anemia

and Sabine Schrör, medical journalist

Hanna Rutkowski is a freelance writer for the medical team.

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Sabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.

More about the experts All content is checked by medical journalists.

In anemia (anemia), there is a lack of red blood pigment (hemoglobin). Signs of this are paleness, reduced performance, poor concentration and an increased susceptibility to infections. Because of their menstrual bleeding, women are much more likely to suffer from anemia than men. However, the anemia can also have serious causes that must be treated by a doctor. Read more about the causes and symptoms of anemia here.

Brief overview

• What is anemia (anemia)? decreased concentration of hemoglobin. This is the iron-containing dye in the red blood cells that binds the oxygen to be transported.
• Causes: disorders of blood formation (e.g.iron deficiency, folic acid deficiency, vitamin B12 deficiency, kidney weakness or inflammation), internal or external bleeding (e.g. bleeding stomach ulcer, open wound), increased breakdown of red blood cells (e.g. due to genetic defects, drugs, chemicals or infections), blood distribution disorders ( for example with a greatly enlarged spleen).
• Symptoms: dizziness, headache, reduced mental and physical performance, shortness of breath, ringing in the ears, pale skin and mucous membrane, smooth red tongue (lacquer tongue). Depending on the type of anemia, there may be other symptoms such as brittle nails and inflamed corners of the mouth in iron deficiency anemia; Burning tongue, memory and digestive disorders in vitamin B12 anemia, jaundice in hemolytic anemia.
• When to the doctor Always if anemia is suspected, especially if blood appears in stool or vomit.
• Diagnosis: blood test (e.g. measurement of hematocrit, hemoglobin, number of erythrocytes, MCV, ferritin, reticulocytes, inflammation values). If the cause of the anemia is still unclear, additional examinations (such as occult blood test, gastroscopy / colonoscopy, bone marrow diagnostics).
• Treatment: depending on the cause and severity of the anemia, e.g. iron preparations for iron deficiency, hormone preparations with hematopoietic erythropoietin for renal anemia, blood transfusion for severe anemia, stop bleeding, removal of the spleen for severe hemolytic anemia, stem cell transplantation for severe sickle cell anemia.

What is anemia

From a medical point of view, a decreased hemoglobin concentration in the blood is the main characteristic of anemia. The pigment hemoglobin is the most important component of the red blood cells (erythrocytes): The iron-containing protein transports oxygen from the lungs to the body cells. On the way back, it takes carbon dioxide (CO2), which is produced as a waste product in the cell metabolism, into the lungs. There CO2 can be exhaled.

In anemia, there is too little hemoglobin so that the body cells can no longer be adequately supplied with oxygen.

Anemia: types

Medical professionals differentiate between different types of anemia, depending on the shape and appearance of the red blood cells under the microscope and how much hemoglobin they contain:

• Microcytic, hypochromic anemia: the red blood cells are too small and contain too little hemoglobin. A typical example of this form of anemia is iron deficiency anemia.
• Macrocytic, hyperchromic anemia: In this case, the red blood cells are too large and contain plenty of hemoglobin. In this way they can transport enough oxygen, but are broken down too early in the spleen. This form of anemia occurs when there is a folic acid deficiency or vitamin B-12 deficiency. So-called pernicious anemia also belongs to this group.
• Normocytic, normochromic anemia: This form of anemia is triggered by excessive blood loss. The red blood cells are normal in size and otherwise normal.

What is anemia

When anemia is present, there are fewer red blood cells in the blood. They can also be abnormally small or large.

Anemia: causes

There are several possible causes of anemia. Due to certain genetic defects, it can already be congenital and lead to life-threatening complications even in small children. In other cases, anemia is only acquired in the course of life, for example through poor, unbalanced diet. Often it is also a secondary finding of chronic diseases. In addition, anemia can occur more frequently in old age as a result of slower regeneration processes.

Overall, anemia can be divided into the following groups according to the mechanism of origin:

Anemia due to blood disorders

Blood formation is a sensitive process that can be disturbed at various stations. The origin of the blood lies in the bone marrow: This is where the various types of blood cells, including precursors of red blood cells, are created from so-called stem cells with the help of a wide variety of messenger substances (hormones).

A deficiency in building blocks, hormones or vitamins, but also diseases of the bone marrow such as inflammation or leukemia (blood cancer) can impair blood formation. Then not fully functional red blood cells are formed, which cannot adequately ensure the transport of oxygen.

