Iron deficiency anemia

Related Terms

Anemic, aplastic anemia, blood, blood disorder, erythrocytes, fatigue, ferritin test, folate, folic acid, hemoglobin, hemoglobin electrophoresis, hemoglobin S, hematocrit, iron deficiency, leukocytes, megaloblastic anemia, microcytic anemia, pernicious anemia, platelets, red blood cells, sickle cell disease, TIBC, total iron-binding capacity, vitamin deficiency anemia, vitamin B-6, vitamin B-12, white blood cells.

Background

The blood is made of three types of cells - erythrocytes (red blood cells), leukocytes (white blood cells) and platelets. Red blood cells are disc-shaped, and are continually produced in the bone marrow. This is because they only live for about 120 days. Red blood cells contain hemoglobin, which is a red, iron-rich protein that carries oxygen from the lungs to the body's muscles and organs. These cells also remove carbon dioxide (a waste product) from cells and carry it to the lungs to be exhaled.
White blood cells are part of the body's immune system, and they fight off disease and infection.
Platelets help blood clot and live an average of six days.
Anemia occurs when the body does not have enough red blood cells. Individuals who are anemic may experience fatigue because the heart has to work harder to deliver oxygen to the muscles and organs. There are many possible causes of anemia, including chronic diseases, bone marrow disorders, iron deficiency, vitamin deficiencies and genetic abnormalities (like sickle cell anemia).
Anemia is a common blood disorder, affecting an estimated 3.4 million people in the United States. Women and individuals with chronic diseases are at an increased risk for anemia. Many forms of anemia are mild, short-term and can be easily treated. However, other forms can be long-term and more severe.

Author information

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

American Academy of Family Physicians. .
Anemia.com. .
Iron Disorders Institute. .
National Anemia Action Counsel. Anemia: General. .
National Heart Lung and Blood Institute. .
Natural Standard: The Authority on Integrative Medicine. .
Sickle Cell Disease Association of America. .

Symptoms

Certain types of anemia may be severe, long-lasting and life threatening if not diagnosed and treated.
The main symptom of nearly every type of anemia is fatigue, which is nonspecific. Initially, symptoms may appear minor. However, as the condition progresses, symptoms become more serious and may include pale skin, fast heartbeat, shortness of breath, chest pain, dizziness, cognitive problems, headache and numb or cold sensations in the extremities.

Diagnosis

Complete blood count (CBC): Both hemoglobin and hematocrit (percentage of red blood cells in a blood sample) values are used to diagnose anemia. A CBC test shows the hemoglobin and hematocrit values. In general, men with a hematocrit value less than 41% and women with a hematocrit value less than 36% are considered anemic. The World Health Organization defines anemia as hemoglobin less than 12g/dL for non-pregnant women and less than 13g/dL for men.
Ferritin test: If a CBC indicates low hemoglobin and hematocrit values, a ferritin test may be conducted to confirm the diagnosis. This test determines how much iron is stored in the body for future use.
TIBC (total iron-binding capacity) and transferrin test): This test measures how much iron is carried in the blood. Individuals who have low iron with a high transferrin or TIBC usually have iron deficiency.
Hemoglobin electrophoresis: Hemoglobin electrophoresis is a type of blood test used to diagnose sickle cell anemia. An electrical charge is passed through a solution of hemoglobin. Depending on the hemoglobin's composition, it will move different distances. This technique differentiates between normal hemoglobin and sickle hemoglobin.

