What are the symptoms and treatment options for anemia?

Symptoms and Treatment Options for Anemia

Anemia presents with symptoms including fatigue, dizziness, weakness, cold skin, palpitations, dyspnea, and in severe cases can lead to heart failure and cognitive impairment, requiring treatment based on the specific type of anemia identified through diagnostic testing. 1, 2

Common Symptoms of Anemia

• Fatigue and weakness are the most common symptoms, affecting almost every organ system as the body attempts to compensate for reduced oxygen-carrying capacity 1
• Dizziness, lightheadedness, and palpitations occur due to cardiovascular compensation mechanisms 1, 2
• Shortness of breath (dyspnea), especially with exertion, results from decreased oxygen delivery to tissues 1, 3
• Cold skin and pale appearance due to reduced blood flow to peripheral tissues 1, 4
• Neurological symptoms may include tingling sensations, numbness, and cognitive impairment 1, 4
• Severe anemia can lead to pulmonary edema, heart failure, and depression 1
• Symptoms vary based on the severity of anemia, rapidity of onset, and the patient's age and physiologic status 1

Diagnostic Approach

• Initial evaluation requires a complete blood count (CBC) with hemoglobin, hematocrit, and mean corpuscular volume (MCV) 5
• Serum ferritin is the primary test for assessing iron stores, with levels below 15 μg/L confirming iron deficiency 5
• For patients with inflammatory conditions, iron deficiency may exist with ferritin levels between 45-100 μg/dL, requiring additional testing such as transferrin saturation 6
• Mean corpuscular volume (MCV) helps classify anemia as microcytic, normocytic, or macrocytic, guiding further diagnostic workup 3

Treatment Options by Anemia Type

Iron Deficiency Anemia

• Oral iron supplementation is first-line treatment with recommended dosage of 60-120 mg elemental iron daily for adults 5, 6
• Children should receive 3 mg/kg/day of iron drops 5
• Treatment should continue for 2-3 months after hemoglobin normalizes to replenish iron stores 5
• Lower-dose iron formulations may be as effective with fewer side effects 3
• Intravenous iron is indicated for patients who don't tolerate oral iron, show no improvement in ferritin levels with oral therapy, or have conditions affecting iron absorption 6

Vitamin B12 Deficiency/Pernicious Anemia

• Intramuscular vitamin B12 is the recommended treatment for pernicious anemia 7, 4
• Initial dosing is 100 mcg daily for 6-7 days by intramuscular or deep subcutaneous injection 7
• If clinical improvement occurs, continue with 100 mcg on alternate days for seven doses, then every 3-4 days for 2-3 weeks 7
• Maintenance therapy is 100 mcg monthly for life in pernicious anemia 7
• Oral B12 may be used for patients with normal intestinal absorption 7

Anemia of Chronic Disease/Inflammation

• Treatment focuses on addressing the underlying condition causing inflammation 5
• Erythropoiesis stimulating proteins may be used for symptomatic anemia with hemoglobin below 11 g/dL 5

Anemia in Special Populations

Pregnant Women

• Screening for anemia should occur at the first prenatal visit 5
• Low-dose iron supplementation (30 mg/day) should be started at the first prenatal visit 5, 6
• If anemia develops during pregnancy, increase iron supplementation to 60-120 mg/day 5

Older Adults

• Evaluation should focus on identifying underlying causes, including occult gastrointestinal malignancy 3
• Blood transfusion may be considered for symptomatic patients with hemoglobin levels of 8 g/dL or less 3

Important Considerations and Pitfalls

• Acute anemia (often due to blood loss) typically presents with more severe symptoms than chronic anemia, which may be well-tolerated and discovered incidentally 2, 8
• Endoscopic evaluation is warranted in older patients with iron deficiency anemia to rule out gastrointestinal malignancy 3
• Empiric use of nutritional supplements without identifying the specific cause of anemia is discouraged 8
• A restrictive transfusion strategy (for patients with hemoglobin < 6-8 g/dL) is associated with better outcomes than liberal transfusion approaches 8
• Side effects of oral iron include constipation, diarrhea, and nausea, which may affect compliance 6
• Intravenous iron formulations that can replace iron deficits with 1-2 infusions are preferred over those requiring multiple infusions 6