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Anemia is a medical condition characterized by a decrease in the number of red blood cells or a deficiency in the amount of hemoglobin, a protein that carries oxygen, in the blood. This condition can lead to insufficient oxygen supply to the body's tissues and organs, resulting in various symptoms and complications. Anemia can be caused by a range of factors, including nutritional deficiencies, chronic diseases, genetic disorders, or blood loss.
	'''Anaemia''' is a condition in which the blood has too little haemoglobin, too few red blood cells, or red blood cells that do not work properly. Haemoglobin is the iron-containing protein in red blood cells that carries oxygen from the lungs to the rest of the body.

== Overview ==	== Overview ==
Anemia is a common condition that affects people of all ages, although it is more prevalent in women of childbearing age and older adults. It can occur as a primary condition or as a secondary manifestation of an underlying disease or condition.

Red blood cells play a vital role in delivering oxygen to tissues and removing carbon dioxide from the body. Anemia disrupts this oxygen transport process, leading to symptoms such as fatigue, weakness, shortness of breath, and pale skin.
	Anaemia is not a single disease. It is a finding with many possible causes. Some forms are mild and temporary. Others are long-term, inherited, linked to chronic disease, or caused by blood loss.

== Causes ==
There are several causes of anemia, including:
	Anaemia reduces the blood's oxygen-carrying capacity. The body may compensate by increasing heart rate or breathing effort, but symptoms can still appear when tissues receive less oxygen than they need.

* Nutritional Deficiencies: Inadequate intake or absorption of essential nutrients, such as iron, vitamin B12, or folate, can result in anemia.
* Hemolytic Anemia: Conditions that cause the premature destruction of red blood cells, such as autoimmune disorders, certain medications, or inherited disorders, can lead to anemia.
* Chronic Diseases: Chronic diseases, including kidney disease, cancer, inflammatory bowel disease, and HIV/AIDS, can contribute to anemia.
* Bone Marrow Disorders: Dysfunction of the bone marrow, where red blood cells are produced, can lead to anemia. Conditions such as aplastic anemia, myelodysplastic syndromes, and leukemia can affect the production of healthy red blood cells.
* Blood Loss: Acute or chronic blood loss due to trauma, menstruation, gastrointestinal bleeding, or surgery can result in anemia.
	== Main Types ==
	Common types and causes include:

Determining the underlying cause of anemia is essential for appropriate management and treatment.
	* '''Iron deficiency anaemia''': caused by low iron stores, often from blood loss, pregnancy, poor absorption, or increased need.
	* '''Vitamin B12 deficiency anaemia''': caused by low vitamin B12 intake, poor absorption, pernicious anaemia, or digestive conditions.
	* '''Folate deficiency anaemia''': caused by low folate intake, poor absorption, pregnancy, some medicines, or increased need.
	* '''Anaemia of chronic disease''': associated with long-term inflammation, infection, kidney disease, cancer, or autoimmune disease.
	* '''Haemolytic anaemia''': caused by red blood cells being destroyed too quickly.
	* '''Aplastic anaemia and bone marrow disorders''': caused by reduced production of blood cells.
	* '''Inherited anaemias''': including sickle cell disease and thalassaemia.

== Symptoms ==	== Symptoms ==
The symptoms of anemia can vary depending on the severity and underlying cause. Common signs and symptoms include:
	Symptoms depend on the severity, the speed of onset, and the cause. Slowly developing anaemia may cause few symptoms at first.

* Fatigue and weakness
* Pale or yellowish skin
* Shortness of breath
* Rapid or irregular heartbeat
* Dizziness or lightheadedness
* Cold hands and feet
* Headaches
* Chest pain
* Difficulty concentrating or decreased cognitive function
	Common symptoms include:

It is important to note that the symptoms of anemia can overlap with those of other medical conditions. Proper diagnosis by a healthcare professional is necessary to identify the specific cause of anemia.
	* Tiredness and low energy.
	* Shortness of breath.
	* Pale skin or pale inner eyelids.
	* Palpitations.
	* Dizziness, light-headedness, or faintness.
	* Headache.
	* Cold hands and feet.
	* Chest discomfort in some people, especially if heart disease is present.
	* Reduced exercise tolerance.

	Some causes produce extra clues. Iron deficiency may cause brittle nails, hair loss, a sore tongue, pica, or difficulty swallowing. Vitamin B12 deficiency may cause numbness, tingling, memory problems, balance changes, or other nerve symptoms.

	== Causes ==
	Anaemia can develop through blood loss, reduced red-cell production, increased red-cell destruction, or a mixture of these.

	Important causes include:

	* Heavy menstrual bleeding.
	* Pregnancy.
	* Gastrointestinal bleeding, including ulcers, bowel disease, cancer, or medicine-related bleeding.
	* Low iron intake or poor absorption, including malabsorption from [[Coeliac Disease\|coeliac disease]].
	* Vitamin B12 or folate deficiency.
	* Chronic kidney disease.
	* Inflammatory and autoimmune disorders.
	* Bone marrow disease.
	* Inherited haemoglobin disorders.

