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Take a deep breath. Let the air fill your lungs, rich with vital oxygen. How's it feel? Refreshing? Calming? That deep breath doesn't just release tension in your shoulders and neck–it also keeps your blood oxygenated and your body functioning. For anyone with a low red blood cell count caused by severe anemia, each breath is not delivering adequate oxygen, leaving them weak, dizzy, and unfocused.
Fortunately, if you're anemic you don't have to resign yourself to low energy. From medications to procedures to supplements, there are many options available to help rally red blood cells and replenish iron stores.
What is anemia?
At the basic level, anemia is a deficiency of red blood cells or hemoglobin, which inhibits oxygen delivery to muscles, organs, and other tissues. As a result, symptoms of anemia include fatigue, weakness, lightheadedness, shortness of breath, and dizziness. There are numerous causes for anemia, each with its own symptoms and treatments, so the condition can vary drastically in severity and longevity.
Red blood cells, the body's microscopic oxygen couriers, are produced by the stem cells in red bone marrow, but there are many contributing agents, including iron, vitamin B-12, and folate. An imbalance, abnormality, or condition affecting any of these factors can be a cause of anemia.
There are many different types of anemia, but they all arise from three root causes: blood loss, decreased red blood cell production, or red blood cell destruction. These are a few of the most common types:
- Iron deficiency anemia: Bone marrow needs iron to manufacture hemoglobin, which allows blood cells to carry oxygen. Blood loss from menstrual bleeding, ulcers, hernias, or colon cancer can often lead to low hemoglobin levels.
- Vitamin deficiency anemia: Vitamin B-12 and folate are necessary to produce healthy red blood cells. An insufficiency could hinder blood cell production.
- Pernicious anemia: This type of vitamin deficiency anemia is specifically caused by the body's inability to absorb vitamin B-12, hampering red blood cell development.
- Aplastic anemia: This is an autoimmune disease that inhibits the production of not just red blood cells, but also white blood cells and platelets. It's much rarer than the other types, but can also be life-threatening.
- Thalassemia: An inherited blood disorder that decreases the body's hemoglobin production.
- Hemolytic anemia: This condition destroys red blood cells (hemolysis) faster than they're produced, causing a deficiency.
- Sickle cell anemia: This type of hemolytic anemia is characterized by defective hemoglobin and crescent-shaped red blood cells that die prematurely. Because it's an inherited condition, sickle cell disease usually appears in the first year of life and, while the severity varies from person to person, often worsens with age, says the CDC.
- Anemia of chronic disease: This type of anemia stems from a persistent pre-existing condition such as chronic kidney disease, autoimmune disease, and Crohn's disease.
A common misconception is that every anemia patient must be losing blood, according to Jesse P. Houghton, MD, Senior Medical Director of Gastroenterology at Southern Ohio Medical Center. “Two other very common forms of anemia are anemia as a result of chronic kidney disease (chronic kidney disease), and anemia as a result of a chronic medical condition (diabetes, COPD, CHF),” Dr. Houghton says.
With so many disparate causes, anemia cases are fairly widespread. According to the World Health Organization, anemia affects 1.62 billion people worldwide, a staggering 24.8% of the global population. That translates to more than 3 million U.S. cases per year. Fortunately, in most cases, it's treatable, although the specific treatment depends on the underlying cause.
How is anemia diagnosed?
Fatigue, lightheadedness, weakness, and dizziness—especially when accompanied by a condition like cancer or kidney disease—are key signs of anemia. When making a diagnosis, a healthcare provider's first move is often a physical exam, along with asking questions about the patient's symptoms, medical history, and family history, which prove essential in helping determine the cause and best course of action. Then, they will usually order one or more blood tests.
Complete blood count (CBC)
This is often the first test ordered by a healthcare provider takes because it analyzes a few different blood features, including:
- Red blood cells
- White blood cells
- Platelets
- Hemoglobin levels
- Hematocrit, which is the ratio of your red blood cell volume to your overall blood volume
- Mean corpuscular volume (MCV), or the average size of your red blood cells
Together, these measurements can point to a root cause or underlying condition. For example, deficiencies in all three types of blood cells could indicate aplastic anemia while a low MCV might suggest iron deficiency anemia. Blood cell size is also important, says Shikha Jain MD, FACP, a hematology-oncology physician at Rush University Medical Center. “If they are too small, it can be indicative of anemia due to iron deficiency or bleeding,” Dr. Jain explains. “But if the red blood cells are too large, it may be due to a vitamin deficiency such as vitamin B12 or folate.”
