Anaemia generally refers to a deficit in the number or oxygen-carrying capacity of red blood cells (RBCs) in one’s body. There are several types of anaemia, which may result in some similar symptoms and complications, but which arise due to different reasons. The WHO regards anaemia as “a serious global public health problem”, enhanced by poor diet and nutrition. While anaemia can occur in both men and women, it is more commonly prevalent among women. The WHO estimates that 40% of pregnant women and 42% of children under the age of five years are anaemic.

RBCs, or erythrocytes, are responsible for the transport of oxygen from the lungs to the rest of the body. In order to carry out this function, each RBC is equipped with molecules of a protein called haemoglobin whose four constituent globin molecules are each bound to the iron-containing pigment ‘heme’.

It is to this haemoglobin within the RBC that oxygen inhaled into the lungs binds, forming oxyhaemoglobin which is transported by circulation and dissociates to release oxygen at the target site. Hence, healthy levels of iron, haemoglobin and RBCs are required for the efficient transport of oxygen to all of the body’s tissues and organs.

This article focuses on iron deficiency anaemia, which – as the name suggests – is caused by a deficiency of iron. However, let’s take a quick look at some of the different types of anaemia before we delve into our topic:

– Iron deficiency anaemia – results in an insufficient production of haemoglobin protein, subsequently compromising the effectiveness of RBCs; very common form of anaemia

– Aplastic anaemia – condition where the body does not produce enough blood cells, sometimes leading to uncontrolled bleeding

– Sickle cell anaemia – inherited disease where some RBCs are ‘sickle’ shaped and sticky, making them ineffective and possibly causing blockages in blood vessels

– Thalassaemia – inherited condition where the body has lower haemoglobin levels than normal, subsequently reducing the oxygen-carrying capacity of RBCs

– Vitamin deficiency anaemia – results in an insufficient number of healthy RBCs; linked to vitamin B, vitamin C and folic acid deficiencies

­– Haemolytic anaemia – condition where RBCs are destroyed faster than they can be replaced, often in the case of autoimmune diseases

– Inflammatory anaemia – condition caused by chronic diseases which interfere with RBC production

Symptoms

Iron deficiency anaemia may be asymptomatic in some cases. However, in cases where symptoms are experienced, these may include:

• fatigue and/or weakness
• feeling tired easily after minimal activity
• shortness of breath
• feeling lightheaded or dizzy
• pale skin
• palpitation or irregular heart beat
• difficulty concentrating
• frequent headaches
• cold extremities

Complications

If left untreated, anaemia could lead to other complications such as:

• an increased risk of infection and illness as the immune system is compromised
• an increased risk of heart disease such as tachycardia, arrhythmia or heart failure
• complications in pregnancy and premature birth
• severe fatigue where day-to-day tasks become increasingly challenging
• death, in extreme cases

Causes

There are several direct and indirect factors that could increase the risk of anaemia:

• a diet low in iron (as well as vitamin B-12 and folic acid)
• menstruation, particularly heavy periods
• pregnancy and breastfeeding, particularly if folic acid and iron supplements are not taken
• premature birth (in babies)
• puberty, if a suitable diet and supplements are not provided to support growth and development of the child
• cancers, stomach ulcers, intestinal or oesophagal swelling, haemorrhoids, kidney disease, diabetes, blood diseases, autoimmune disorders and other chronic illnesses
• excessive alcohol consumption
• certain medications, such as long-term NSAIDs that may trigger stomach ulcers and bleeding
• vegetarianism, veganism or extreme diets for weight loss
• age, particularly over 65 years

Diagnosis

Anaemia can be identified by means of a simple full blood count (FBC) test where a sample of blood from the patient is tested for several aspects including levels of RBCs (haematocrit or erythrocyte count) and haemoglobin.

In a healthy adult male, a normal RBC count is considered to be 4.7 – 6.1 million cells/mcL, while in females this is considered to be 4.2 – 5.4 million cells/mcL. A healthy range for blood haemoglobin in adult males is defined as 13.5 – 17.5 g/dL, whereas for females this is 12.0 – 15.5 g/dL. A consistently low level of either parameter would denote anaemia. Iron deficiency anaemia is typically characterised by low levels of haemoglobin.

Once an initial diagnosis of anaemia has been made, your doctor might recommend further tests to determine the cause of the condition.

Prevention

Since this form of anaemia is caused by a deficiency of iron, the key to prevention is to maintain a healthy diet that provides you with your iron requirement. Recommendations include:

• regularly including dark green leafy vegetables (e.g. spinach, kale, watercress), fortified foods (e.g. fortified bread, juices, cereals), meat (red meat usually has a higher iron content than lean meat, but should be consumed in moderate amounts), liver, legumes (beans, lentils, peas), vitamin C-rich foods (e.g. oranges, tomatoes, strawberries) in your diet
• avoiding excessive consumption of tea, coffee, dairy and foods with high levels of phytic acid (e.g. wholegrain cereals) which could hamper absorption of iron
• taking an iron supplement regularly, particularly menstruating and pregnant women and those who follow a vegetarian/vegan diet
• taking vitamin C regularly (vitamin C improves absorption of iron from food/supplements)

Treatment

If iron deficiency anaemia is diagnosed, a few measures that your doctor might recommend include:

• daily intake of iron supplements, usually accompanied by vitamin C (or even fresh orange juice)
• incorporation of iron-rich foods (as mentioned above) into your diet
• iron injections, if your haemoglobin levels are very low
• blood transfusion or oxygen therapy, in extreme cases
• surgery or some sort of invasive procedure if anaemia is caused by abnormal bleeding

Cover illustration adapted from Depositphotos