Treatment

Anemia of chronic disease:
There is no specific treatment for anemia caused by chronic disease. Doctors focus on treating the underlying disease. Iron supplements and vitamins generally do not help this type of anemia. However, if symptoms become severe, a blood transfusion or injections of synthetic erythropoietin, a hormone normally produced by the kidneys, may help stimulate red blood cell production and relieve symptoms.
Aplastic anemia:
Treatment for aplastic anemia may include blood transfusions to increase the levels of red blood cells. In severe cases, some individuals may need a bone marrow transplant, if the marrow is unable to produce healthy blood cells. After a bone marrow transplant, immunosupressants are often taken to lessen the immune system's response and give the transplanted bone marrow a chance to start functioning again.
Hemolytic anemia:
Managing hemolytic anemia includes avoiding suspect medications, treating related infections and taking immunosuppressants. Short courses of treatment with steroids or gamma globulin can help suppress the immune system's attack on the red blood cells. If the condition has caused an enlarged spleen, the spleen may have to be surgically removed. The spleen filters out and stores defective red blood cells. Hemolytic anemia may cause the spleen to become enlarged with damaged red blood cells.
Iron deficiency anemia:
Iron: Patients with iron deficiency anemia are typically given iron supplements. Treatment may last several months or longer. Taking iron orally with epoetin alfa (erythropoietin, EPO, Epogen?, Procrit?) is effective for treating anemia associated with chronic renal failure and chemotherapy. Ferrous sulfate (Feratab?, Fer-Iron?, Slow-FE?) is the standard treatment for treating iron deficiency anemia. Dextran-iron (INFeD?) is given intravenously by healthcare providers to restore adequate iron levels when oral iron therapy has failed.
Iron supplements have been shown to help prevent iron deficiency anemia in pregnant women. Anemia in pregnant women is associated with adverse outcomes such as low birth weight, premature birth and maternal mortality. Screening by a qualified healthcare provider is needed.
The Recommended Dietary Allowance (RDA) of iron for males (19- 50 years) is 8 milligrams per day; females (19- 50 years) 18 milligrams per day; adults (51 years and older) 8 milligrams per day; pregnant women (all ages) 27 milligrams per day; breastfeeding women (19 years and older) 9 milligrams per day.
For children, the Recommended Dietary Allowance (RDA) of iron is 11 milligrams for 7-12 months; 7 milligrams for 1-3 years; 10 milligrams for 4-8 years; 8 milligrams for 9-13 years (male and female); 11 milligrams for males 14-18 years; 15 milligrams for females 14-18 years.
Low doses are generally well tolerated and associated with better compliance. Avoid if known to be allergic to products containing iron. Pregnant or breastfeeding women should seek guidance from a qualified healthcare provider before taking dietary supplements.
If the underlying cause of iron deficiency is loss of blood (other than menstruation), then the source of the bleeding must be located and stopped.
Megaloblastic anemia:
Folate (folic acid): If folate deficiency is the cause of anemia, then supplementation with folate is the standard approach. Patients with anemia should be evaluated by a physician in order to diagnose and address the underlying cause.
Folate is found naturally in food, and folic acid is the synthetic form of this vitamin. Folic acid is well-tolerated in amounts found in fortified foods and supplements. Sources include cereals, baked goods, leafy vegetables (spinach, broccoli, lettuce), okra, asparagus, fruits (bananas, melons, lemons), legumes, yeast, mushrooms, organ meat (beef liver, kidney), orange juice and tomato juice. Folic acid is frequently used in combination with other B vitamins in vitamin B complex formulations.
