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Anemia happens when blood does not have enough red blood cells to properly carry oxygen to your organs and tissues. Because your body does not get enough oxygen, you feel tired. Feeling tired is 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 does not 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, which is 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 is caused when certain chronic diseases (such as cancer, kidney failure, or Crohn disease) interfere with the production of red blood cells.
  • Aplastic anemia is caused when bone marrow cannot make all three types of blood cells. Aplastic anemia is life threatening.
  • Hemolytic anemias are caused when red blood cells are destroyed faster than the bone marrow can replace them.
  • Sickle cell anemia is caused by a 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 mainly affects people of African, Mediterranean, Arabic, or South American descent.

Signs and Symptoms

Many people with mild anemia have no complaints.

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

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

What Causes It?

Anemia may have the following causes:

  • Iron-deficiency anemia may be caused by 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 may result from not getting enough folic acid and vitamin B12 in your diet, or not being able 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 is inherited
  • Anemia of inflammation, which is the second most common anemia after iron-deficiency anemia, occurs as a result of a chronic disease.

What to Expect at Your Provider's Office

Anemia is often caused by another 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 see what type of anemia you have.

Treatment Options

The cause of your anemia, and how serious your anemia is, will determine your treatment. Your doctor may suggest changes in your diet to make sure you get all the nutrients you need, 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 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 needed 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 often, anemia is caused by a lack of iron or vitamins. Making changes to your diet or taking supplements usually help. You should, however, find out from your doctor the cause of your anemia. 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 3 times a day, or taking iron with meals, may reduce side effects. If you miss a dose, DO NOT take an extra dose the next time. 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 helps your body absorb iron. Dietary sources include citrus fruits and juices, tomatoes, broccoli, and cauliflower. Vitamin C supplements may interact with other medications, including chemotherapy drugs, estrogen, warfarin (Coumadin), and others.

Vitamin B12 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 can be taken for folic acid deficiency, which can cause anemia. Good food sources include green leafy vegetables, orange juice, and grains. Taking a folic acid supplement can hide a vitamin B12 deficiency, so always take vitamin B12 when taking folic acid. Folic acid may interact with the chemotherapy drugs 5-fluorouracil and capecitabine (Xeloda). It may also interact with the antiseizure drugs phenytoin (Dilantin), phenobarbital, and primidone (Mysoline).

Blackstrap molasses, also known as pregnancy tea (1 tablespoon 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.


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 medicines. 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 teaspoon per day. If you take medications to suppress your immune system, ask your doctor before taking spirulina.
  • 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. Simmer roots for 20 minutes and leaves for 5 minutes. You may use a single herb, or a combination of these four herbs. These herbs may interact with several medications, including warfarin (Coumadin), and other blood-thinning medications, as well as lithium, and digoxin, among others.
  • 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. Gentian may lower blood pressure, so be careful if you already take medication for high blood pressure. Taking gentian could cause your blood pressure to drop too low.

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, which is 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. A growing number of studies have reported an association between anemia and an increased risk of heart disease, including heart failure.

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 women who are not pregnant. A folic acid deficiency during pregnancy can cause a group of birth defects known as neural-tube defects, such as spina bifida.

Supporting Research

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CDC Recommendations to prevent and control iron deficiency in the United States. Centers for Disease Control and Prevention. MMWR Recomm Rep. 1998;47:1-29.

Elia M. Oral or parenteral therapy for B12 deficiency. Lancet. 1998;352:1721-22.

Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011.

Hayden SJ, Albert TJ, Watkins TR, Swenson ER. Anemia in critical illness: insights into etiology, consequence, and management. Am J Respir Crit Care Med. 2012;185(10):1049-57.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-9.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-53.

Lu K, Cheng MC, Ge X, et al. A retrospective review of acupuncture use for the treatment of pain in sickle cell disease patients: descriptive analysis from a single institution. Clin J Pain. 2014;30(9):825-30.

McClung JP, Karl JP, Cable SJ, Williams KW, Nindl BC, Young AJ, Lieberman HR. Randomized, double-blind, placebo-controlled trial of iron supplementation in female soldiers during military training: effects on iron status, physical performance, and mood. Am J Clin Nutr. 2009 Jul;90(1):124-31.

McCullough PA, Barnard D, Clare R, et al. Anemia and associated clinical outcomes in patients with heart failure due to reduced left ventricular systolic function. Clin Cardiol. 2013;36(10):611-20.

Mozaffari-Khosravi H, Noori-Shadkam M, Fatehi F, Naghiaee Y. Once weekly low-dose iron supplementation effectively improved iron status in adolescent girls. Biol Trace Elem Res. 2009 Aug 4. [Epub ahead of print]

O'Meara E, Rouleau JL, White M, et al. Heart failure with anemia: novel findings on the roles of renal disease, interleukins, and specific left ventricular remodeling processes. Circ Heart Fail. 2014;7(5):773-81.

Peña-Rosas JP, Viteri FE. Effects and safety of preventive oral iron or iron+folic acid supplementation for women during pregnancy. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD004736.

Prakash D. Anemia in the ICU. Critical Care Clinics. Philadelphia, PA: Elsevier Saunders. 2012;28(3).

Ranucci M, Di Dedda U, Castelvecchio S, Menicanti L, Frigiola A, Pelissero G. Impact of preoperative anemia on outcome in adult cardiac surgery: a propensity-matched analysis. Ann Thorac Surg. 2012;94(4):1134-41.

Rizack T, Rosene-Montella K. Special Hematologic Issues in the Pregnant Patient. Hematology/Oncology Clinics of North America. Philadelphia, PA: Elsevier Saunders. 2012;26(2).

Selmi C, Leung PS, Fischer L, German B, Yang CY, Kenny TP, Cysewski GR, Gershwin ME. The effects of Spirulina on anemia and immune function in senior citizens. Cell Mol Immunol. 2011 May;8(3):248-54.

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Winther SA, Finer N, Sharma AM, Torp-Pedersen C, Andersson C. Association of anemia with the risk of cardiovascular adverse events in overweight/obese patients. Int J Obes (Lond). 2014; 38(3):432-7.





Review Date: 12/19/2015  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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