	In men and post-menopausal women, iron deficiency anaemia often needs investigation for gastrointestinal blood loss. NHS inform notes that bleeding in the stomach or intestines is the most common cause in those groups.

== Diagnosis ==	== Diagnosis ==
Diagnosing anemia involves a thorough medical history assessment, physical examination, and laboratory tests. The diagnostic process may include:
	A full blood count is the usual starting test. It measures haemoglobin, red blood cells, white blood cells, and platelets. Red-cell size and appearance help narrow the cause.

# Complete Blood Count (CBC): This blood test measures the levels of red blood cells, white blood cells, and platelets, as well as the concentration of hemoglobin and other parameters.
# Peripheral Blood Smear: A sample of blood is examined under a microscope to evaluate the size, shape, and appearance of red blood cells.
# Additional Blood Tests: Additional tests may be conducted to assess specific nutrients, such as iron, vitamin B12, or folate, and to investigate potential underlying causes or disorders.
# Bone Marrow Examination: In some cases, a bone marrow biopsy may be necessary to evaluate the production and maturation of blood cells within the bone marrow.
	Further tests may include:

The diagnosis of anemia involves identifying the underlying cause to determine the most appropriate treatment approach.
	* Ferritin and iron studies.
	* Vitamin B12 and folate levels.
	* Reticulocyte count, which shows whether the bone marrow is making new red blood cells.
	* Kidney, liver, thyroid, or inflammatory marker tests.
	* Blood film examination.
	* Tests for hidden blood loss from the bowel.
	* Coeliac disease testing where malabsorption is suspected.
	* Bone marrow tests in selected cases.

	Diagnosis should identify the cause, not only the low haemoglobin. Treating the cause reduces the risk of recurrence.

== Treatment ==	== Treatment ==
The treatment of anemia depends on the underlying cause and severity of the condition. Common treatment approaches include:
	Treatment depends on the type of anaemia and the underlying cause.

* Iron Supplementation: Iron-deficiency anemia, the most common type, is often treated with oral iron supplements to replenish iron stores in the body.
* Vitamin Supplementation: Anemia caused by deficiencies in vitamin B12 or folate may require vitamin supplementation.
* Treating Underlying Conditions: Addressing the underlying condition or disease contributing to anemia is crucial for effective treatment.
* Blood Transfusions: In severe cases, blood transfusions may be necessary to replenish red blood cells and improve oxygen transport.
* Erythropoietin Therapy: In certain situations, synthetic erythropoietin injections may stimulate red blood cell production.
	Iron deficiency anaemia is commonly treated with iron replacement and investigation or treatment of the reason iron was lost. Vitamin B12 deficiency may need hydroxocobalamin injections, especially where absorption is poor. Folate deficiency is usually treated with folic acid tablets and dietary advice.

Treatment plans should be individualized based on the specific type of anemia and the patient's overall health condition.
	Other treatments may include:

== Prevention ==
Preventing anemia involves maintaining a healthy and balanced diet that includes foods rich in iron, vitamin B12, and folate. Regular health check-ups and early detection of any underlying conditions can also help prevent anemia.
	* Treating heavy menstrual bleeding or gastrointestinal bleeding.
	* Treating coeliac disease, inflammatory bowel disease, kidney disease, or another underlying condition.
	* Changing medicines that contribute to bleeding, where clinically appropriate.
	* Erythropoietin-stimulating treatment in selected kidney disease or specialist settings.
	* Blood transfusion for severe anaemia or urgent clinical need.

	== Complications ==
	Untreated anaemia can affect daily function, work, exercise, pregnancy, and recovery from illness. Severe anaemia can strain the heart and lungs. In pregnancy, severe or untreated anaemia can increase risks for both mother and baby.

	Vitamin B12 deficiency is especially important because nerve symptoms may become long-lasting if the deficiency is not recognised and treated.

== See Also ==	== See Also ==
	* [[Haemoglobin]]
	* [[Coeliac Disease]]
	* [[Thalassemia]]
	* [[Red Blood Cells]]

* [[Iron-Deficiency Anemia]] - Learn more about the most common type of anemia caused by insufficient iron levels.
* [[Vitamin B12 Deficiency]] - Explore a condition that can cause anemia and neurological symptoms due to insufficient vitamin B12 levels.
* [[Folate Deficiency]] - Understand how low levels of folate can contribute to anemia and other health issues.
* [[Sickle Cell Disease]] - Discover an inherited disorder affecting the shape and function of red blood cells.
	== References ==
	* [https://www.nhsinform.scot/illnesses-and-conditions/nutritional/iron-deficiency-anaemia/ NHS inform: Iron deficiency anaemia]
	* [https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/treatment/ NHS: Vitamin B12 or folate deficiency anaemia treatment]
	* [https://www.nice.org.uk/guidance/ng239 NICE: Vitamin B12 deficiency in over 16s]
	* [https://www.healthdirect.gov.au/anaemia Healthdirect Australia: Anaemia]

	[[Category:Medicine]]
	[[Category:Haematology]]