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What organ is most affected by anemia?


Anaemia is a condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal. Haemoglobin is needed to carry oxygen and if you have too few or abnormal red blood cells, or not enough haemoglobin, there will be a decreased capacity of the blood to carry oxygen to the body’s tissues. This results in symptoms such as fatigue, weakness, dizziness and shortness of breath, among others. The optimal haemoglobin concentration required to meet physiologic needs varies by age, sex, elevation of residence, smoking habits and pregnancy status. Anaemia may be caused by several factors: nutrient deficiencies through inadequate diets or inadequate absorption of nutrients, infections (e.g. malaria, parasitic infections, tuberculosis, HIV), inflammation, chronic diseases, gynaecological and obstetric conditions, and inherited red blood cell disorders. The most common nutritional cause of anaemia is iron deficiency, although deficiencies in folate, vitamins B12 and A are also important causes.

Anaemia is a serious global public health problem that particularly affects young children, menstruating adolescent girls and women, and pregnant and postpartum women. WHO estimates that 40% of children 6–59 months of age, 37% of pregnant women, and 30% of women 15–49 years of age worldwide are anaemic.


Anaemia can cause a range of non-specific symptoms including tiredness, weakness, dizziness or light-headedness, drowsiness, and shortness of breath, especially upon exertion. Children and pregnant women are especially vulnerable, with more severe cases of anaemia leading to an increased risk of maternal and child mortality. Iron deficiency anaemia has also been shown to affect cognitive and physical development in children and reduce productivity in adults.

Anaemia is an indicator of both poor nutrition and poor health. It is problematic on its own, but it can also impact other global public health concerns such as stunting and wasting, low birth weight and childhood overweight and obesity due to lack of energy to exercise. School performance in children and reduced work productivity in adults due to anaemia can have further social and economic impacts for the individual and family.

WHO response

Accurate characterization of anaemia is critical to understand the burden and epidemiology of this problem, for planning public health interventions, and for clinical care of people across the life course. While iron deficiency anaemia is the most common form and can often be treated through dietary changes, other forms of anaemia must be treated by addressing underlying infections and chronic conditions requiring comprehensive health interventions.

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WHO has guidance that covers all WHO Regions to help reduce the prevalence of anaemia through prevention and treatment. These guidelines aim to increase dietary diversity, improve infant feeding practices and improve the bioavailability and intake of micronutrients through fortification or supplementation with iron, folic acid and other vitamins and mineral. Social and behaviour change communication strategies are used to change nutrition-related behaviours. Interventions to address the underlying and basic causes of anaemia look at issues such as disease control, water, sanitation and hygiene, reproductive health and root causes such as poverty, lack of education and gender norms.

Anaemia, as a public health issue, needs to be addressed from multiple perspectives and through multiple coordinated efforts, including multiple government sectors, nongovernmental organizations, United Nations agencies and the private sector – each with specific and complementary roles to collectively achieve anaemia reduction and improve health and well-being.

See here for more information.

What organ is most affected by anemia?

Anemia is when your body’s level of red blood cells goes below normal. When you do not have enough red blood cells, your body parts do not get enough oxygen. As a result, they cannot work the way they should and cause problems.

You can develop anemia if your body does not make enough red blood cells or destroys them. You can also develop anemia if you lose too much blood from your bloodstream.

Anemia is a common side effect of cancer and cancer treatment. This is especially true for people receiving chemotherapy.

What are the signs and symptoms of anemia?

Many people with anemia feel fatigue or muscle weakness. These symptoms can make it harder to cope with other physical and emotional effects of cancer treatment.

Symptoms of anemia may also include:

  • Rapid or irregular heart beat
  • Occasional chest pain
  • Trouble breathing or shortness of breath
  • Dizziness or fainting
  • Pale or lighter than normal color of the skin, nail beds, lips, gums, or tongue
  • Headaches
  • Trouble concentrating
  • Insomnia
  • Becoming tired more easily
  • Trouble staying warm
  • Bleeding problems

Talk with your health care team about any symptoms you experience. This includes any new symptoms or a change in symptoms. Managing anemia and other cancer side effects is an important part of your medical care and treatment. This type of care is called palliative care or supportive care.

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What are the causes of anemia?