The recommended dietary allowance for folate is 400 micrograms per day for males or females ages 14 years and older; 500 micrograms per day for breastfeeding adult women; 600 micrograms per day for pregnant adult women.
Vitamin B12 (cobalamin): If vitamin B12 deficiency is the cause of anemia, then supplementation with B12 is the standard approach. A physician should evaluate patients with anemia in order to diagnose and address the underlying cause.
Vitamin B12 binds with intrinsic factor before it is absorbed and used by the body. An absence of intrinsic factor prevents normal absorption of B12 in the intestine and may result in pernicious anemia. Treatment of pernicious anemia is usually lifelong supplemental vitamin B12, which is administered intramuscularly, intranasally or by mouth.
Vitamin B-12 is commonly found in a variety of foods such as fish, shellfish, meats and dairy products. The recommended dietary allowances (RDAs) are 2.4 micrograms per day for adults and adolescents aged 14 years and older, 2.6 micrograms per day for adult and adolescent pregnant females, 2.8 micrograms per day for adult and adolescent lactating females.
Vitamin B12 supplements should be avoided in people sensitive or allergic to cobalamin, cobalt or any other product ingredients. Vitamin B12 is likely safe when taken orally in amounts that do not exceed the recommended dietary allowance (RDA).
Sickle cell anemia:
Sickle cell anemia is incurable, but treatment may help relieve symptoms. Treatment may include the administration of oxygen, pain-relieving drugs, and oral and intravenous fluids to reduce pain and prevent complications. Doctors also commonly use blood transfusions, folic acid supplements and antibiotics. A bone marrow transplant may be an effective treatment in some circumstances. A cancer drug called hydroxyurea (Droxia?, Hydrea?) also is used to treat sickle cell anemia in adults.
Zinc: There is strong scientific evidence to suggest that zinc may help manage or reduce symptoms of sickle cell anemia. Most of these studies reported increased height, weight, immune system function and testosterone levels, as well as decreased numbers of crises and sickle cell formation following zinc treatment.
Zinc is regarded as a relatively safe and generally well-tolerated therapy, when taken at recommended doses, and few studies report side effects. The recommended daily dose for adult and teenage males is 15mg. The recommended daily dose for adult and teenage females is 12mg. The recommended daily dose for pregnant females is 15mg, and 16-19mg for breastfeeding females. The recommended daily dose for children ages 4-10 is 10mg, and 5-10mg for children 0-3 years old. Zinc acetate should only be used during pregnancy or breastfeeding if clearly needed.
Sideroblastic anemia:
Vitamin B6: Pyridoxine supplements are effective for treating hereditary sideroblastic anemia under the supervision of a qualified healthcare provider. Some individuals seem to be particularly sensitive to vitamin B6 and may have problems at lower doses. Avoid excessive dosing. Vitamin B6 is likely safe when used orally in doses not exceeding the recommended dietary allowance (RDA).
The Recommended Daily Allowances (RDA) of Vitamin B6 for males (19-50 years) 1.3 milligrams; (51 years and older) 1.7 milligrams; females (19-50 years) 1.3 milligrams; (51 years and older) 1.5 milligrams. Some researchers think the RDA for women 19-50 years should be increased to 1.5-1.7 milligrams per day. Pregnant women, 1.9 milligrams; and lactating women, 2 milligrams.

