Red blood cells carry haemoglobin, an iron-rich protein that attaches to oxygen in the lungs and carries it to tissues throughout the body. Anemia occurs when you do not have enough red blood cells or when your red blood cells do not function properly. It is diagnosed when a blood test shows a haemoglobin value of less than 13.5 gm/dl in a
man or less than 12.0 gm/dl in a woman. Normal values for children vary with age.

When you have anaemia, your body lacks oxygen, so you may experience one or more of the following symptoms:

• Shortness of breath
• Dizziness
• Fast or irregular heartbeat
• Pounding or “whooshing” in your ears
• Headache
• Cold hands or feet
• Pale or yellow skin
• Chest pain.

Many people are at risk for anaemia because of poor diet, intestinal disorders, chronic diseases, infections, and other conditions. Women who are menstruating or pregnant and people with chronic medical conditions are most at risk for this disease. The risk of anaemia increases as people grow older.

If you have any of the following chronic conditions, you might be at greater risk for developing anaemia:

• Rheumatoid arthritis or other autoimmune disease
• Kidney disease
• Cancer
• Liver disease
• Thyroid disease
• Inflammatory bowel disease (Crohn disease or ulcerative colitis)

The signs and symptoms of anaemia can easily be overlooked. In fact, many people do not even realize that they have anaemia until it is identified in a blood test.

Iron-deficiency anaemia is the most common type of anaemia. It happens when you do not have enough iron in your body. Iron deficiency is usually nutritional or due to blood loss or poor absorption of iron. Pregnancy and childbirth consume a great deal of iron and thus can result in pregnancy-related anaemia. People who have had gastric bypass surgery for weight loss or other reasons may also be iron deficient due to poor absorption.

Vitamin-deficiency anaemia may result from low levels of vitamin B12 or folate (folic acid), usually due to poor dietary intake.

Pernicious anaemia is a condition in which vitamin B12 cannot be absorbed in the gastrointestinal tract.

Anaemia and Pregnancy – Learn about the risk factors and symptoms of anaemia during pregnancy.

Aplastic anaemia is a rare bone marrow failure disorder in which the bone marrow stops making enough blood cells (red blood cells, white blood cells, and platelets). This occurs as a result of destruction or deficiency of blood-forming stem cells in your bone marrow, in particular when the body’s own immune system attacks the stem cells. Viral infections, ionizing radiation, and exposure to toxic chemicals or drugs can also result in aplastic anaemia.

Haemolytic anemia occurs when red blood cells are broken up in the bloodstream or in the spleen. Haemolytic anemia may be due to mechanical causes (leaky heart valves or aneurysms), infections, autoimmune disorders, or congenital abnormalities in the red blood cell. Inherited abnormalities may affect the haemoglobin or the red blood cell structure or function. The treatment will depend on the cause.

Sickle cell anaemia is an inherited haemolytic anaemia in which the haemoglobin protein is abnormal, causing the red blood cells to be
rigid and clog the circulation because they are unable to flow through small blood vessels.

Anaemia caused by other diseases – Some diseases can affect the body’s ability to make red blood cells. For example, some patients with kidney disease develop anaemia because the kidneys are not making enough of the hormone erythropoietin to signal the bone marrow to make new or more red blood cells. Chemotherapy used to treat various cancers often impairs the body’s ability to make new red blood cells, and anaemia often results from this treatment.

The treatment for anaemia depends on what causes it. If you have iron-deficiency anaemia, your doctor may order tests to determine
if you are losing blood from your stomach or bowels. Other nutritional anaemias, such as folate or B-12 deficiency, may result from poor diet or from an inability to absorb vitamins in the gastro-
intestinal tract. Treatment varies from changing your diet to taking dietary supplements.

If your anaemia is due to a chronic disease, treatment of the underlying disease will often improve the anaemia. Under some circumstances, such as chronic kidney disease, your doctor may
prescribe medication such as erythropoietin injections to stimulate your bone marrow to produce more red blood cells.

Aplastic anaemia occurs if your bone marrow stops producing red blood cells. Aplastic anaemia may be due to primary bone marrow failure, myelodysplasia (a condition in which the bone marrow produces abnormal red blood cells that do not mature properly), or occasionally as a side effect of some medications. If you appear to
have a form of aplastic anaemia, your doctor may refer you to a haematologist for a bone marrow biopsy to determine the cause of the anaemia. Medications and blood transfusions may be used to treat aplastic anaemia.

Haemolytic anaemia occurs when red blood cells are destroyed in the blood stream. This may be due to mechanical factors (a leaky heart valve or aneurysm), infection, or an autoimmune disease. The cause can often be identified by special blood tests and by looking at the red blood cells under a microscope. The treatment will depend upon the cause and may include referral to a heart or vascular specialist, antibiotics, or drugs that suppress the immune system.

Talk with your doctor if you believe you may be at risk for anemia. Your doctor will determine your best course of treatment and, depending on your condition, may refer you to a haematologist, a
doctor who specializes in blood disorders.

While many types of anaemia cannot be prevented, eating healthy foods can help you avoid both iron-and vitamin-deficiency anemia.
Foods to include in your diet include those with high levels of iron (beef, dark green leafy vegetables, dried fruits, and nuts), vitamin

leafy vegetables, legumes, and fortified cereals).
A daily multivitamin will also help prevent nutritional anaemias; however, older adults should not take iron supplements for iron deficiency anaemia unless instructed by their physicians.