Red blood cells are made in the bone marrow. Bone marrow is the soft, spongy tissue found inside your larger bones. A hormone from the kidneys, called erythropoietin, tells your body when to make more red blood cells. Damage to either the bone marrow or the kidneys can cause anemia. Anemia can be caused by cancer, cancer side effects, or cancer treatment. It can also be caused by factors unrelated to cancer.

Common causes of anemia in people with cancer include:

Chemotherapy. Chemotherapy can damages bone marrow. This damage usually does not last and anemia often improves a few months after chemotherapy ends. Also, chemotherapy with platinum-based drugs may harm the kidneys. These drugs include cisplatin (Platinol) and carboplatin (Paraplatin).

Radiation therapy. Radiation therapy to large areas of the body can damage bone marrow. So can radiation therapy to bones in the pelvis, legs, chest, or abdomen.

Certain types of cancer. Leukemia, lymphoma, and multiple myeloma damage bone marrow. Also, cancer that spreads to the bone or bone marrow may crowd out healthy red blood cells.

Nausea, vomiting, and loss of appetite. Nausea and vomiting and loss of appetite may cause you to lose nutrients. Your body needs nutrients to make red blood cells. These includes iron, vitamin B12, and folic acid.

Too much blood loss. You can lose red blood cells faster than your body can make them. This may happen after surgery or if a tumor causes bleeding inside your body.

How is anemia diagnosed?

Doctors use a blood test called a complete blood count (CBC) to diagnose anemia. The test results include your number of red blood cells.

There are several ways to check your red blood cell count, including measuring hemoglobon and hematocrit. Hemoglobin is the iron-rich protein in red blood cells that carries oxygen. Hematocrit is the percentage of blood that is made up of red blood cells.

People with specific types of cancer or who are receiving certain cancer treatments may have regular CBC tests to monitor their health. In addition to anemia, a CBC looks for other blood-related problems. If the test shows that you have anemia, you may need other tests to find the cause.

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How is anemia treated?

Doctors treat anemia based on the cause and symptoms. Here are some examples.

Blood transfusion. If anemia is causing symptoms or problems, you may need a red blood cell transfusion. During the transfusion, healthy red blood cells from a donor go into your body through a needle into a vein.

Medication. If chemotherapy causes anemia, your doctor may prescribe medications called erythropoiesis-stimulating agents (ESAs). ESAs are forms of erythropoietin made in the laboratory. They work by telling your bone marrow to make more red blood cells.

ESAs include epoetin alfa (Epogen, Procrit, Retacrit) and darbepoetin work equally well for treating anemia from chemotherapy. They also have similar risks. Epoetin and darbepoetin are injected in the body at regular intervals. They can take several weeks to start working.

The American Society of Clinical Oncology (ASCO) and the American Society of Hematology (ASH) provide these recommendations for using epoetin and darbepoetin:

  • When ESAs may be given. You may get ESAs to treat anemia if you are receiving chemotherapy as a treatment to manage cancer symptoms. This is called palliative treatment. You may also get ESAs if you have low-risk myelodysplastic syndrome (MDS) even when you are not receiving chemotherapy. MDS is a bone marrow disorder that can cause anemia.
  • When ESAs should not be given. ESAs are not recommended if you are not receiving chemotherapy or if you are receiving chemotherapy to cure cancer. You should also not receive ESAs if your hemoglobin level is 10 grams per deciliter (g/dL) or higher.
  • How ESAs are given. You should get ESAs at the lowest dose possible. The goal is to raise your hemoglobin level just enough for your to avoid a blood transfusion. Your doctor may lower the dose when that level is reached. They may also lower the dose if your hemoglobin level rises more than 1 g/dL within 2 weeks. If your hemoglobin level does not rise after 6 to 8 weeks, ESA treatment is not working. Your doctor should stop the treatment.
  • Risks of ESAs. ESAs have serious health risks. This includes an increased risk of death and blood clots. Talk with your doctor about the possible risks and benefits of using ESAs. Together, you should compare them with the risks and benefits of a red blood cell transfusion. You and your doctor should be very cautious about using ESAs if you have a high risk of blood clots. Risk factors for developing a blood clot from ESAs include:
    • A previous blood clot
    • Recent major surgery
    • Long periods of bed rest or limited activity, such as being in the hospital
    • Some types of chemotherapy and hormone therapy
    • Some types of treatment for multiple myeloma, especially thalidomide (Thalomid) or similar drugs

    This information is based on ASCO and ASH recommendations about treatment of anemia with ESAs. Please note that this link takes you to another ASCO website.

