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Red blood cells, elliptocytosis
Red blood cells, elliptocytosis
Red blood cells, spherocytosis
Red blood cells, spherocytosis
Red blood cells, multiple sickle cells
Red blood cells, multiple sickle cells
Red blood cells, sickle and pappenheimer
Red blood cells, sickle and pappenheimer
Red blood cells, target cells
Red blood cells, target cells



Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues.

Different types of anemia include:


Although many parts of the body help make red blood cells, most of the work is done in the bone marrow. Bone marrow is the soft tissue in the center of bones that helps form all blood cells.

Healthy red blood cells last between 90 and 120 days. Parts of your body then remove old blood cells. A hormone called erythropoietin (epo) made in your kidneys signals your bone marrow to make more red blood cells.

Hemoglobin is the oxygen-carrying protein inside red blood cells. It gives red blood cells their color. People with anemia do not have enough hemoglobin.

The body needs certain vitamins, minerals, and nutrients to make enough red blood cells. Iron, vitamin B12, and folic acid are three of the most important ones. The body may not have enough of these nutrients due to:

  • Changes in the lining of the stomach or intestines affect how well nutrients are absorbed (for example, celiac disease)
  • Poor diet
  • Slow blood loss (for example, from heavy menstrual periods or stomach ulcers)
  • Surgery that removes part of the stomach or intestines

Possible causes of anemia include:

  • Certain medicines
  • Destruction of red blood cells earlier than normal (which may be caused by immune system problems)
  • Long-term (chronic) diseases such as chronic kidney disease, cancer, ulcerative colitis, or rheumatoid arthritis
  • Some forms of anemia, such as thalassemia or sickle cell anemia, which can be inherited
  • Pregnancy
  • Problems with bone marrow such as lymphoma, leukemia, myelodysplasia, multiple myeloma, or aplastic anemia


You may have no symptoms if the anemia is mild or if the problem develops slowly. Symptoms that may occur first include:

  • Feeling grumpy
  • Feeling weak or tired more often than usual, or with exercise
  • Headaches
  • Problems concentrating or thinking

If the anemia gets worse, symptoms may include:

  • Blue color to the whites of the eyes
  • Brittle nails
  • Desire to eat ice or other non-food things (pica syndrome)
  • Light-headedness when you stand up
  • Pale skin color
  • Shortness of breath with mild activity or even at rest
  • Sore tongue

The doctor will perform a physical examination, and may find:

  • A heart murmur
  • Low blood pressure, especially when you stand up
  • Pale skin
  • Rapid heart rate

Some types of anemia may cause other findings on a physical exam.

Blood tests used to diagnose some common types of anemia may include:

Other tests may be done to find medical problems that can cause anemia.


Treatment should be directed at the cause of the anemia, and may include:

  • Blood transfusions
  • Corticosteroids or other medicines that suppress the immune system
  • Erythropoietin, a medicine that helps your bone marrow make more blood cells
  • Supplements of iron, vitamin B12, folic acid, or other vitamins and minerals

Severe anemia can cause low oxygen levels in vital organs such as the heart, and can lead to a heart attack.

Call your health care provider if you have any symptoms of anemia or unusual bleeding.

Bunn HF. Approach to the anemias. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 158.

Marks PW. Approach to anemia in the adult and child. In: Hoffman R, Benz EJ Jr, Silberstein LE, Weitz JI, Anastasi J, eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 32.

Review Date: 2/13/2015
Reviewed By: Rita Nanda, MD, Assistant Professor of Medicine, Section of Hematology/Oncology, University of Chicago Medicine, Chicago, IL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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