What is Anaemia?

Anaemia is a medical term that describes low levels of haemoglobin or red blood cell count. The role of red blood cells is to deliver oxygen from the lungs and remove carbon dioxide. Oxygen is required to keep the body alive and functioning. Haemoglobin is a protein found in the red blood cell needed to transport oxygen.

What is Considered Anaemia?

Anaemia is diagnosed by assessing the level of haemoglobin in the blood. Depending on characteristics, such as your age and sex, your blood tests will be compared to a reference range to determine whether you may be anaemic. The World Health Organisation describes anaemia as haemoglobin levels lower than [1]:

130 g/L in men
120 g/L in women
110 g/L in pregnant women and preschool children

How Many People have Anaemia?

About one in three people around the world have anaemia. Most cases are asymptomatic and require no treatment [2]. In Australia, women and indigenous individuals are the most at risk population for having anaemia. According to Australian research [2], around 1 in 10 women who don't take iron supplements, and 18-55% of indigenous men and women are anaemic. The Royal Children's Hospital notes that around 100,000 Australian pre-schoolers also live with this condition [3].

Types of Anaemia

There are several types of anaemia that can occur for different reasons, such as autoimmune problems or a lack of micronutrients (e.g. iron, vitamin B12, etc.). These include:

Sickle cell anaemia
Aplastic anaemia
Macrolytic anaemia
Pernicious anaemia
Normolytic anaemia
Megaloblastic anaemia
Iron deficiency anaemia

Anaemia Symptoms

Those with milder cases of anaemia may not experience any signs and/or symptoms. Many times, anaemia may be incidentally diagnosed after undergoing blood tests for other reasons. Due to the reduced oxygen circulation through the body from lower levels of red blood cells or haemoglobin, symptoms of anaemia are often non-specific. Examples of symptoms include [4]:

Fatigue or low energy
Tiredness
Shortness of breath
Feeling faint
Dizziness or light-headedness
Weakness
Faster or abnormal heart rates
Headaches
Ringing in ears
Altered tastes and cravings

Anaemia Causes

There are many causes of anaemia, including [2]:

Blood loss from surgery, trauma, heavy menstrual bleeding, internal bleeding, etc.
Lack of consumption or absorption of micronutrients, such as folate, vitamin B12 and iron (e.g. iron deficiency, macrolytic, pernicious, megaloblastic anaemia, etc.).
Autoimmune disorders of the bone marrow (where red blood cells are produced), such as aplastic anaemia
Other chronic conditions, such as kidney disease, cancer, infections, heart disease and rheumatoid arthritis
Inherited conditions, such as sickle cell anaemia
Certain drugs and medications

Tests and Diagnosis

If you suspect that you may have anaemia, please consult a GP for a diagnosis and/or further testing. A medical screening involving questioning, a review of your medical history and/or a physical examination may be required.

Blood Test

Your GP will require a blood test to check for your blood cell count and haemoglobin levels [1] to diagnose anaemia. Further tests may also be performed to examine for potential causes of anaemia, including levels of folate, iron, vitamin B12 and the size of the red blood cells.

Additional Tests

Given a large number of causes for anaemia, your GP may also need to perform additional tests to determine whether other chronic conditions or illnesses (e.g. kidney disease, internal bleeding, etc.) may be responsible. Your GP may recommend tests, including urine tests, colonoscopy, faecal tests, and bone marrow biopsies.

Anaemia Treatment

For an appropriate treatment plan, your GP must perform the necessary tests to identify the reason for your anaemia. There is no single treatment that will help with all types and causes of this condition.

Dietary Changes

Those with anaemia related to iron deficiency may benefit from increasing your dietary intake of iron. Foods, such as red meat, eggs, fish, fortified cereal and bread, dark leafy green vegetables (e.g. spinach, broccoli, etc.) and nuts [1]. Additionally, the consumption of foods that contain specific vitamins and minerals, such as vitamin B12 and folate, may also be beneficial for certain forms of anaemia.

Taking Supplements

Suppose dietary changes alone are not enough to increase iron levels sufficiently. In that case, your GP may recommend taking supplements (e.g. iron, folate, vitamin B12, etc.) as tablets, liquids or intravenously [1].

Intravenous (IV) Therapies

Intravenous (IV) therapies involve delivering fluids, nutrients and medications through your vein. There are several benefits of intravenous delivery, such as having a rapid effect and minimising the breakdown of the treatment. Examples of common IV treatments for anaemia include iron therapy and blood transfusions.

Other Treatments

Depending on the reason for your anaemia, your GP may recommend other treatments to help improve your symptoms, red blood cell count and/or haemoglobin. Suppose you have an underlying condition that is causing your anaemia (e.g. kidney disease, cancer, etc.). In that case, you may need treatment for this first. Other anaemia treatments include:

Oxygen therapy
Antibiotics (if an infection is the cause)
Medications
Bone marrow transplantation
Surgery

Recovery

Recovery will depend on the nature of the anaemia and the person's overall health. When the underlying cause is treated appropriately and early, most people should be able to make a recovery, improve their blood tests and help resolve symptoms [2]. To ensure a quick recovery, consult your GP as soon as possible.

Complications

Anaemia can be dangerous if left undiagnosed and untreated. It can lead to organ failure and even death if it is severe or persists for a long time. Prompt treatment is pivotal for preventing complications and increases the chances of a positive outcome. Pregnant women commonly experience anaemia which can lead to several complications, including increased risks of premature birth, more blood loss during delivery and impacting the baby's health. About 25% of Australian pregnant women are affected by anaemia, primarily because of low iron levels [5]. Children with anaemia are also at risk of long-term issues, such as impaired physical, cognitive, behavioural and mental development [6]. On the opposite spectrum, older Australians with anaemia are at an elevated risk of heart complications, such as angina, heart attacks and irregular heartbeats. Other complications associated with anaemia include significant fatigue and restless leg syndrome.

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References

Pasricha, S. R. S., Flecknoe‐Brown, S. C., Allen, K. J., Gibson, P. R., McMahon, L. P., Olynyk, J. K., ... & Robinson, K. L. (2010). Diagnosis and management of iron deficiency anaemia: a clinical update. Medical Journal of Australia, 193(9), 525-532.
Turner J, Parsi M, Badireddy M. Anemia. [Updated 2022 Jan 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499994/
https://www.rch.org.au/clinicalguide/guideline_index/Anaemia/
https://www.lifeblood.com.au/patients/reasons-for-a-transfusion/anaemia
Frayne, J., & Pinchon, D. (2019). Anaemia in pregnancy. Australian journal of general practice, 48(3), 125-129.
Saloojee, H., & Pettifor, J. M. (2001). Iron deficiency and impaired child development. BMJ (Clinical research ed.), 323(7326), 1377–1378. https://doi.org/10.1136/bmj.323.7326.1377

Anaemia- Symptoms, Diagnosis, and Treatment