Text-only Preview

F r e q u e n t l y A s k e d q u e s t i o n s
don't have enough iron in your
body. You need iron to make hemo-
globin. People with this type of
anemia are sometimes said to have
Q: What is anemia?
“iron-poor blood” or “tired blood.”
A: “Anemia” (uh-NEE-mee-uh) occurs

A person can have a low iron level
when you have less than the normal
because of blood loss. In women,
number of red blood cells in your
iron and red blood cells are lost
blood or when the red blood cells
when bleeding occurs from very
in your blood don’t have enough
heavy and long periods, as well as
hemoglobin (HEE-muh-gloh-bin).
from childbirth. Women also can
Hemoglobin is a protein. It gives the
lose iron and red blood cells from
red color to your blood. Its main job
uterine fibroids, which can bleed
TDD: 1-888-220-5446
is to carry oxygen from your lungs
slowly. Other ways iron and red
to all parts of your body. If you have
blood cells can be lost include:
anemia, your blood does not carry

• ulcers, colon polyps, or colon
enough oxygen to all the parts of your
body. Without oxygen, your organs

• regular use of aspirin and other
and tissues cannot work as well as they
drugs for pain
should. More than 3 million people in
the United States have anemia. Women

• infections
and people with chronic diseases are at

• severe injury
the greatest risk for anemia.

• surgery

Eating foods low in iron also can
Q: What are the types and causes
cause IDA. Meat, poultry, fish, eggs,
of anemia?
dairy products, or iron-fortified
A: Anemia happens when:
foods are the best sources of iron

1. the body loses too much blood
found in food. Pregnancy can cause
(such as with heavy periods, certain
IDA if a woman doesn’t consume
diseases, and trauma); or
enough iron for both her and her
unborn baby.

2. the body has problems making red
blood cells; or
Foods that are fortified have important

3. red blood cells break down or die
vitamins and minerals added, such as
faster than the body can replace
cereal with added folic acid.
them with new ones; or

4. more than one of these problems
happen at the same time.

Some people have enough iron
in their blood, but have problems

There are many types of anemia, all
absorbing it because of diseases, such
with different causes:
as Crohn’s disease and Celiac dis-

Iron deficiency anemia (IDA).
ease, or drugs they are taking.
IDA is the most common type of

Vitamin deficiency anemia (or
anemia. IDA happens when you
U.S. Department of Health and Human Services, Office on Women’s Health

F r e q u e n t l y A s k e d q u e s t i o n s
megaloblastic [MEG-uh-loh-
problems absorbing vitamins. It also
BLASS-tik] anemia). Low levels
may occur during the third trimester
of vitamin B12 or folate are the
of pregnancy, when your body needs
most common causes of this type of
extra folate. Folate is a B vitamin
found in foods such as leafy green

Vitamin B12 deficiency anemia (or
vegetables, fruits, and dried beans
pernicious [pur-NISH-us] anemia).
and peas. Folic acid is found in forti-
This type of anemia happens due to
fied breads, pastas, and cereals.
a lack of vitamin B12 in the body.

Anemias caused by underlying
Your body needs vitamin B12 to
diseases. Some diseases can hurt
make red blood cells and to keep
the body's ability to make red blood
your nervous system working nor-
cells. For example, anemia is com-
mally. This type of anemia occurs
mon in people with kidney disease.
TDD: 1-888-220-5446
most often in people whose bodies
Their kidneys can't make enough of
are not able to absorb vitamin B12
the hormones that signal the body
from food because of an autoim-
to make red blood cells. Plus, iron
mune disorder. It also can happen
is lost in dialysis (what some people
because of intestinal problems.
with kidney disease must have to

You also can get this type of ane-
take out waste from the blood).
mia if the foods you eat don’t have

Anemias caused by inherited
enough vitamin B12. Vitamin B12
blood disease. If you have a blood
is found in foods that come from
disease in your family, you are at
animals. Fortified breakfast cereals
greater risk to also have this disease.
also have vitamin B12. Folic acid
Here are some types:
supplements (pills) can treat this

Sickle cell anemia. The red blood cells
type of anemia. But, folic acid can-
of people with sickle cell disease are
not treat nerve damage caused by a
hard and have a curved edge. These
lack of vitamin B12.
cells can get stuck in the small blood

With this type of anemia, your doc-
vessels, blocking the flow of blood
tor may not realize that you're not
to the organs and limbs. The body
getting enough vitamin B12. Not
destroys sickle red cells quickly. But,
getting enough vitamin B12 can
it can't make new red blood cells fast
cause numbness in your legs and
enough. These factors cause anemia.
feet, problems walking, memory

Thalassemia (thal-uh-SEE-mee-uh).
loss, and problems seeing. The
People with thalassemia make less
treatment depends on the cause. But
hemoglobin and fewer red blood
you may need to get vitamin B12
cells than normal. This leads to mild
shots or take special vitamin B12
or severe anemia. One severe form
of this condition is Cooley’s anemia.

