the cause. Iron deficiency in an adult who is not menstruating heavily means blood is being lost somewhere, and a cancer of the stomach or bowel is one of the possibilities that has to be excluded. Treating the anaemia without finding the cause hides it.
Questions about anaemia
Why do I need tests to find out where the blood is going?
Because iron deficiency in an adult who is not losing blood with periods means it is being lost somewhere else, most often slowly from the stomach or bowel. Correcting the iron without finding the source treats the number and leaves the cause.
Can I fix it with diet?
Diet maintains iron stores; it rarely refills them once they are empty. Established deficiency needs treatment doses, and diet keeps the level up afterwards.
Why is iron given into a vein sometimes?
Where the haemoglobin is too low to wait the two to three months tablets take, where the gut is not absorbing, or where tablets cause side effects every time. It corrects the deficit in one or two sittings.
Other general medicine treatments
One doctor for the whole family, for everyday illness, long-term conditions, check-ups and referral to the right specialist
Day CareDiagnosis and long-term medical management of diabetes, including blood sugar, lifestyle and complication monitoring
Day CareTalk to a care coordinator about anaemia
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one