Integrative therapies

Strong scientific evidence:
Folate: Folate deficiency can cause megaloblastic anemia. In this type of anemia, red blood cells are larger than normal, and the ratio of nucleus size to cell cytoplasm is increased. There are other potential causes of megaloblastic anemia, including vitamin B12 deficiency or various inborn metabolic disorders. If the cause is folate deficiency, then treatment with folate is the standard approach. Patients with anemia should be evaluated by a physician in order to diagnose and address the underlying cause. Avoid if allergic or hypersensitive to folate or any folate product ingredients. Use cautiously if receiving coronary stents or with seizure disorders. It is recommended that pregnant women consume 400 micrograms of folate daily in order to reduce the risk of the fetus developing a defect. Folate is likely safe if breastfeeding.
Iron: Ferrous sulfate (Feratab?, Fer-Iron?, Slow-FE?) is the standard treatment for treating iron deficiency anemia. Dextran-iron (INFeD?) is given intravenously by healthcare providers to restore adequate iron levels in bone marrow when oral iron therapy has failed. Taking iron orally with epoetin alfa (erythropoietin, EPO, Epogen?, Procrit?) has been found to be effective for treating anemia of chronic disease associated with chronic renal failure and chemotherapy. Iron is a trace mineral, and hypersensitivity is unlikely. Avoid with known allergy/hypersensitivity to products containing iron. Avoid excessive intake. Avoid with blood disorders that require frequent blood transfusions. Use cautiously with history of kidney disease, intestinal disease, peptic ulcer disease, enteritis, colitis, pancreatitis, hepatitis, alcoholism, in patients who plan to become pregnant, or are over age 55 and have a family history of heart disease. Pregnant or breastfeeding women should consult a healthcare professional before beginning iron supplementation.
Liver extract: Ingestion of liver increases red blood cell counts, and liver extract (by mouth or by injection) has the same effect. Both liver and liver extract have high vitamin B12 content. Today, pernicious anemia is typically treated with vitamin B12 injections. Avoid if allergic or hypersensitive to liver extract or its constituents. Use cautiously if taking antacids or with acid reflux. Use cautiously with clotting disorders, compromised immune function, or abnormal iron levels. Use cautiously if taking antihypercholesterolemic drugs (drugs that affect blood cholesterol), antiviral agents, especially interferon, or any agents for cancer. Use cautiously as raw liver may contain liver flukes or the bacterium, Vibrio fetus. Use cautiously in hepatopathic patients with reduced human growth hormone metabolic clearance rate. Avoid liver extract with iron metabolism disorders or iron shortage disorders, such as hemochromatosis. Avoid liver extract from countries where bovine spongiform encephalitis (BSE or "mad cow disease") has been reported. Avoid if sensitive to liver extract or any of its components, as liver extract therapy has caused severe anaphylactic shock. Avoid if pregnant or breastfeeding.
Vitamin B12: Vitamin B12 deficiency is a cause of megaloblastic anemia. In this type of anemia, red blood cells are larger than normal, and the ratio of nucleus size to cell cytoplasm is increased. There are other potential causes of megaloblastic anemia, including folate deficiency or various inborn metabolic disorders. If the cause is B12 deficiency, then treatment with B12 is the standard approach. Patients with anemia should be evaluated by a physician in order to diagnose and address the underlying cause. Pernicious anemia (blood abnormality) is a form of anemia that occurs when there is an absence of intrinsic factor, a substance normally present in the stomach. Vitamin B12 binds with intrinsic factor before it is absorbed and used by the body. An absence of intrinsic factor prevents normal absorption of B12 and may result in pernicious anemia. Pernicious anemia treatment is usually lifelong supplemental vitamin B12 given intramuscularly, intranasally, or by mouth. Avoid vitamin B12 supplements if allergic or hypersensitive to cobalamin, cobalt, or any other vitamin B12 product ingredients. Avoid with coronary stents (mesh tube that holds clogged arteries open) and Leber's disease. Use cautiously if undergoing angioplasty and with anemia. Vitamin B12 is generally considered safe when taken in amounts that are not higher than the Recommended Dietary Allowance (RDA). There is not enough scientific data available about the safety of larger amounts of vitamin B12 during pregnancy and/or breastfeeding.
Vitamin B6: Pyridoxine supplements have been found to be effective for treating hereditary sideroblastic anemia under the supervision of a qualified healthcare provider. Avoid vitamin B6 products if sensitive or allergic to any vitamin B6 product ingredients. Some individuals seem to be particularly sensitive to vitamin B6 and may have problems at lower doses. Avoid excessive dosing. Vitamin B6 is likely safe when used orally in doses not exceeding the recommended dietary allowance (RDA). Use cautiously if pregnant or breastfeeding.
Zinc: There is strong scientific evidence to suggest that zinc may help manage or reduce symptoms of sickle cell anemia. Most available studies reported increased height, weight, immune system function, and testosterone levels, as well as decreased numbers of crises and sickle cell formation following zinc treatment. Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
Good scientific evidence:
Iron: Iron supplementation has been shown to be effective for prevention of iron deficiency in menstruating women and prevention of iron deficiency anemia in pregnancy. Anemia in pregnant women is associated with adverse outcomes such as low birth weight, premature birth, and maternal mortality. Screening by a qualified healthcare provider is needed. Low doses are generally well tolerated and associated with better compliance. Iron is a trace mineral, and hypersensitivity is unlikely. Avoid with known allergy/hypersensitivity to products containing iron. Avoid excessive intake. Avoid with blood disorders that require frequent blood transfusions. Use cautiously with a history of kidney disease, intestinal disease, peptic ulcer disease, enteritis, colitis, pancreatitis, hepatitis, alcoholism, in patients who plan to become pregnant, or in patients who are over age 55 and have a family history of heart disease. Pregnant or breastfeeding women should consult a healthcare professional before beginning iron supplementation.
Unclear or conflicting scientific evidence:
Antineoplastons: Preliminary study reported positive findings with use of antineoplastons for sickle cell anemia/thalassemia, but there is currently insufficient evidence to make a conclusion in this area. Avoid if allergic or hypersensitive to antineoplastons. Use cautiously with high medical or psychiatric risk, an active infection due to a possible decrease in white blood cells, high blood pressure, heart conditions, chronic obstructive pulmonary disease, liver disease/damage, or kidney disease/damage. Avoid if pregnant or breastfeeding.
Art therapy: There is preliminary evidence suggesting that art therapy may improve coping and reduce health care visits with sickle cell disease in children. More studies are needed to verify this. Art therapy may evoke distressing thoughts or feelings. Use under the guidance of a qualified art therapist or other mental health professional. Some forms of art therapy use potentially harmful materials. Only materials known to be safe should be used. Related clean-up materials (like turpentine or mineral spirits) that release potentially toxic fumes should only be used with good ventilation.
Betel nut: Early poor-quality research reports that betel nut chewing may lessen anemia in pregnant women. Reasons for this finding are not clear, and betel nut chewing may be unsafe during pregnancy. Betel nut cannot be considered safe for human use by mouth. This is due to toxic effects associated with short or long-term chewing or eating of betel nut. Avoid if allergic to betel nut or other plants of the Palmaceae family. Avoid if pregnant or breastfeeding.
Copper: Copper deficiency is one of the causes of sideroblastic anemia that is considered when evaluating this condition, particularly when the anemia is unresponsive to iron therapy alone. This anemia appears to be caused by defective iron mobilization due to decreased ceruloplasmin activity. Avoid if allergic/hypersensitive to copper. Avoid during the early phase of recovery from diarrhea. Avoid with hypercupremia, occasionally observed in disease states including cutaneous leishmaniasis, sickle-cell disease, unipolar depression, breast cancer, epilepsy, measles, Down syndrome, and controlled fibrocalculous pancreatic diabetes (a unique form of secondary diabetes mellitus). Avoid with genetic disorders affecting copper metabolism such as Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis. Avoid with HIV/AIDS. Use cautiously with water containing copper concentrations greater than 6mg/L. Use cautiously with anemia, arthralgias and myalgias. Use cautiously if taking oral contraceptives. Use cautiously if at risk for selenium deficiency. The United States Recommended Dietary Allowance (RDA) is 1,000?g for pregnant women. The United States Recommended Dietary Allowance (RDA) is 1,300?g for nursing women.
Iron: The results of early study indicate that elemental iron may adequately compensate for iron deficiency after blood donation in males and females who donate whole blood up to four (females) or six times per year (males). Intravenous high-dose iron sucrose therapy in patients may lead to the prevention of iron deficiency anemia due to gastrointestinal bleeding. It appears to be safe and therefore is a therapeutic option which may save time and improve patient compliance. More study is needed in this area. Preliminary study suggests that iron supplementation may prevent iron deficiency in exercising women. This may lead to such benefits as reversing mild anemia after exercise, and improving energy and performance. However, other studies disagree. Further research is needed before a clinical recommendation can be made. Adequate iron supplementation may be beneficial as an adjunct therapy with erythropoietin in predialysis anemia treatment. Predialysis anemia should be treated by a qualified healthcare provider. More study is needed in this area. Finally, further study of prenatal iron supplementation is needed before a conclusion can be made regarding prevention of anemia associated with preterm/low birth weight infants. Iron is a trace mineral, and hypersensitivity is unlikely. Avoid with known allergy/hypersensitivity to products containing iron. Avoid excessive intake. Avoid with blood disorders that require frequent blood transfusions. Use cautiously with a history of kidney disease, intestinal disease, peptic ulcer disease, enteritis, colitis, pancreatitis, hepatitis, alcoholism, in patients who plan to become pregnant, or in patients who are over age 55 and have a family history of heart disease. Pregnant or breastfeeding women should consult a healthcare professional before beginning iron supplementation.
