anaemia

Anaemia is a condition that occurs when there is a reduced number of red blood cells or concentration of haemoglobin.There
are several different types of anaemia, and each one has a different
cause. The most common form of the condition is iron-deficiency
anaemia. This is where your body lacks enough iron to keep the red
blood cells functioning properly.Iron is a key component of
haemoglobin, the substance that helps to store and carry the oxygen in
red blood cells. If there is a lack of iron in your blood, your organs
and tissues will not get as much oxygen as they usually do.Other
forms of anaemia can be caused by a lack of vitamin B12 or folate in
your body. This article concentrates on iron-deficiency anaemia. Treatment
for iron-deficiency anaemia is usually very effective, and the
condition rarely causes any serious complications. Your blood may need
to be monitored every few months after your diagnosis to check that you
are responding to treatment and that your iron levels have returned to
norma
Symptoms of anaemia

The most common symptoms of iron deficiency anaemia include:

• tiredness,
  
• lethargy,
  
• shortness of breath (dyspnoea), and
  
• palpitations (irregular heart beat).
  

Less common symptoms of iron deficiency anaemia include:

• headache,
  
• ringing in your ears (tinnitus),
  
• an altered sense of taste,
  
• a desire to eat non-food items, such as ice, paper, or clay (pica),
  
• sore tongue, and
  
• difficulty swallowing (dysphagia).
  

You may also notice changes in your physical appearance. For example, signs that you may have iron deficiency anaemia include:

• pale complexion,
  
• abnormally smooth tongue (atrophic glossitis),
  
• painful ulcers on the corners of your mouth (angular chelosis),
  
• dry, flaking nails, and
  
• spoon-shaped nails.
  

Many
people with iron deficiency anaemia will only display a few signs or
symptoms of the illness. The severity of your symptoms may also depend
on how quickly your anaemia develops. For example, if your anaemia is
being caused by a chronic (long-term) slow loss of blood, such as a
stomach ulcer, then you may notice very few symptoms
Causes of anaemia
Iron deficiency anaemia occurs when the body does not have enough iron.A lack of iron in your body can be caused by a variety of factors. Some of these factors are outlined below.Gastrointestinal blood loss

Your
gastrointestinal tract is made up of your stomach and your intestines,
and is the part of your body responsible for digesting food.Bleeding
in the stomach and intestines is the most common cause of iron
deficiency anaemia in men, and is also the most common cause for women
who have been through the menopause.Some of the causes of gastrointestinal bleeding are outlined below.Non-steroidal anti-inflammatory drugs (NSAIDs)

If
used for a prolonged period of time, in high doses, NSAIDs can
sometimes cause bleeding in the stomach. Ibuprofen and aspirin are
examples of commonly prescribed NSAIDs.If your GP suspects your
medication is causing gastrointestinal bleeding, they may be able to
prescribe you an alternative medicine which is less harmful to your
stomach and intestines. However, you should never stop taking a
medicine unless your GP specifically advises you to.Stomach ulcers

Sometimes,
the acid in your stomach (which usually helps your body to digest food)
can eat into your stomach lining. When this happens, the acid forms an
ulcer.A stomach ulcer can occasionally cause your stomach lining
to bleed. In some cases, this may cause you to vomit blood, or to pass
blood in your stools. However, if the ulcer is slow-bleeding, you may
not display these symptoms. Either way, the blood loss from the stomach
can cause you to develop anaemia.Cancer

In some
rare cases, gastrointestinal bleeding can be caused by cancer, usually
of the stomach, or colon. This is why your GP will be very careful when
diagnosing the cause of your anaemia, to check for any possible signs
of cancer.If your GP suspects that cancer may be a cause of your
gastrointestinal bleeding, you will be immediately referred to a
gastrointestinal specialist for a more thorough examination. This way,
if cancer is found, it can be diagnosed and treated as quickly as
possible.Menstruation

Menstruation is the most
common cause of iron deficiency anaemia in women who have yet to go
through the menopause. Usually, only women with particularly heavy
periods develop iron deficiency anaemia. If you have heavy bleeding
over several consecutive menstrual cycles, it is known as menorrhagia.Pregnancy

It
is very common for women to develop iron deficiency during pregnancy.
This is because your body needs extra iron so that your baby has a
sufficient blood supply, and receives all of the necessary oxygen and
nutrients. Many pregnant women require an iron supplement, particularly
from the 20th week of pregnancy.Diet