    Vitamin or mineral supplements. If a lack of nutrients causes anemia, your doctor may prescribe supplements. These include iron, folic acid, or vitamin B12. These supplements are usually pills taken by mouth. Occasionally, you may get a vitamin B12 injection. These injections may help your body better absorb the vitamin.

    Also consider eating foods high in iron or folic acid. Foods high in iron include:

    • Red meat
    • Beans
    • Dried apricots
    • Almonds
    • Broccoli
    • Enriched bread and cereal

    Foods high in folic acid include:

    • Asparagus
    • Broccoli
    • Spinach
    • Lima beans
    • Enriched breads and cereals

    Questions to ask the health care team

    • Does my cancer or cancer treatment put me at risk for developing anemia?
    • Will you test my blood to look for signs of anemia? If so, how often will I need to have this test?
    • What signs or problems of anemia should I watch for? Which ones should I tell you about right away?
    • What is causing my anemia?
    • How can my anemia be treated?
    • Who can help me understand my nutritional needs?

    Iron-Deficiency Anemia

    Iron-deficiency anemia is anemia that happens when there isn’t enough iron in the body.

    Someone with anemia has a lower number of red blood cells (RBCs) than usual. RBCs contain hemoglobin, a protein that carries oxygen throughout the body. The body needs iron to make hemoglobin (HEE-muh-glow-bin). Without enough iron, less hemoglobin and fewer red blood cells are made, leading to anemia.

    Treatment with iron supplements usually makes the anemia better.

    What Are the Signs & Symptoms of Iron-Deficiency Anemia?

    At first, children with iron-deficiency anemia may not have any symptoms. When symptoms do happen, a child might:

    • look pale
    • seem moody
    • be very tired
    • get tired quickly from exercise
    • feel dizzy or lightheaded
    • have a fast heartbeat
    • have developmental delays and behavioral problems
    • want to eat ice or non-food items (called pica)

    What Causes Iron-Deficiency Anemia?

    Iron-deficiency anemia can happen when:

    • There’s a problem with how the body absorbs iron (such as in celiac disease).
    • Someone has blood loss from an injury, heavy menstrual periods, or bleeding inside the intestines.
    • Someone doesn’t get enough iron in the diet. This can happen in:
      • children who drink too much cow’s milk, and babies given cow’s milk before they’re 1 year old
      • vegetarians because they don’t eat meat, a source of iron
      • breastfed babies who don’t get iron supplements
      • babies given formula with low iron
      • babies who were born early or small who may need more iron than formula or breast milk contains

      How Is Iron-Deficiency Anemia Diagnosed?

      Doctors usually can diagnose iron-deficiency anemia by:

      • asking questions about symptoms
      • asking about the diet
      • finding out about the patient’s
      • doing a physical exam
      • doing blood tests to:
        • look at the red blood cells with a microscope
        • check the amount of hemoglobin and iron in the blood
        • check how fast new RBCs are being made
        • do other blood tests to rule out other types of anemia

        How Is Iron-Deficiency Anemia Treated?

        Doctors treat iron-deficiency anemia with iron supplements taken as a liquid or pill for at least 3 months. To help iron get absorbed into the body:

        • Avoid taking iron with antacids, milk, or tea because these interfere with the body’s ability to absorb iron.
        • Take iron before eating (unless this causes an upset stomach).

        Someone whose anemia is very severe may get iron or a blood transfusion through an IV (intravenous) line.

        When iron-deficiency anemia is caused by something other than a lack of iron in the diet, treatment also may include:

        • treatments to reduce bleeding in heavy menstrual periods
        • reducing the amount of cow’s milk in the diet
        • treating an underlying disease

        How Can Parents Help?

        If your child has iron-deficiency anemia:

        • Make sure your child takes the iron supplements exactly as prescribed.
        • Include iron-rich foods in the family’s diet. Good sources of iron include:
          • iron-fortified cereals
          • lean meat, poultry, and fish
          • tofu
          • egg yolks
          • beans
          • raisins

          To help prevent iron-deficiency anemia in young children:

          • Don’t give cow’s milk to babies under 1 year old.
          • Limit cow’s milk in kids over 1 year old to less than 2 cups of milk a day. Giving them more can make them feel full and lower the amount of iron-rich foods they eat.
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