L-carnitine: Preliminary evidence suggests the absence of any therapeutic effect of propionyl-L-carnitine for sickle cell disease. Additional studies are required before a conclusion can be made. Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, hypertension (high blood pressure), alcohol-induced liver cirrhosis, and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.
Prayer: Prayer has been studied as a coping mechanism for patients with sickle cell anemia with mixed results. More high-quality studies are needed in this area. Prayer is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Sometimes religious beliefs come into conflict with standard medical approaches, and require an open dialog between patients and caregivers. Based on limited available clinical study, patients certain that they were receiving intercessory prayer had a higher incidence of complications following cardiac bypass surgery than those who did not know they were being prayed for.
Riboflavin (Vitamin B2): Some research suggests that riboflavin may play an adjunct role in the treatment of iron deficiency anemia and sickle cell anemia; levels of riboflavin may be low in these conditions. Correction of riboflavin deficiency in individuals who are both riboflavin deficient and iron deficient appears to improve response to iron therapy. Avoid if allergic or hypersensitive to riboflavin. Since the amount of riboflavin a human can absorb is limited, riboflavin is generally considered to be safe. Riboflavin is also generally regarded as safe during pregnancy and breastfeeding. The U.S. Recommended Daily Allowance (RDA) for riboflavin in pregnant women is higher than for non-pregnant women, and is 1.4 milligrams daily (1.6 milligrams for breastfeeding women).
Taurine: For iron deficiency anemia, preliminary study suggests that the amino acid taurine aids in the ability of iron supplements to increase hemoglobin, red blood cell count, and serum ferritin. Additional study is needed before a firm recommendation can be made. Allergies related to taurine are considered unlikely. However, allergies may occur from multi-ingredient products that contain taurine. Use cautiously in patients with high cholesterol, low blood pressure, coagulation disorders, potential for mania, or epilepsy. Avoid consumption of energy drinks containing taurine, caffeine, glucuronolactone, B vitamins, and other ingredients, then consuming alcohol or exercising. Use cautiously if pregnant or breastfeeding because taurine is a natural component of breast milk.
Vitamin A: Vitamin A supplementation in combination with iron may have beneficial effects in patients with iron deficiency anemia, including children and pregnant women. It is not clear that there are benefits in individuals who are not vitamin A deficient. This area remains controversial, and further evidence is necessary before a clear conclusion can be drawn. Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken in high doses. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Excessive doses of vitamin A have been associated with central nervous system malformations. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
Vitamin B12: Preliminary study suggests that a practical daily combination for sickle cell disease may include folic acid, vitamin B12, and vitamin B6. This combination may reduce these patients' inherently high risk of endothelial damage, however, further research is needed. Avoid vitamin B12 supplements if allergic or hypersensitive to cobalamin, cobalt, or any other vitamin B12 product ingredients. Avoid with coronary stents (mesh tube that holds clogged arteries open) and Leber's disease. Use cautiously if undergoing angioplasty and with anemia. Vitamin B12 is generally considered safe when taken in amounts that are not higher than the Recommended Dietary Allowance (RDA). There is not enough scientific data available about the safety of larger amounts of vitamin B12 during pregnancy and/or breastfeeding.
Vitamin E: Studies of vitamin E supplementation for anemia have yielded mixed results. Further research is needed before a conclusion can be made. Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders or if taking blood thinners. Avoid doses above the recommended daily level in pregnant and breastfeeding women.
Wheatgrass: Evidence suggests that wheatgrass may be beneficial for patients with beta thalassemia, and may decrease the number of blood transfusions needed. However, further research is needed before a firm conclusion can be drawn. Avoid if allergic or hypersensitive to wheatgrass. Use cautiously because wheatgrass is grown in soils or water and consumed raw, and it may be contaminated with bacteria, molds, or other substances. Use cautiously if pregnant or breastfeeding.
Zinc: Preliminary study suggests that children with beta-thalassemia who took oral zinc supplements for one to seven years increased in height more than those who did not take zinc. Additional information is needed to confirm these findings. Zinc is generally considered safe when taken at the recommended doses. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
Fair negative scientific evidence:
Iron: Early study reports that iron may not be an effective therapy for anemia after orthopedic surgery (such as elective hip or knee replacement). It may not result in higher hemoglobin after surgery, or a faster rate of increase in hemoglobin than placebo.
Strong negative scientific evidence:
Urine therapy: Some evidence suggests that urea may help prevent and treat sickle cell crises in addition to helping eliminate complications. However, evidence from clinical studies to support the use of urine or urea in the treatment of sickle cell anemia is currently lacking.