Reticulocyte count
Reticulocytes are young red blood cells. A high volume of these immature cells means the bone marrow is producing them at a normal rate, but they're being destroyed or lost quickly. Conversely, a low reticulocyte count means the bone marrow is having difficulty producing blood cells.
Blood smear
This test is exactly what it sounds like. The doctor will smear a drop of blood on a slide, then examine it to observe blood cell size and shape. The results can be especially helpful in diagnosing sickle cell disease or a vitamin deficiency.
Ferritin blood test
Ferritin is the body's main iron storage protein. A doctor performing this test will measure the ferritin levels of venous blood. Elevated levels can indicate an iron storage disorder.
Anemia treatment options
Anemia treatment can include everything from dietary supplements to blood transfusions. In some cases, a doctor might also use supplementary treatments like intravenous fluids and pain relievers to deal with pain and prevent complications.
For the 5 million Americans with iron deficiency anemia, doctors often recommend an iron supplement and dietary changes to combat low iron. Likewise, doctors may prescribe vitamin B-12, vitamin C, or folic acid supplements for other deficiencies. However, severe cases or ones caused by an underlying condition might require additional procedures, like a blood transfusion or a bone marrow transplant.
Blood transfusions are a common and effective treatment for various types of anemia, including aplastic anemia, hemolytic anemia, sickle cell, and inherited diseases like thalassemia. During a transfusion, doctors use an intravenous line (IV) to supply a patient with blood from a viable donor.
This can replenish lost blood or boost the number of cells or platelets in the bloodstream, making it a versatile procedure for treating a wide scope of conditions. Very rarely, blood transfusions can cause an allergic reaction or bloodborne infection, but these cases are few and far between.
A healthcare provider might also recommend certain medications to stimulate red blood cell production or reduce iron overloads caused by multiple transfusions.
Anemia medications
Erythropoiesis-stimulating agents (ESAs)
Erythropoietin (EPO) is a hormone produced by the kidneys and helps catalyze red blood cell production. It also promotes blood cell synthesis with hemoglobin, which allows the cells to carry oxygen throughout the body. An erythropoietin shortage is one of the causes of anemia, and EPO-stimulating drugs like Procrit and Epogen can help the body generate more essential red blood cells. These drugs are effective for a variety of anemia cases, but side effects can include hypertension, headaches, body aches, nausea, and vomiting.
Iron supplements (ferrous sulfate)
These supplements replenish the body's iron levels, enabling it to continue producing adequate red blood cells and hemoglobin. According to UCSF Health, an adult male body stores 1,000 mg in iron, and an adult female has 300 mg. Generally, iron should come from a healthy, well-rounded diet, but blood loss from menstrual bleeding, gastrointestinal bleeding, or acute injury can quickly deplete these stores. That’s where iron supplements like Feosol and Slow FE come in. They’re best absorbed on an empty stomach or with vitamin C from a glass of orange juice. Unlike other vitamins and minerals in the body, it's possible to overdose on iron, so carefully follow a doctor's recommendation and the dosage guidelines.
Vitamin B supplements
Vitamin-deficiency anemia often requires vitamin B-12 or folate (vitamin B-9) supplements, which are available over the counter at pharmacies and health food stores. By replenishing vitamin levels, they allow the body to resume normal blood cell production. Some anemia patients only require supplements for a short period of time, while others take them for life—it all depends on the anemia’s cause and severity. Side effects are rare but may include headache, dizziness, nausea, and vomiting.
What is the best medication for anemia?
Anemia is such a diverse condition that there's no single overarching cure. Instead, doctors and hematologists develop individualized treatment plans based on each patient's anemia type, severity, age, history, and current medications. With that in mind, these are a few common medications that can help treat it.
| Drug name | Drug class | Administration route | Standard dosage | Common side effects |
| Feosol(ferrous sulfate) | Iron Supplement | Oral | 600 mg daily in 1-3 doses | Upset stomach, diarrhea, constipation |
| Slow Fe | Iron Supplement | Oral | 600 mg daily in 1-3 doses | Upset stomach, diarrhea, constipation |
| Vitamin B-12 (cyanocobalamin) | Vitamin B-12 supplement | Oral, injection | 100-1000 mcg monthly | Dizziness, headache, nausea |
| Folic Acid (folate) | Folate supplement | Oral, injection | 250 mcg, 1 mg daily | Allergic sensitization |
| Foltrate (vitamin B-12 + folic acid) | Vitamin B-12 and folic acid supplement | Oral | One tablet daily | Allergic sensitization |
| Procrit | Erythropoiesis-stimulating agent | Injection | 50-100 units/kg 3 times weekly | Hypertension, headaches, body aches, nausea |
| Epogen | Erythropoiesis-stimulating agent | Injection | 50-100 units/kg 3 times weekly | Hypertension, headaches, body aches, nausea |
| Micera (methoxy polyethylene glycol-epoetin beta) | Erythropoiesis-stimulating agent | Injection | 0.6 mcg/kg intravenously or subcutaneously once every two weeks | Hypertension, diarrhea, nasopharyngitis |
Dosage is determined by your healthcare provider based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are some common side effects of anemia medication?
