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• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Drug Therapies
• Surgical and Other Procedures
• Complementary and Alternative Therapies
• Following Up
• Special Considerations
• Supporting Research.

Anemia is characterized by a deficiency in red blood cells or in the concentration of hemoglobin (iron-containing portions of red blood cells). These deficiencies are caused by either decreased production or increased destruction of red blood cells. Anemia is most common among women in their reproductive years (5.8 percent), infants (5.7 percent), and the elderly (12 percent). Because one of the major functions of red blood cells is to transport oxygen, a decrease in red blood cells decreases the amount of oxygen delivered to the body's tissues, which results in the symptoms of anemia.

Signs and Symptoms

There is tremendous variability among individuals as to when the following symptoms of anemia develop.

• Tiredness
• Shortness of breath
• Paleness
• Lightheadedness
• Headache
• Heart palpitations and chest pain

What Causes It?

Anemia may have the following causes.

• Pregnancy and breast-feeding
• Iron, folic acid, vitamin B12, or other vitamin deficiencies
• Certain chronic conditions
• Gastrointestinal blood loss (caused by ulcers, cancer, parasites)
• Genitourinary blood loss (such as from heavy menstruation)
• Excessive blood loss (after surgery or regular blood donations)
• Excessive alcohol or drug use
• Malabsorption syndromes (for example, celiac disease)
• Congenital diseases (for example, sickle-cell anemia)
• Malnutrition

What to Expect at Your Provider's Office

Anemia is often the result of an underlying disease. Laboratory tests to examine your blood will be ordered. If you are anemic, your health care provider will determine the cause in order to begin treatment.

Treatment Options

Treatment depends on the cause and severity of the anemia. Because anemia is often the result of nutritional deficiencies, your health care provider can help you outline a diet that contains all of the nutrients you need for healthy blood formation such as vitamin B12, iron, and folic acid. If your anemia is the result of an underlying disease, that disease must first be successfully treated.

Drug Therapies
• Erythropoietin plus iron—for anemia caused by chronic kidney failure
• Corticosteroid medications (such as prednisone)
• Immunosuppressant medications (such as azathioprine)
• Pain relievers (analgesics)—for sickle-cell 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, such as sickle-cell anemia

Complementary and Alternative Therapies

Most cases of anemia will respond well to nutritional therapy. Note that excess iron is toxic and you should not take supplements unless lab tests indicate iron deficiency and your health care provider recommends them. Herbal and nutritional treatments may be helpful when used along with medical treatment.

Nutrition • Ferrous fumerate, glycerate, or glycinate (100 mg per day for three to six months) are the most absorbable forms of iron. Ferrous sulfate (325 mg per day) is poorly absorbed and more frequently causes problems with gastrointestinal upset and constipation. Dietary sources of iron include meat, beans, green leafy vegetables, beet greens, blackstrap molasses, almonds, and brewer's yeast.
• Vitamin C—250 to 500 mg twice a day to aid in absorption of iron.
• Vitamin B12—cyanocobalamine, 1,000 IU via injection twice a day for one week, then weekly for a month, then every two to three months. Dietary sources include organ meats, meats, eggs, fish, and cheese.
• Folic acid (1 to 2 mg per day)—for folic acid deficiency. Good food sources include green leafy vegetables and grains.
• Omega-3 and omega-6 essential fatty acids (1,000 to 1,500 IU) have been shown to decrease the frequency of sickle-cell crisis. EFAs can increase clotting times, so if you are taking anticoagulants, your health care provider will need to check these times.

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to work with your provider on getting your problem diagnosed before you start any treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. Tinctures may be used singly or in combination as noted.

You may be treated with the following herbal therapies for one to three months and then reassessed.
• Blackstrap molasses, also known as pregnancy tea (1 tbsp. per day in a cup of hot water), is a good source of iron, B vitamins, minerals, and is also a very gentle laxative.
• Spirulina, or blue-green algae, has been used successfully to treat both microcytic and macrocytic 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 long 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 tbsp. per cup of water. Simmer roots for 20 minutes and leaves for 5 minutes. A single herb, or a combination of these four herbs, may be used.

Although very 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. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
• Ferrum phosphoricum -- for iron deficiency
• Calcarea phosphorica -- particularly for children with nighttime bone aches, cool hands and feet, lack of energy, and/or poor digestion

Following Up

Maintaining a normal balanced diet is very important if the cause of your anemia is nutritional. Also, avoid drugs that can have adverse effects on your gastrointestinal system and avoid excessive alcohol intake if one or both of these are the cause of your anemia.

Special Considerations

Complications from anemia can range from loss of productivity due to weakness and fatigue to coma and death. Some neurologic changes caused by anemia are irreversible. Pregnant women need three or four times as much iron as normal. A folic acid deficiency during pregnancy can result in infants being born with neural-tube defects, such as spina bifida.

Supporting Research

Branch WT Jr. Office Practice of Medicine. Philadelphia, Pa: WB Saunders Company; 1994.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.

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):2118-2119.

Kelley WN, ed. Textbook of Internal Medicine. 3rd ed. Philadelphia, Pa: Lippincott-Raven; 1997.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Tyler VE. The Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. 3rd ed. Binghamton, NY: Pharmaceutical Products Press; 1993.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995:181.

Review Date

August 1999

Reviewed By

Participants in the review process include: Dahlia Hirsch, MD, Center for Holistic Healing, BelAir, MD; Sherif H. Osman, MD, President, Medical Staff Harford Memorial Hospital, Falston General Hospital, Bel Air, MD; Leonard Wisneski, MD, FACP, George Washington University, Rockville, MD.

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