Folate deficiency anemia. Folate, also

Aplastic (ay-PLAS-tik) ane-
called folic acid, is also needed to
mia. This is a rare blood disorder
make red blood cells. This type of
in which the body stops making
anemia can occur if you don’t con-
enough new blood cells. All blood
sume enough folate or if you have
cells—red cells, white cells, and
U.S. Department of Health and Human Services, Office on Women’s Health

F r e q u e n t l y A s k e d q u e s t i o n s
platelets—are affected. Low levels

All of these signs and symptoms can
of red blood cells leads to anemia.
occur because your heart has to work
With low levels of white blood cells,
harder to pump more oxygen-rich
the body is less able to fight infec-
blood through the body.
tions. With too few platelets, the
blood can’t clot normally. This can
Q: How do I find out if I have
be caused by many things:

• cancer treatments (radiation or
Your doctor can tell if you have ane-
mia by a blood test called a CBC. Your

• exposure to toxic chemicals (like
doctor also will do a physical exam and
those used in some insecticides,
talk to you about the food you eat, the
paint, and household cleaners)
medicines you are taking, and your
TDD: 1-888-220-5446

• some drugs (like those that treat
family health history. If you have ane-
rheumatoid arthritis)
mia, your doctor may want to do other
tests to find out what's causing it.

• autoimmune diseases (like lupus)

• viral infections
Q: What’s the treatment for

• family diseases passed on by
genes, such as Fanconi anemia
A: With any type of anemia, there are two
treatment goals:
Q: What are the signs of anemia?

1) to get red blood cell counts or
hemoglobin levels back to normal so
A: Anemia takes some time to develop. In
that your organs and tissues can get
the beginning, you may not have any
enough oxygen
signs or they may be mild. But as it gets
worse, you may have these symptoms:

2) to treat the underlying cause of the

• fatigue (very common)

The treatment your doctor prescribes

• weakness (very common)
for you will depend on the cause of

• dizziness
the anemia. For example, treatment

• headache
for sickle cell anemia is different than
treatment for anemia caused by low

• numbness or coldness in your hands
iron or folic acid intake. Treatment may
and feet
include changes in foods you eat, tak-

• low body temperature
ing dietary supplements (like vitamins

• pale skin
or iron pills), changing the medicines
you are taking, or in more severe forms

• rapid or irregular heartbeat
of anemia, medical procedures such as

• shortness of breath
blood transfusion or surgery.

• chest pain
Q: What will happen if my anemia

• irritability
goes untreated?

• not doing well at work or in school
A: Some types of anemia may be life
U.S. Department of Health and Human Services, Office on Women’s Health

F r e q u e n t l y A s k e d q u e s t i o n s
threatening if not diagnosed and treat-
tor about the best way to also get
ed. Too little oxygen in the body can
enough calcium.
damage organs. With anemia, the heart

• Make sure you consume enough
must work harder to make up for the
folic acid and vitamin B12.
lack of red blood cells or hemoglobin.
This extra work can harm the heart and

• Make balanced food choices. Most
even lead to heart failure.
people who make healthy, balanced
food choices get the iron and vita-
Q: How do I prevent anemia?
mins their bodies need from the
foods they eat. Food fads and dieting
A: There are steps you can take to help
can lead to anemia.
prevent some types of anemia.

• Talk to your doctor about taking

• Eat foods high in iron:
iron pills (supplements). Do NOT
TDD: 1-888-220-5446

• cereal/breads with iron in it
take these pills without talking to
(100% iron-fortified is best.
your doctor first. These pills come
Check food label.)
in two forms: ferrous and ferric.