Blood cancers affect the production and function of your blood cells. Most of these cancers start in your bone marrow where blood is produced. Stem cells in your bone marrow mature and develop
into three types of blood cells: red blood cells, white blood cells, or platelets. In most blood cancers, the normal blood cell development
process is interrupted by uncontrolled growth of an abnormal type of blood cell. These abnormal blood cells, or cancerous cells, prevent your blood from performing many of its functions, like fighting off infections or preventing serious bleeding.

There are three main types of blood cancers:

Leukemia, a type of cancer found in your blood and bone marrow,is caused by the rapid production of abnormal white blood cells.
The high number of abnormal white blood cells are not able to fight infection, and they impair the ability of the bone marrow to produce red blood cells and platelets.

Lymphoma is a type of blood cancer that affects the lymphatic system, which removes excess fluids from your body and produces immune cells. Lymphocytes are a type of white blood cell that fight infection. Abnormal lymphocytes become lymphoma cells, which multiply and collect in your lymph nodes and other tissues. Over time, these cancerous cells impair your immune system.

Myeloma is a cancer of the plasma cells. Plasma cells are white blood cells that produce disease- and infection fighting antibodies in your body. Myeloma cells prevent the normal production of
antibodies, leaving your body’s immune system weakened and susceptible to infection.

Bleeding disorders are a group of conditions that result when the blood cannot clot properly. In normal clotting, platelets, a type of blood cell, stick together and form a plug at the site of an injured blood vessel. Proteins in the blood called clotting factors then interact to form a fibrin clot, essentially a gel plug, which holds the platelets in place and allows healing to occur at the site of the

injury while preventing blood from escaping the blood vessel. While too much clotting can lead to conditions such as heart attacks and strokes, the inability to form clots can be very dangerous as well, as it can result in excessive bleeding. Bleeding can result from either too few or abnormal platelets, abnormal or low amounts of clotting proteins, or abnormal blood vessels

Haemophilia is perhaps the most well-known inherited bleeding disorder, although it is relatively rare. It affects mostly males. Many more
people are affected by von Willebrand disease, the most common in herited bleeding disorder in America caused by clotting proteins. Von Willebrand disease can affect both males and females. Platelet disorders are the most common cause of bleeding disorder and are usually acquired rather than inherited. You can find information on other bleeding disorders by following the links at the bottom of this page.

Am I at Risk?

Bleeding disorders such as haemophilia and von Willebrand disease result when the blood lacks certain clotting factors. These diseases
are almost always inherited, although in rare cases they can develop later in life if the body forms antibodies that fight against the blood’s
natural clotting factors. Individuals and pregnant women with a family history of bleeding disorders should talk to their doctors about detection and treatment. Symptoms of bleeding disorders may include:

• Easy bruising
• Bleeding gums
• Heavy bleeding from small cuts or dental work
• Unexplained nosebleeds
• Heavy menstrual bleeding
• Bleeding into joints
• Excessive bleeding following surgery

Haemophilia is a rare, inherited bleeding disorder that can range from mild to severe, depending on how much clotting factor is present in the blood. Haemophilia is classified as type A or type B, based on which type of clotting factor is lacking (factor VIII in type A and factor IX in type B).

Haemophilia results from a genetic defect found on the X chromosome. Women have two X chromosomes. Women who have one X  chromosome with the defective gene are termed carriers and they can pass the disease onto their sons. Due to random chromosome activation, some women carriers may range from asymptomatic to symptomatic depending on how much of their factor VIII or IX is inactivated. In fact, some women may have “mild haemophilia,” though this is less common. Men have one X and one Y chromosome, so if their X chromosome has the defective gene, they will have haemophilia. Because blood does not clot properly without enough clotting factor,any cut or injury carries the risk of excessive bleeding. In addition,people with haemophilia may suffer from internal bleeding that can damage joints, organs, and tissues over time.

In the past, people with haemophilia were treated with transfusions of factor VIII obtained from donor blood, but by the early 1980s these products were discovered to be transmitting blood-borne viruses, including hepatitis and HIV. Thanks to improved screening techniques, and a major breakthrough that enabled scientists to create synthetic blood factors in the laboratory by cloning the genes responsible for specific clotting factors, today’s factor-replacement therapies are
pure and much safer than ever before.

Von Willebrand disease is an inherited condition that results when the blood lacks functioning von Willebrand factor, a protein that helps the blood to clot and also carries another clotting protein, factor VIII.
It is usually milder than haemophilia and can affect both males and females. Women are especially affected by von WIllebrand disease during menses. Von Willebrand disease is classified into three different types (Types 1, 2, and 3), based on the levels of von Willebrand factor and factor VIII activity in the blood. Type 1 is the mildest and most common form; Type 3 is the most severe and least common form.

With early diagnosis, people with von Willebrand disease can lead normal, active lives. People with mild cases may not require treatment, but should avoid taking drugs that could aggravate bleeding, such as aspirin and ibuprofen, without first consulting with a doctor. More serious cases may be treated with drugs that increase the level of von Willebrand factor in the blood or with infusions of blood factor concentrates. It is important for people with von Willebrand disease to consult with their doctors before having surgery, having dental work, or giving birth, so that proper precautions can be taken to prevent excessive bleeding. You may be referred to a haematologist, a doctor who specializes in the treatment of blood disorders.