The most common forms of anemia are caused by such a bleeding disorder:

• Iron deficiency anemia: Iron is an indispensable component of hemoglobin. Iron deficiency can therefore cause anemia. The iron deficiency is usually caused by chronic bleeding, for example with prolonged or very heavy menstrual bleeding or a bleeding stomach ulcer (especially if it goes undetected). In other cases, iron deficiency anemia is also due to insufficient iron being supplied to the body with food, iron absorption in the intestine is impaired or the iron requirement is increased (e.g. during pregnancy and breastfeeding).
• Folic acid deficiency anemia: Folic acid is essential for cell division and blood formation. The vitamin is particularly found in various types of cabbage (broccoli, etc.), spinach, asparagus and lettuce. Corresponding malnutrition can therefore cause folic acid deficiency anemia. This form of anemia can develop even with severe alcohol abuse. It is a macrocytic, hyperchromic anemia.
• Vitamin B12 deficiency anemia: Among other things, vitamin B12 (cobalamin) is important for the formation of new cells and the metabolism of various protein building blocks (amino acids). A deficiency usually arises from a disturbed absorption of the vitamin in the body, for example in the case of chronic inflammation of the gastric mucosa (chronic gastritis) or celiac disease. As with folic acid deficiency, macrocytic, hyperchromic anemia then develops.
• Pernicious anemia: This special form of vitamin B12 deficiency anemia can result from an autoimmune disease, damage to the gastric mucosa, partial removal of the stomach or worm infestation of the intestine. In the autoimmune variant, the body's own defense system is directed against the cells of the gastric mucosa and destroys them. As a result, less of the so-called intrinsic factor, which plays an important role in the absorption of vitamin B12, is formed.
• Renal anemia: This type of anemia occurs when the kidneys do not produce enough erythropoietin due to a functional weakness. This hormone stimulates the production of red blood cells in the bone marrow, which is why a deficiency leads to anemia. Kidney weakness can be the result of chronic kidney disease or kidney damage. The resulting renal anemia is usually exacerbated by a shortened lifespan of the red blood cells and the blood washes (dialysis) that are often required in patients with chronic kidney disease.
• Aplastic anemia: Here the production of all blood cells (red and white blood cells, blood platelets) is reduced. The reason is a dysfunction of the bone marrow, which can be congenital (e.g. Fanconi anemia) or acquired (e.g. from drugs, toxins, ionizing radiation or certain infectious diseases).
• Thalassemia: As a result of a genetic defect, the formation of hemoglobin is disturbed here - and with it the production of red blood cells. In addition, the erythrocytes formed are reduced in size and have a shortened lifespan. Thalassemia belongs to the group of microcytic, hypochromic anemia.
• Anemia as a result of other diseases: Anemia caused by inflammation, viral infections, cancer (such as leukemia), chemotherapy or autoimmune diseases are often misunderstood. Chronic diseases in particular are among the most common causes of anemia. Depending on their severity, they can interfere with blood formation to different degrees and lead to small-cell anemia.

Bleeding anemia

Blood loss occurs when blood leaks from an external or internal wound. For example, someone with an open injury can lose so much blood as a result of an accident that they become anemia. But even small sources of bleeding can lead to chronic blood loss, which over time can develop into anemia. This can be the case, for example, with an undetected bleeding stomach ulcer or hemorrhoids.

Anemia due to acute or chronic bleeding is also called bleeding anemia.

Anemia due to increased erythrocyte breakdown

So-called hemolytic anemia is what doctors call anemia, which is caused by the increased breakdown or disintegration of red blood cells. The lifespan of the erythrocytes from normally 120 days is reduced to less than 30 days.

This may be due to the red blood cells themselves (corpuscular hemolytic anemia). This means that the erythrocytes usually have a genetic defect and are therefore broken down prematurely. This is the case with sickle cell anemia: here the red blood cells are not - as is usually the case - disk-shaped and slightly dented on both sides, but sickle-shaped. They clump together easily and are increasingly broken down in the spleen. Another example is spheroid cell anemia with spherical erythrocytes.

In extracorpuscular hemolytic anemia, the cause lies outside the erythrocytes. For example, the red blood cells can be destroyed mechanically, for example by artificial heart valves. In other cases, chemicals, drugs, immune reactions, or infectious agents (such as malaria pathogens) are responsible for the excessive breakdown of erythrocytes.

Distribution disorder anemia

Occasionally, anemia can be due to a distributional disorder. For example, in people with a greatly enlarged spleen (hypersplenism), so much blood can collect in the organ that there is a lack of erythrocytes in the rest of the body.

Anemia: symptoms

Not only does anemia have many causes, it is also associated with numerous symptoms that are not always clear. However, symptoms that result from the insufficient supply of oxygen to the body are typical of all anemias:

• dizziness
• headache
• decreased mental and physical performance
• Difficulty breathing (dyspnea) during exertion, in advanced anemia also at rest
• Palpitations and ringing in the ears
• pale skin, conjunctiva and mucous membrane
• red, smooth tongue (so-called lacquer tongue)

Depending on the type of anemia, there may be other symptoms. Some examples:

• Iron deficiency anemia: brittle hair and nails, inflamed corners of the mouth and mucous membranes
• Pernicious anemia / vitamin B12 deficiency anemia: memory disorders, loss of appetite, burning tongue, digestive disorders such as constipation or diarrhea, weight loss
• Haemolytic anemia: jaundice (jaundice) with yellow skin and yellowish color of the originally white area in the eye
• Internal bleeding anemia: black stool (tarry stool or melena) or red blood in the stool or urine, circulatory collapse, low blood pressure, high heart rate

Anemia: when to see a doctor?