• liver
The ferrous form is better absorbed
by your body. But taking iron pills

• lentils and beans
can cause side effects, like nausea,

• oysters
vomiting, constipation, and diarrhea.
Reduce these side effects by taking

• tofu
these steps:

• green, leafy vegetables such as

• Start with half of the recom
mended dose. Gradually increase

• red meat (lean only)
to the full dose.

• fish

• Take the pill in divided doses.

• dried fruits such as apricots,
For example, if you are pre
prunes, and raisins
scribed two pills daily, take one
in morning with breakfast and

For more sources of iron, visit www.
the other after dinner.

• Take the pill with food.

• Eat and drink foods that help your

• If one type of iron pill is causing
body absorb iron, like orange juice,
problems, ask your doctor for
strawberries, broccoli, or other fruits
another brand.
and vegetables with vitamin C.

It is important to keep iron pills tightly

• Don't drink coffee or tea with meals.
capped and away from children’s reach. In
These drinks make it harder for your
children, death has occurred from ingesting
body to absorb iron.
200 mg of iron.

• Calcium can hurt your absorption

• If you are a non-pregnant woman
of iron. If you have a hard time get-
of childbearing age, get tested for
ting enough iron, talk to your doc-
anemia every five to 10 years. This
U.S. Department of Health and Human Services, Office on Women’s Health

F r e q u e n t l y A s k e d q u e s t i o n s
can be done during a regular health
those who drink a lot of milk or are
exam. Testing should start in adoles-
having a growth spurt)

• pregnant women (about half of preg-

• If you are a non-pregnant woman
nant women have iron-deficiency
of childbearing age with these risk
factors for iron deficiency, get tested

• Female athletes who engage in regu-
every year:
lar, intense exercise

• heavy periods

These groups of people should be

• low iron intake
screened at times for iron deficiency. If

• have been diagnosed with anemia
the tests show that the body isn't getting
enough iron, iron pills (supplements)
in the past
may be prescribed. In extreme cases
TDD: 1-888-220-5446

• Follow your doctor’s orders for
of iron deficiency, your doctor might
treating the underlying cause of your
prescribe iron shots. Many doctors
anemia. This will prevent the ane-
prescribe iron pills during pregnancy
mia from coming back or becoming
because many pregnant women don't
get enough iron. Iron pills can help
when diet alone can't restore the iron
Q: How much iron do I need every
level back to normal. Talk with your
doctor to find out if you are getting
enough iron through the foods you eat
A: Most people get enough iron by mak-
or if you or your child needs to be tak-
ing healthy, balanced food choices and
ing iron pills. Please see the chart below
eating iron-rich foods. But some groups
to see how many milligrams (mg) of
of people are at greater risk for low iron
iron you should consume every day.

• teenage girls/women of childbearing
Q: How much iron do I need if I am
age (who have heavy bleeding dur-
ing their period, who have had more
than one child, or use an intrauter-
A: Pregnant women need to consume
ine device [IUD])
twice as much iron as women who
are not pregnant. But about half of all

• older infants and toddlers (mainly
pregnant women do not get enough
Infants & Children Women
7 to 12 months
11 mg
1 to 3 years
7 mg
4 to 8 years
10 mg
9 to13 years
8 mg
14 to18 years
15 mg
27 mg
10 mg
19 to 50 years
18 mg
27 mg
9 mg
51+ years
8 mg
U.S. Department of Health and Human Services, Office on Women’s Health

F r e q u e n t l y A s k e d q u e s t i o n s
iron. During pregnancy, your body
Q: I am a vegetarian. What steps
needs more iron because of the growing
should I take to make sure I get
fetus, the higher volume of blood, and
enough iron?
blood loss during delivery. If a pregnant
A: It depends on the food choices you
woman does not get enough iron for
make. Since meat, poultry, and seafood
herself or her growing baby, she has
are the best sources of iron found in
an increased chance of having preterm
food, some vegetarians may need to
birth and a low-birth-weight baby. If
take a higher amount of iron each day
you're pregnant, follow these tips:
than what is recommended for other

• Make sure you get 27mg of iron
people. Follow the tips above to prevent
every day. Take an iron supplement
anemia, and try to take vitamin C with
(pill). It may be part of your prenatal
the iron-rich foods you eat.
vitamin. Start taking it at your first
TDD: 1-888-220-5446
prenatal visit.
Q: What happens if my body gets

• Get tested for anemia at your first
more iron than it needs?
prenatal visit.
A: Iron overload happens when too much