Unless you
are pregnant, it is very rare for iron deficiency anaemia to be caused
solely by a lack of iron in your diet. People most at risk from iron
deficiency anaemia, as a result of their diet, are elderly people and
vegans. However, even the most iron-poor diets rarely cause iron
deficiency anaemia.Pregnant women may have to increase the
amount of iron-rich food they consume during their pregnancy in order
to help avoid iron deficiency anaemia
Complications of anaemia

Iron
deficiency anaemia rarely causes any serious or long-term
complications. However, some people with iron deficiency anaemia do
find that it impacts on their daily life. Some of the more common
complications are outlined below.Tiredness

As
iron deficiency anaemia can leave you tired and lethargic, you may find
that you are less productive and active at work. Your ability to stay
awake and focus can be reduced, and you may not feel able to exercise
regularly.Immune system

Research has shown that
iron deficiency anaemia can affect your immune system, making you more
susceptible to illness and infection.Pregnancy

Pregnant
women who are severely anaemic are at increased risk of developing
complications, particularly during and after the birth. Research
suggests that babies born to anaemic mothers are more likely to be born
prematurely, or have a low birth weight. Babies affected by iron
deficiency anaemia, may also go onto suffer problems with their iron
levels themselve
Treating anaemia
Iron supplementsIron deficiency anaemia is usually treated by replacing the iron that is missing from your body.Your
GP will prescribe you an iron supplement to help restore the iron which
is missing from your body. The most commonly prescribed supplement is
ferrous sulphate. This supplement is taken orally, up to three times a
day.Most people will not experience any side effects when taking
iron supplements. However, in some cases, ferrous sulphate may upset
your stomach causing sickness, heartburn, constipation, and diarrhoea.
This supplement can also turn your stools black. However, taking this
medicine with, or shortly after, food will help to minimise any side
effects.If you find that ferrous sulphate is not suitable for
you because of the side effects, you may be prescribed a different iron
supplement known as ferrous gluconate. This supplement should produce
fewer side effects because it contains a less concentrated dose of
iron. However, this does mean it may take longer for the levels of iron
in your body to be restored.Safe storage of iron supplementsIf
you have young children, it is very important that you keep your iron
supplements safely stored away, and out of their reach. This is because
an overdose of iron supplements in a young child has a toxic effect and
can be fatal.Dietary adviceIf a dietary
lack of iron is thought to be contributing to your iron deficiency
anaemia, then your GP will give you advice on ways that you can change
your diet to include more iron.Iron-rich foods include:

• dark green leafy vegetables (such as spinach),
  
• iron-fortified bread,
  
• beans,
  
• nuts,
  
• meat,
  
• apricots,
  
• prunes, and
  
• raisins.
  

should include foods from all the major food groups in your diet.
However, those with iron deficiency anaemia should also make sure that
they eat plenty of iron-rich foods, such as those listed above.If
you are still struggling to include iron in your diet, you may be
referred to a dietician. A dietician will be able to give you more
detailed, personalised guidance about how you can change your diet.Underlying causesYour
GP will also have to make sure that the underlying cause of your
anaemia is treated, to help ensure that your condition does not become
a recurrent problem.For example, if non-steroidal
anti-inflammatory drugs (NSAIDs) are causing bleeding in your stomach,
your GP may prescribe an alternative type of medicine, which will help
minimise the risk of stomach bleeding. Heavy periods (menorrhagia) can
also be treated in a number of ways, using both medicines and special
internal devices. MonitoringYour GP
will ask you to return for a check up, two to four weeks after you have
started taking your iron supplements. At this check-up, your GP will be
able to assess whether you have responded to treatment. They will do
this by taking a further blood test so that your haemoglobin levels can
be checked again.If your blood test shows an improvement, you
will be asked to return in 2-4 months time for a further blood test to
ensure that your haemoglobin levels have returned to normal.Once
your haemoglobin and red blood cell levels are normal, your GP will
usually advise that you continue taking iron supplements for three
months to help replenish the iron stores in your body. After this,
depending on the cause of the iron deficiency anaemia, you should be
able to stop taking the supplements. Your condition will then be
monitored every three months for one year.If your iron levels do
not improve, your GP will ask you about how regularly you have been
taking your iron supplements. Some people are put off from taking the
medication because of the side effects (see 'iron supplements' above),
but not taking the supplements will mean that your condition will not
improve.If you have been taking the supplements as prescribed,
and your iron levels have not improved, your GP will refer you for an
assessment with a specialis