If you think you have anemia, you should see a doctor quickly. This is especially true if you see blood in your stool, urine, or vomit. There is then presumably serious internal bleeding. People with underlying diseases (heart disease, diabetes, etc.) should also see a doctor immediately if they show signs of anemia: the anemia can put additional strain on and weaken the sick body.

Anemia: what does the doctor do?

If you suspect anemia, the doctor will draw blood from you so that it can be examined more closely in the laboratory. During this blood test, the following parameters are particularly important:

• Hematocrit: The hematocrit value indicates the ratio of solid cells to the liquid part of the blood. In healthy people, the cells make up around 40 to 50 percent of the blood. In anemia, on the other hand, the hematocrit value is lowered.
• Number of erythrocytes: If the number of red blood cells is decreased, it could be caused by a hematopoietic disorder.
• Hemoglobin: If you are anemic, your hemoglobin (Hb) level is too low.
• MCV (mean corpuscular volume): The MCV indicates the average volume of a red blood cell. MCV is decreased in microcytic anemia, increased in macrocytic anemia, and normal in normocytic anemia.
• MCH (mean corpuscular hemoglobin): It indicates the average hemoglobin content of an erythrocyte. If the erythrocyte has too little hemoglobin, it is called hypochromic anemia. If the hemoglobin content is increased, this indicates hyperchromic anemia. If there is anemia even though the MCH values ​​are normal, this is referred to as normochromic anemia.
• Serum ferritin: This is the most important laboratory value for assessing iron stores. If it is humiliated, there is an iron deficiency.
• Reticulocytes: These are the young progenitor cells of the red blood cells. If their number is increased, this can indicate anemia that has existed for a long time, anemia due to impaired blood formation or an increased breakdown of erythrocytes.
• Inflammation values: These include the rate of sedimentation, CRP (C-reactive protein) and the number of white blood cells. If, for example, an inflammatory disease is the cause of the anemia, this is reflected in increased inflammation values.

If the cause of the anemia is unclear, the doctor may do additional tests:

• Occult blood test: This tests whether traces of blood can be detected in the stool that cannot be seen with the naked eye. Such occult blood indicates small bleeding in the digestive tract.
• Endoscopy: With a gastroscopy and colonoscopy, sources of bleeding in the digestive tract can be identified and breast-fed at the same time.
• Bone marrow diagnostics: It enables the doctor to identify serious anemia with bone marrow disorders (such as aplastic anemia). Certain forms of leukemia, which are often associated with anemia, can also be determined by means of an analysis of the bone marrow cells.

Anemia: treatment

Treatment for anemia depends on the cause and severity of the anemia. Some examples:

• If there is a lack of iron, vitamin B12 or folic acid, the deficit is compensated for with appropriate medication, such as iron or folic acid tablets. However, only take such supplements on the recommendation of a doctor (especially iron supplements).
• If malnutrition plays a role (such as folic acid deficiency, iron deficiency) in the development of anemia, it is advisable to adjust the diet.
• If bleeding is the cause of the anemia, it must be stopped. For example, a bleeding gastric ulcer can be treated surgically. If the blood loss is very great, the patient is given infusions with concentrated red blood cells ("blood transfusion").
• Patients with renal anemia who have kidney disease are given erythropoietin to make up for the lack of blood-forming hormone.
• In severe cases of hemolytic anemia, it may be necessary to remove the spleen - the organ that is responsible for breaking down red blood cells.
• A stem cell transplant can help in severe congenital forms of anemia such as sickle cell anemia.

Anemia: You Can Do It Yourself

Eating a balanced diet can help prevent certain forms of anemia. For example, make sure that you get enough folic acid with your food. Larger amounts of the vitamin can be found in beans, asparagus, spinach, lettuce, white cabbage and liver. Folic acid is particularly important during pregnancy. Therefore, expectant mothers are recommended to take folic acid supplements.

Foods with vitamin B12 should also be on your menu on a regular basis. These include fish, meat, eggs and dairy products.

A sufficient supply of iron is particularly important for women: because of menstruation, part of the important trace element is regularly lost. Especially women with heavy, prolonged menstrual bleeding (menorrhagia) often develop iron deficiency anemia. But athletes are also prone to iron deficiency, as they excrete more iron with their sweat. Iron-rich foods like liver, red meat, parsley, whole grains, legumes, sesame seeds, and nuts can help meet your iron needs.

To support the absorption of iron in the intestines, you should combine foods containing iron with sources of vitamin C. For example, add a dash of lemon juice to the salad dressing or drink a glass of orange juice with the pork schnitzel or whole grain rice. This is how you can prevent iron deficiency anemia.

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