Every anemia medication has a small chance of side effects. Pairing iron supplements with MiraLAX or Milk of Magnesia is often a good idea, according to Dr. Jain. "Iron pills have the potential side effect of upset stomach and constipation," she says. "So taking a stool softener regularly is important." They can also cause nausea, vomiting, and heartburn.
Vitamin B12 supplements can cause nausea and vomiting too, along with dizziness and headache, while folate supplements sometimes prompt bloating, nausea, trouble sleeping, and poor appetite.
Anemia patients that require an erythropoiesis-stimulating agent like Procrit, Epogen, or Aranesp may experience headaches, body aches, nausea, and vomiting.
These are the most common side effects, but this certainly isn't a complete list. It's important to consult a healthcare provider about all potential side effects and drug interactions before beginning a medication or other treatment.
What is the best home remedy for anemia?
Diet is important. People are often surprised by the profound impact dietary changes can have on their lives. Sometimes, thoughtful and dedicated diet changes are all that's necessary to treat anemia, primarily for cases associated with minor vitamin deficiencies. For example, people with iron deficiency anemia would want to fortify their diets with iron-rich foods like:
- Dark green, leafy vegetables
- Red meats
- Eggs
- Soy products
- Legumes
- Broccoli
- Fish
People with a vitamin B-12 deficiency should add these foods:
- Fish
- Greek yogurt
- Liver
- Eggs
- Milk (both dairy and fortified non-dairy)
For boosted folate levels, good options include:
- Citrus fruits and juices
- Leafy greens
- Seafood
- Beans
- Peanuts
- Whole grains
A well-balanced diet that includes many of the foods listed above is a great way not just to prevent anemia, but to maintain overall health. Supplements are great, but it's best to obtain iron and vitamins through a natural diet.
Frequently asked questions about anemia
Can anemia be caused by medications?
Yes. Certain drugs can cause autoimmune hemolytic anemia, where the immune system mistakes red blood cells for foreign entities and attacks them. These drugs include:
- Cephalosporins
- Dapsone
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Penicillin and similar antibiotics
- Levodopa
- Levofloxacin
- Methyldopa
- Nitrofurantoin
- Phenazopyridine
Is anemia curable?
It depends on the underlying cause. Anemia as a result of blood loss, for example, will recede after transfusions and once the root condition or injury is addressed. Chronic conditions or deficiencies, however, might require long-term treatment, medications, or supplements.
How long does it take to recover from anemia?
It depends on the anemia’s type and cause. Using medication and procedures, doctors may be able to correct iron deficiency anemia in a matter of weeks, but the National Heart, Lung, and Blood Institute says that replenishing your iron stores takes three to six months. Other types, like aplastic anemia or sickle cell disease, often require long-term maintenance.
What should you do if you are anemic?
Visit a healthcare provider for blood work to determine the anemia’s cause. A physician can prescribe a course of treatment to address any underlying conditions, which may include medications, blood transfusions, bone marrow transplants, or other procedures. Your healthcare provider may also refer you to a hematologist or vascular specialist for further evaluation.
Which medicine is best for anemia?
Iron deficiency anemia is the most prevalent type, making iron supplements the most common medication. However, the best medicine is different for each type. Anemia caused by vitamin deficiencies responds well to vitamin B-12 and folate supplements, while other types might require erythropoiesis-stimulating agents to spur on red blood cell production.
How can I raise my iron levels fast?
Revamping your diet to include iron-rich foods like red meats, eggs, and dark green, leafy vegetables can go a long way. However, taking an iron supplement will provide a much more concentrated dose. But be careful–too much iron can result in iron poisoning, so follow your healthcare provider’s advice and the supplement’s dosage instructions.
What should you eat if you are anemic? What should you drink?
For iron deficiency anemias, eat red meats, fish, eggs, soy products, and plenty of green, leafy vegetables. For vitamin B-12 deficiency anemia, go for fish, poultry, milk, and other dairy products. Folate-rich foods include beans, leafy greens, nuts, and citrus.