Prevention

Some forms of anemia can be prevented with a healthy diet and other forms can be treated with dietary supplements.
Iron: Consuming an adequate amount of iron may help reduce the risk of developing iron deficiency anemia. The Recommended Dietary Allowance (RDA) of iron for males (19- 50 years) is 8 milligrams per day; females (19- 50 years) 18 milligrams per day; adults (51 years and older) 8 milligrams per day; pregnant women (all ages) 27 milligrams per day; breastfeeding women (19 years and older) 9 milligrams per day. The Recommended Dietary Allowance (RDA) of iron is 11 milligrams for 7-12 months; 7 milligrams for 1-3 years; 10 milligrams for 4-8 years; 8 milligrams for 9-13 years (male and female); 11 milligrams for males 14-18 years; 15 milligrams for females 14-18 years.
Folate (folic acid): Consuming an adequate amount of folate may help reduce the risk of developing megaloblastic anemia. Folate occurs naturally in food and folic acid is the synthetic form of this vitamin. Folic acid is well-tolerated in amounts found in fortified foods and supplements. Sources include cereals, baked goods, leafy vegetables (spinach, broccoli, lettuce), okra, asparagus, fruits (bananas, melons, lemons), legumes, yeast, mushrooms, organ meat (beef liver, kidney), orange juice and tomato juice. Folic acid is frequently used in combination with other B vitamins in vitamin B complex formulations. The recommended dietary allowance for folate is 400 micrograms per day for males or females ages 14 years and older; 500 micrograms per day for breastfeeding adult women; 600 micrograms per day for pregnant adult women. Given as dietary folate equivalents (DFE).
To prevent anemia during pregnancy, the expectant mother should stay in close contact with her doctor eat a diet that includes foods rich in iron and folate, like liver and dark green leafy vegetables. Folate also plays an important role in the normal development of a baby's spinal cord and can help prevent serious disorders like spinal bifida.
Vitamin B12: Consuming an adequate amount of folate may help reduce the risk of developing megaloblastic anemia. Vitamin B12 is commonly found in a variety of foods such as fish, shellfish, meats and dairy products. The recommended dietary allowances (RDAs) are 2.4 micrograms per day for adults and adolescents aged 14 years and older, 2.6 micrograms per day for adult and adolescent pregnant females, 2.8 micrograms per day for adult and adolescent lactating females.
Vitamin B6: Consuming an adequate amount of Vitamin B6 may help reduce the risk of developing Sideroblastic anemia. The Recommended Daily Allowances (RDA) of Vitamin B-6 for males (19-50 years) 1.3 milligrams; (51 years and older) 1.7 milligrams; females (19-50 years) 1.3 milligrams; (51 years and older) 1.5 milligrams. Some researchers think the RDA for women 19-50 years should be increased to 1.5-1.7 milligrams per day. Pregnant women, 1.9 milligrams; and lactating women, 2 milligrams.

Risk factors

Poor diet: A diet that is consistently low in vitamins, especially iron, folate and vitamin B12, increases the risk of anemia. These vitamins are essential for the body to produce a sufficient amount of red blood cells. Individuals who are dependent on alcohol may be more susceptible to develop anemia because alcohol interferes with the body's ability to absorb folic acid. Also, individuals who follow a strict vegetarian diet may be at an increased risk for the disorder because they may not consume enough iron or vitamin B12, which is typically found in meat.
Intestinal disorders: Individuals who have intestinal disorders that interfere with the body's ability to absorb nutrients (like Crohn's disease or celiac disease) are at risk for developing anemia.
Menstruation: Women are more likely to develop anemia than men because during menstruation women lose blood, which contains iron.
Pregnancy: Pregnant women are at an increased risk of developing iron deficiency anemia because their iron stores and hemoglobin must also support the growing fetus.
Chronic conditions: Some chronic conditions can result in a shortage of red blood cells. Individuals who have cancer, kidney disease, liver disease or other types of chronic conditions, may be at risk for anemia.
Family history: Individuals with a family history of an inherited anemia (like sickle cell anemia) may be at risk for developing the disorder.
Other: Some types of infections, blood diseases, autoimmune disorders, exposure to toxic chemicals and some medications can also result in a decreased number of red blood cells and cause anemia.

