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Anaemia is the name for a range of disorders affecting red blood cells. Red blood cells contain haemoglobin, a special protein that is capable of carrying oxygen. It is thanks to the red blood cells that oxygen can reach every living tissue in the body, enabling the release of energy that keeps the tissue alive.

To produce red blood cells, the body needs iron, vitamin B12 and folic acid. If one or more of these is lacking, the number of red blood cells fall, anaemia develops and the ability of the blood to carry oxygen is reduced.
There are a number of different types of anaemia, each type has different causes. The most common types of anaemia are caused by a lack of iron, vitamin B12 or folic acid.

A lack or deficiency of iron causes iron-deficiency anaemia. This is the most common anaemia affecting up to 30% of the population. Women are more likely to suffer from iron-deficiency anaemia than men because women lose blood during their period. A woman's need for iron is also increased during pregnancy as her body has to make the baby's blood as well as her own.

If the body's need for iron is increased, for example because of prolonged heavy periods, blood loss due to haemorrhage, a stomach ulcer or piles, in rapidly growing children or during pregnancy, then iron-deficiency anaemia may develop.

Another type of anaemia, called megaloblastic anaemia, where the red blood cells are large and abnormal, develops if vitamin B12 or folic acid are lacking.

Folic acid deficiency may occur when the body's demand for the vitamin are high, for example during pregnancy. A deficiency may also occur when the absorption of folic acid from the stomach is reduced by excessive alcohol consumption. Some medicines may also interfere with the body's ability to use folic acid.

Another type of anaemia caused by a deficiency of vitamin B12 is called pernicious anaemia. Absorption of vitamin B12 from the diet is dependent on the presence of a substance called intrinsic factor in the lining of the stomach. In pernicious anaemia, antibodies are formed that attack the stomach lining and damage the cells that produce intrinsic factor. This stops intrinsic factor from attaching to B12, and so the vitamin cannot be absorbed into the body.

Other times when vitamin B12 cannot be absorbed are when the intestine is damaged by disease or shortened by surgery.
Tiredness, breathlessness, dizziness, headache, pale skin, loss of weight and headache are typical symptoms of all forms of anaemia.

Bleeding gums, poor sense of smell and poor reflexes may indicate the onset of pernicious anaemia. If pernicious anaemia is left untreated the nervous system may be affected, causing tingling of the fingers and toes, muscle weakness, difficulty walking, depression and confusion.
Tablets, capsules or liquids providing iron, vitamin B12 or folic acid may be taken to correct anaemia arising as a result of a deficiency of any of these substances.

Women who want to start a family should take folic acid supplements for three months before they become pregnant and for at least the first 12 weeks of their pregnancy. A daily supplement of 400 microgram folic acid will not only help stop the woman from becoming anaemic, but is also essential for the development of the baby's spinal cord and general growth.

An iron supplement will provide the woman with the extra iron she needs during her pregnancy. The normal recommended daily dose for a pregnant woman is 30mg taken around the 20th week of pregnancy when most extra blood production occurs and when most iron is needed.

Pernicious anaemia is treated with a course of vitamin injections, rather than an oral vitamin B12 supplement, as the lack of intrinsic factor prevents the vitamin being absorbed from the stomach. A form of vitamin B12 known as hydroxocobalamin is injected into a muscle every other day for about two weeks. Once the blood is restored to normal, injections are continued at two or three month intervals throughout the person's life.
When to see your pharmacist
If you have any of the symptoms described above, talk to your pharmacist. If you think that you are not eating a balanced diet, you smoke or drink a lot, you have growing children, you are recovering from an illness, you are over 65, you are pregnant or are thinking of starting a family, talk to your pharmacist.

Your pharmacist will be able to advise you about healthy eating, which foods supply the correct sources of iron and vitamins, and will be able to guide you around the confusing number of vitamin, mineral and health supplements that are available.

If you are taking iron supplements that upset your stomach, cause diarrhoea or constipation your pharmacist will be able to recommend an alternative or advise you to take the supplement at a different time.

If you are on other medicines, the pharmacist will also be able to tell you whether it is safe to use iron or vitamin supplements at the same time.
When to see your doctor
You should make an appointment to see your doctor if you have any of the symptoms listed above or if the symptoms persist. Your doctor will examine you to look for signs of iron or vitamin B12 deficiency. Your doctor may also decide to do a blood test to confirm the diagnosis of anaemia. If there is a deficiency, the appropriate iron, vitamin B12 or folic acid supplements will be prescribed.

Tests may also be performed to look for pernicious anaemia. If confirmed, your doctor will start you on a course of hydroxocobalamin injections.

You should also tell your doctor if you intend to become pregnant to allow ante-natal care to begin.
Living with anaemia
In normal circumstances, a balanced diet containing green vegetables, fruit, nuts, pulses and lean red meat usually provides enough iron and folic acid for the body's everyday needs. Adequate amounts of vitamin B12 are also usually obtained from a diet that includes meat, fish, eggs, cheese and other dairy products. It is important to eat healthily. If the diet is lacking in these foods, anaemia may develop.

If you are feeling tired and listless and lack energy to do things, think about your diet and what you have been eating. If your diet does not include the foods listed above, include them in your diet and you should start to feel the benefit within a few days.

If you are a vegan or a strict vegetarian that does not eat any products of animal origin, ensure that you eat foods fortified with vitamin B12 or think about taking a supplement containing vitamin B12 to avoid the risks of megaloblastic anaemia.

If your body's need for red blood cells is increased, for example if you have lost blood because of heavy periods or piles, or if you are recovering from illness consider adding an iron and folic acid supplement to your diet. It is essential that you do so if you are planning to have a baby.

Elderly people who are not looking after themselves properly and children who are growing rapidly may also benefit from a supplement containing iron, folic acid or vitamin B12.
Further information
The Pernicious Anaemia Society is an international society that exists to provide information, help and support to sufferers of pernicious anaemia and vitamin B12 deficiency, and to their families and friends.

The Pernicious Anaemia Society
4 Brackla House
Brackla Street
CF31 1BZ

Reviewed on 16 July 2011