Introduction:

Anemia occurs when your blood does not have enough red blood cells to properly carry oxygen to your organs and tissues. Because your body doesn' t get enough oxygen, you feel tired -- one of the primary symptoms of anemia.

Your blood contains three types of cells -- white blood cells, which fight off infection; platelets, which help blood to clot; and red blood cells, which carry oxygen from your lungs throughout your body. Red blood cells are made in your bone marrow. They contain hemoglobin, an iron-based protein that helps blood cells carry oxygen. With anemia, your body either doesn' t make enough red blood cells or loses them faster than they can be replaced.

There are several types of anemia. The most common type is iron deficiency anemia, caused by a lack of iron in your body. Other types include:

• Vitamin deficiency anemia, megaloblastic anemia -- caused by a lack of folic acid and vitamin B12 in your body.
• Anemia of chronic disease -- caused when certain chronic diseases (such as cancer, kidney failure, or Crohn' s disease) interfere with the production of red blood cells.
• Aplastic anemia -- caused when bone marrow loses its ability to produce all three types of blood cells. Aplastic anemia is life threatening.
• Hemolytic anemias -- caused when red blood cells are destroyed faster than the bone marrow can replace them.
• Sickle cell anemia -- caused by a defective type of hemoglobin that makes red blood cells form a crescent or sickle shape. These sickle cells die early, meaning the body is always short of red blood cells. The abnormal shape can block blood flow through small vessels, causing pain. Sickle cell anemia is an inherited condition that affects mainly people of African, Mediterranean, Arabic, or South American descent.

Signs and Symptoms:

Symptoms of anemia can be mild at first, and can be mistaken for other symptoms of other conditions. They include:

• Tiredness
• Weakness
• Shortness of breath
• Pale skin
• Lightheadedness
• Headache
• Feeling cold
• Rapid heartbeat and chest pain

What Causes It?:

Anemia may have the following causes:

• Iron deficiency anemia -- Blood loss, such as from an ulcer or heavy menstruation or after surgery; not getting enough iron in your diet; pregnancy; side effect of medication
• Vitamin deficiency anemia -- Not getting enough folic acid and vitamin B12 in your diet, or being unable to absorb these vitamins (due to celiac disease, for example); side effect of medication
• Aplastic anemia -- may be caused by an autoimmune disorder
• Hemolytic anemia -- can be caused by medication, autoimmune disorders
• Sickle cell anemia -- inherited

What to Expect at Your Provider's Office:

Anemia is often caused by an underlying disease. Your doctor will draw blood and run lab tests, including a complete blood count (CBC) that measures the amount of red blood cells and hemoglobin in your blood. If you are anemic, your doctor may run more tests to determine what type of anemia you have.

Treatment Options:

Treatment depends on the cause of the anemia and how serious it is. Your doctor may suggest changes in your diet to make sure you receive all of the nutrients you need for healthy blood formation, such as vitamin B12, iron, and folic acid. Your doctor may also suggest nutritional supplements or medication. If your anemia is due to an underlying disease, your doctor will treat that disease.

Drug Therapies

Erythropoietin plus iron -- for anemia of chronic disease. Erythropoietin is a hormone made by the kidneys that stimulates the production of red blood cells

Corticosteroids (such as prednisone) -- for some hemolytic anemias. Corticosteroids suppress the immune system, and may help when anemia is caused by an autoimmune disorder

Medications that suppress the immune system (such as antithymocyte globulin or ATG and cyclosporine) -- for aplastic anemia

Surgical and Other Procedures

Removal of the spleen (splenectomy) -- may be necessary in cases of hereditary spherocytosis

Transfusions -- may help treat certain types of anemia, including anemia of chronic disease, sickle cell anemia, and aplastic anemia

Bone marrow or stem cell transplant -- may be used in severe cases of aplastic anemia or some cases of sickle cell anemia

Complementary and Alternative Therapies

Most cases of anemia are either iron deficient or vitamin deficient. Making changes in your diet or taking supplements usually help. You should, however, already have the underlying cause of anemia diagnosed so you can start the right treatment. For example, too much iron is toxic, and you should not take supplements unless you have iron deficiency anemia and your doctor recommends them. Herbal and nutritional treatments may help when used along with medical treatment.

Nutrition and Supplements

Iron -- ferrous fumerate, glycerate, or sulfate are the forms of iron your body can absorb most easily. Always ask your doctor before taking an iron supplement. Taking a smaller dose three times a day may reduce side effects, as can taking iron with meals. If you miss a dose, don't take an extra dose the next time. Never take a double dose of iron. Keep iron supplements away from children. Even a little excess iron can be fatal. Dietary sources of iron include red meat (especially calf liver), beans, beet greens, blackstrap molasses, almonds, and brewer's yeast. Green leafy vegetables contain both iron and folic acid.

Vitamin C (250 - 500 mg 2 times per day) helps your body absorb iron. Dietary sources include citrus fruits and juices, tomatoes, broccoli, and cauliflower.

Vitamin B12 (1,000 mcg via injection once a day for 1 - 2 weeks, then every 1 - 3 months; or orally, 1,000 - 2,000 mcg per day) helps in cases of vitamin deficient or pernicious anemia. Dietary sources include liver, meats, eggs, tuna, and cheese. People with pernicious anemia cannot absorb the proper amount of vitamin B12 and may need lifelong supplements.

Folic acid (400 - 1,000 mcg per day) -- for folic acid deficiency, which can cause anemia. Good food sources include green leafy vegetables, orange juice, and grains. Taking folic acid supplements can mask vitamin B12 deficiency, so always take vitamin B12 when taking folic acid.

Blackstrap molasses, also known as pregnancy tea (1 tbs. per day in a cup of hot water), is a good source of iron, B vitamins, and minerals. Blackstrap molasses is also a very gentle laxative.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, take herbs only under the supervision of a health care provider.

Spirulina, or blue-green algae, may treat some anemias. Dose is 1 heaping tsp. per day.

Alfalfa (Medicago sativa), dandelion (Taraxacum officinale) root or leaf, burdock (Arctium lappa), and yellowdock (Rumex crispus) have traditionally been used to fortify and cleanse the blood. For mild cases of anemia, they may help bring levels of hemoglobin into normal range. Dosage is 1 tbs. per cup of water. Simmer roots for 20 minutes and leaves for 5 minutes. You may use a single herb, or a combination of these four herbs.

Gentian (Gentiana lutea) is often used in Europe to treat anemia by stimulating the digestive system to more easily absorb iron and other nutrients. Chinese herbalists do not use gentian if someone has chronic pain or frequent urination. Add 1 tsp. powdered dried rhizome to 3 cups of water. Take 1 tbs. about a half hour before eating.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of anemia based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

A homeopath will usually consider anemia as symptomatic of an underlying condition, and treat that condition.

• Ferrum phosphoricum -- for iron deficiency
• Calcarea phosphorica -- particularly for children with nighttime bone aches, cool hands and feet, lack of energy, or poor digestion

Following Up:

Eating a normal, balanced diet is very important if a nutrition problem is causing your anemia. You should avoid drugs that can cause stomach problems and too much alcohol if they are causing your anemia.

Special Considerations:

Complications from anemia can range from loss of productivity due to weakness and fatigue to coma and death.

Pregnant women need more iron and folic acid than normal. A folic acid deficiency during pregnancy can result in infants being born with neural-tube defects, such as spina bifida.