Types and causes

Anemia of chronic disease: Certain chronic diseases (like cancer, rheumatoid arthritis and Crohn's disease) can interfere with the production of red blood cells, which may result in chronic anemia.
Kidney failure may also cause anemia. The kidneys produce a hormone called erythropoietin, which stimulates the bone marrow to produce red blood cells. However, kidney failure or chemotherapy can cause a shortage of erythropoietin, which then results in a shortage of red blood cells.
Aplastic anemia: Aplastic anemia is life threatening. This condition occurs when the bone marrow is unable to produce enough of all three types of blood cells (red blood cells, white blood cells and platelets).
The two main types of aplastic anemia are hereditary and acquired. Individuals are born with hereditary aplastic anemia, which is extremely rare. Acquired, which is the most common, is believed to be an autoimmune response that may be triggered by exposure to toxic chemicals, chemotherapy drugs, radiation or viral infections.
Aplastic anemia is estimated to affect about 500-1,000 people in the United States each year. It is two to three times more common in Asian countries.
Hemolytic anemia: Several types of anemia are considered hemolytic. Hemolytic anemia develops when red blood cells are destroyed faster than the bone marrow can replace them. Common symptoms include jaundice (yellowing of the skin and eyes) and an enlarged spleen.
Certain blood diseases can cause increased red blood cell destruction. Autoimmune disorders can cause the body to produce antibodies to destroy red blood cells. Certain medications and antibiotics that are used to treat infections (like penicillin, cephalosporins, levodopa, methyldopa and quinidine) may also cause red blood cells to decrease.
Iron deficiency anemia: Iron deficiency anemia is the most common form of the disease. Researchers estimate that it affects about 20% of women, 50% of pregnant women and three percent of men in the United States. The World Health Organization considers iron deficiency to be the largest international nutritional disorder.
Iron is necessary for the bone marrow to produce hemoglobin. If the body has inadequate levels of iron, there will not be enough hemoglobin for the red blood cells.
There are two forms of dietary iron: heme and non-heme. Sources of heme iron include meat, fish and poultry. Sources of non-heme iron, which is not absorbed as well as heme iron, include beans, lentils, flours, cereals and grain products. Other sources of iron include dried fruit, peas, asparagus, leafy greens, strawberries and nuts. When red blood cells die, the body recycles the iron in them to produce new blood cells.
Iron deficiency can occur if there is a significant amount of blood loss. One reason women are more susceptible to this form is that they menstruate each month. In addition, slow, chronic blood loss from a source within the body (like an ulcer or colon polyp) can lead to iron deficiency anemia. This condition can also occur if the diet is not rich in iron. In pregnant women, a growing fetus may deplete the mother's stored iron, causing her to develop iron deficiency anemia.
Megaloblastic anemia: When the body lacks vitamins that are needed to produce a sufficient amount of healthy red blood cells, the condition is known as megaloblastic anemia. The condition causes the red blood cells to be much larger than normal. In addition to iron, folate and vitamin B12, are needed to produce healthy red blood cells. Therefore, a diet lacking in either of these two nutrients can result in decreased red blood cell production.
Individuals who have intestinal disorders that affect the absorption of nutrients are at risk for developing this type of anemia. Some people are unable to absorb vitamin B-12 for a variety of reasons and develop vitamin B-12 deficiency anemia, which is sometimes called pernicious anemia.
Sickle cell anemia: Sickle cell anemia is inherited and primarily effects African Americans and people of Arabic decent. Sickle cell anemia occurs in people who have a defective form of hemoglobin (hemoglobin S), which causes red blood cells to assume an abnormal crescent (sickle) shape. These irregular-shaped blood cells die early, causing a chronic shortage of red blood cells.
Normal blood cells are flexible and round, and they are able to move freely through blood vessels in the body. However, the irregular-shaped blood cells in sickle cell anemia patients cannot travel through the body as easily. They often block blood flow through small blood vessels in the body and form blood clots.
Sideroblastic anemia: Sideroblastic anemia is an enzyme disorder in which the body has sufficient amounts of iron, but it is unable to incorporate it into the hemoglobin. It is caused by the abnormal production of red blood cells as part of myelodysplastic syndrome, which can evolve into hematological malignancies (especially acute myelogenous leukemia).
Other anemia: There are several other, less common, forms of anemia, such as thalassemia and anemia caused by defective hemoglobin.