• Ask if you need to be tested for ane-
iron builds up in the body over time.
mia 4 to 6 weeks after delivery.
This condition is called hemochroma-
tosis (HEE-moh-kroh-muh-TOH-
suhss). The extra iron can damage the
Q: I am taking menopausal hor-
organs, mainly the liver, heart, and pan-
creas. Many problems can cause iron
mone therapy (MHT). Does that
overload. Most people with hemochro-
affect how much iron I should
matosis inherit it from their parents.
It is one of the most common genetic
A: It might. If you are still getting your
(runs in families) diseases in the United
period while taking MHT, you may
States. Some other diseases also can
need more iron than women who are
lead to iron overload. It also can hap-
postmenopausal and not taking MHT.
pen from years of taking too much iron
Talk to your doctor.
or from repeated blood transfusions or
dialysis for kidney disease.

Signs of early hemochromatosis may
Q: Does birth control affect my risk
for anemia?

• fatigue
A: It could. Some women who take birth
control pills have less bleeding dur-

• weakness
ing their periods. This would lower

• weight loss
their risk for anemia. But women who

• abdominal pain
use an intrauterine device (IUD) may
have more bleeding and increase their

• joint pain
chances of getting anemia. Talk to your

• fluttering in chest
U.S. Department of Health and Human Services, Office on Women’s Health

F r e q u e n t l y A s k e d q u e s t i o n s

As iron builds up in the body, common

Treatment depends on how severe the
symptoms include:
iron overload is. The first step is to get

• arthritis
rid of the extra iron in the body. Most
people undergo a process called phle-

• missed periods
botomy (fluh-BOT-uh-mee), which

• early menopause
means removing blood. It is simple and
safe. A pint of blood will be taken once

• loss of sex drive
or twice a week for several months to a

• impotence (repeated inability to get
year, and sometimes longer. Once iron
or keep an erection firm enough for
levels go back to normal, you will give
sexual intercourse)
a pint of blood every 2 to 4 months for

• heart problems like shortness of
life. People who cannot give blood can
breath, chest pain, and changes in
take medicine to remove extra iron.
TDD: 1-888-220-5446
rate or rhythm
This is called iron chelation (kuh-LAY-
shuhn) therapy. Although treatment

Signs of advanced hemochromatosis
cannot cure the problems caused by
hemochromatosis, it will help most of

• arthritis
them. Arthritis is the only problem that

• liver disease, including an enlarged
does not improve after excess iron is
liver, cirrhosis, cancer, and liver fail-
removed. n

• damage to the pancreas, possibly
causing diabetes

• chronic (ongoing) abdominal pain

• severe fatigue

• weakening of the heart muscle

• heart failure

• changes in skin color, making it
look gray, yellow or bronze (not
caused by sun)
U.S. Department of Health and Human Services, Office on Women’s Health

F r e q u e n t l y A s k e d q u e s t i o n s
For more information...
For more information on anemia, contact at 800-994-9662 or the
following organizations:
Division of Nutrition, Physical
Cooley’s Anemia Foundation
Activity and Obesity, NCCDPHP,
Phone: (800) 522-7222
Internet Address: http://www.thalassemia.
Phone: (800) 232-4636, (888) 232-6348
Internet Address:
Fanconi Anemia Research Fund, Inc.
Phone: (888) 326-2664
TDD: 1-888-220-5446
National Heart, Lung, and Blood
Internet Address:
Institute Health Information Center,

Iron Disorders Institute
Phone: (301) 592-8573
Phone: (888) 565-4766
Internet Address: http://www.nhlbi.nih.
Internet Address: http://www.irondisor-
American Dietetic Association
Sickle Cell Disease Association of
Phone: (800) 877-1600
America, Inc.
Internet Address:
Phone: (800) 421-8453
Internet Address: http://www.sicklecelldis-
Aplastic Anemia & MDS International
Foundation, Inc.
Phone: (800) 747-2820
Internet Address:
All material contained in this FAQ is free of copyright restrictions, and may be copied,
reproduced, or duplicated without permission of the Office on Women’s Health in the
Department of Health and Human Services. Citation of the source is appreciated.
This FAQ was reviewed by:
Charles M. Peterson, MD
Director, Division of Blood Diseases and Resources
National Heart, Lung and Blood Institute
National Institutes of Health
Content last updated May

13, 2008.
U.S. Department of Health and Human Services, Office on Women’s Health