When your blood doesn't do its job properly

What is anemia?

Anemia, also known as blood deficiency, describes a condition in which the blood does not contain enough red blood cells or haemoglobin to adequately meet the body's oxygen needs. As a result, oxygen transport to the cells is limited, which can negatively affect physical performance.

A lack of haemoglobin or erythrocytes can have various causes. Anemia is not a disease in itself, but rather an indicator of an underlying imbalance in the body. The exact cause should always be investigated medically, as early diagnosis is crucial for targeted treatment.

In medical practice, anemia is usually detected by a blood test, which assesses in particular the haemoglobin level and the concentration of red blood cells.

What types of anemia are there?

There are numerous formsof anemia that differ by the size, appearance and haemoglobin content of red blood cells as well as by their mechanism of origin.

A common classification is based on cell size and haemoglobin content: in microcytic, hypochromicanemia the erythrocytes are smaller than normal and contain too little haemoglobin – a typical example is iron deficiency anemia. Macrocytic anemia, on the other hand, is characterised by enlarged red blood cells with an increased mean cell haemoglobin (MCH), as seen in folate or vitamin B12 deficiency. In normocytic, normochromic anemia the erythrocytes are of normal size and colour, but their total number is reduced, for example after acute blood loss.

There are also specific special forms. Pernicious anemia arises from impaired absorption of vitamin B12 due to a lack of intrinsic factor. In haemolytic anemia red blood cells break down prematurely. A particular form is sickle cell anemia, an inherited disorder in which erythrocytes deform into a sickle shape and are more easily destroyed. Another form is the rare aplastic anemia caused by reduced blood formation in the bone marrow. A renal anemia can also occur in the context of chronic kidney disease because production of the important blood-forming hormone erythropoietin is decreased.

What causes anemia?

The causes of anemia can generally be assigned to three main mechanisms: blood loss, reduced production or increased destruction of red blood cells, with a variety of individual factors involved in each case.

A common trigger is blood loss, which can be acute or insidious. While injuries or surgeries lead to sudden blood loss, chronic bleeding often develops unnoticed, for example due to gastrointestinal diseases or prolonged heavy menstruation. Such ongoing losses often lead to iron deficiency, which impairs haemoglobin production.

Another origin lies in the insufficient production of red blood cells in the bone marrow. For effective blood formation, besides iron, vitamin B12, folic acid, trace elements such as copper and the hormone erythropoietin are required. Deficiencies or metabolic disorders can result in too few or defective erythrocytes. Chronic inflammatory diseases, infections or tumours can also inhibit this process, as can bone marrow disorders such as leukaemia or metastases.

Moreover, anemia can arise when red blood cells are destroyed prematurely – a process called haemolysis. This form occurs in inherited disorders such as sickle cell disease or thalassaemias, but also as a result of autoimmune reactions, infections like malaria, the intake of certain medications or exposure to toxic substances. If destruction outpaces production, anemia develops.

In addition to these main causes there are other influencing factors: a deficiency in certain vitamins, particularly vitamin B12, folic acid, riboflavin and vitamin A, can negatively affect blood formation. Genetic disorders, congenital syndromes such as Fanconi anaemia, as well as chronic infections and systemic diseases like tuberculosis or HIV can also be causal. In many cases several of these factors act together.

What are the symptoms of anemia?

Anemia can cause a wide range of complaints, partly due to insufficient oxygen supply to tissues. Typical signs are persistent fatigue, reduced physical capacity, concentration problems, shortness of breath even with light exertion, as well as sensations of a racing heart and tinnitus. Often the skin, lips or mucous membranes appear noticeably pale. In some cases a reddened, smooth tongue may also be observed.

In addition, certain forms of anemia can present specific symptoms. Iron deficiency may cause brittle nails, cracked corners of the mouth or inflamed mucous membranes. A vitamin B12 deficiency can be associated with a burning tongue, digestive problems, loss of appetite or neurological symptoms such as numbness or memory lapses. In cases of internal bleeding, anemia may present with bloody or black-coloured stools, accompanied by circulatory problems, low blood pressure and a rapid heartbeat. In other cases, for example with increased destruction of red blood cells, jaundice or dark urine can provide clues.

From what value is anemia dangerous?

Anemia is considered concerning when haemoglobin levels fall significantly. In men this value is below 13 g/dL, in women below 12 g/dL. It becomes dangerous, however, when the concentration falls below 7.0 g/dL, as the risk of serious health consequences such as organ damage or heart failure increases markedly in this range. Values below 6.5 g/dL are critical and typically require immediate medical treatment.

Who is commonly affected by anemia?

Anemia occurs preferentially at certain stages of life or with specific health conditions. Groups particularly at risk include women during pregnancy or breastfeeding, as their bodies require significantly more iron during these times. Children and adolescents in growth phases are also at risk, especially if their diet does not provide adequate micronutrients.

In older age there are often problems with the absorption of iron and vitamins, which increases the risk of blood deficiency. Likewise, people with chronic conditions, such as inflammatory diseases, cancers or renal dysfunction, frequently develop anemia because the disease processes can directly impair blood formation or the utilisation of vital substances. In addition, highly active athletes have an increased need for blood-forming nutrients; if this need is not met, deficiency can also occur.

What you can do for anemia: effective tips

• Rely on iron-rich foods. Heme iron, which is particularly well absorbed, is found in red meat, poultry, fish and eggs. Plant-based foods such as whole grains, legumes, spinach or broccoli also provide iron, but in a form that is less well absorbed by the body.
• Vitamin C enhances the absorption of plant-based iron. For example, combine porridge with fresh orange juice or eat bell peppers with iron-rich dishes.
• Ensure adequate intake of folic acid, as it supports blood formation. Good sources are green vegetables, wholegrain products, legumes, potatoes, dairy products, yeast, liver and eggs. Bear in mind that folic acid is sensitive to heat and light – prepare foods as gently as possible.
• Vitamin B12 is essential for blood formation. It is mainly found in animal products such as meat, fish, eggs and milk. Plant foods do not contain a form usable by humans, so supplements are necessary for vegan diets.
• Take iron tablets correctly. If iron has been prescribed, swallow the tablets in the morning on an empty stomach with a glass of water. If you have stomach problems, taking them with breakfast is possible, although this may slightly reduce absorption.
• Take iron tablets with sufficient spacing (at least two hours) from other agents, as calcium, magnesium, zinc, antacids and some antibiotics in particular can hinder iron absorption.
• Avoid certain foods around tablet intake. Dairy products, black tea, coffee, soy and high-fibre foods contain substances that bind iron and block its absorption in the gut. They should therefore not be consumed at the same time as iron tablets.
• Be patient during treatment. Therapy with iron preparations generally lasts several months. It is perfectly normal for stools to turn black – this is a harmless side effect.
• There are juice or herbal tea cures that contain iron-rich plants, such as nettle, dandelion, centaury, couch grass, blackberry leaves or horsetail. These plants cannot replace an iron deficiency, but they can support medical treatment well.
• Have the cause of your anemia medically investigated. If the blood deficiency is a consequence of a chronic disease, iron absorption may be impaired. In such cases, treating the underlying condition is crucial to improving haemoglobin levels.

If anemia is detected early, patients can help improve blood values through targeted dietary choices, restoring iron stores and promoting the production of blood cells and haemoglobin. Watch for warning signs as haemoglobin concentration falls and seek medical advice.