Anaemia - not enough blood - symptoms and diagnosis of

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"Anaemia" means not enough blood. If you have not got enough blood then the circulation is impaired and therefore so is the delivery of essential nutrients including oxygen. This can cause any number of symptoms such as fatigue, inability to get fit, shortness of breath on exercise, cold hands and feet etc.

If anaemia is suspected, then look for paleness - not easy since some people are naturally pale; so look below the whites of the eye under the lower eyelid.

It is easily diagnosed from a blood test - ask for haematology - see Full blood count

What type of anaemia?

If you are not making enough blood:

  • Underactive thyroid: check a T4, T3 and TSH - Thyroid profile: free T3, free T4 and TSH
  • Nutritional deficiencies: see below.
  • Bone marrow failure: This is often caused by poisoning, eg alcohol, heavy metals and pesticides. It is uncommon and bad news. Often associated with nasty chronic illnesses like rheumatoid arthritis and kidney failure, or caused by major disease elsewhere such as cancer.

If you are losing blood somewhere:

  • For women, heavy periods is a common cause. If you are losing so much blood as to cause anaemia, then you must be referred for further investigation and treatment.
  • Blood loss from the gut. Blood may not be easily seen in the stools and should be looked for in every case of anaemia. Ask for Faecal occult blood testing. This may be an early sign of cancer. Faecal calprotectin is a good test for inflammation in the bowel and may become a useful screening test for cancer.

If the red blood cells are breaking up too soon: haemolytic anaemia, e.g.


The haemoglobin is expected to drop during pregnancy as the blood volume increases. This is normal. The trouble is, many doctors treat "blind" by prescribing iron supplements. This is sloppy medicine. Iron blocks zinc absorption and one ends up with zinc deficient babies. Iron should not be prescribed in pregnancy without first checking ferritin levels.


Smoking causes an odd sort of anaemia. Carbon monoxide in cigarette smoke binds to haemoglobin and displaces oxygen. So, we have blood cells circulating which are not carrying any oxygen. The body tries to compensate by making more blood, and as a result one ends up with too much blood (polycythaemia), whilst still showing the symptoms of anaemia. This type of anaemia may not be obvious on a blood test; it has to be suspected clinically. The best test is to try to get fit: if you can't train up to a reasonable level, then there is something wrong. Inability to get fit - or chronic fatigue - is of course a symptom of Carbon monoxide poisoning and multi-sensitivity - a possible explanation for hypersensitivity symptoms

Nutritional deficiencies

These are probably the commonest cause of anaemia. Some deficiencies are easily tested for:

  • Iron deficiency: suspect if the red cells are small (low mean corpuscular volume). Test by doing ferritin levels. The commonest cause of iron deficiency is tea - tea binds to iron (and many other minerals) creating unabsorbable tannates in the stomach.
  • Another common cause of iron deficient anaemia is Hypochlorhydria This is also a problem in children, many of whom present with allergies.
  • Lack of B12 and/or folic acid: this causes the red cells to be too big (high mean corpuscular volume). Test for by measuring B12 and folic acid levels. See B12 vitamin levels and Ferritin levels in serum
  • Zinc deficiency


See Antioxidants and Malabsorption for example in coeliac disease, pancreatic disease.

Once a possible cause for the anaemia has been found it is important to do a follow up blood test to make sure it has been corrected. This is because there may be more than one cause in any one person and one would not like to miss a more serious diagnosis.

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