Anaemia

Every healthy red blood cell is packed full of a protein called haemoglobin, which is responsible for collecting oxygen from the lungs, carrying it in the bloodstream, and delivering it to the cells and tissues around the body.

Anaemia is when the amount of haemoglobin in the body is too low, either from a reduced number of red blood cells, or from a low level of haemoglobin in each red blood cell.

So people with anaemia aren’t able to deliver enough oxygen to the cells and tissues in their body, leading to a variety of symptoms and problems.

There are several causes of anaemia:

Iron deficiancy anaemia

Iron deficiency anaemia is the most common type of anaemia in the UK, and in fact iron deficiency itself is the most common and widespread nutritional disorder in the world, and the only one to be prominent in developed countries.

Every haemoglobin protein contains iron at its core, and without iron, haemoglobin can’t be made in the  body.

The red blood cells become smaller and paler than normal. Low levels of iron in the body may be caused by:

• Blood loss, such as with heavy menstrual periods or bleeding from the stomach or gastrointestinal tract
• A diet low in iron
• Poor absorption of iron due to a problem with the gastrointestinal tract
• Pregnancy

Vitamin B12 or folate deficiency anaemia

Vitamins B12 and B9 (commonly known as folate or folic acid) are both needed for the production and maturation of healthy red blood cells.

When either of these nutrients is reduced in the body, anaemia occurs with underdeveloped red blood cells that are larger than normal circulating in the blood. 

Deficiencies of these vitamins may be caused by:

• Not eating enough dietary sources of the vitamins
• A reduced ability to absorb these vitamins due to stomach or intestinal disorders 
• Certain medications
• Pernicious anaemia, an autoimmune disease that causes severely reduced B12 absorption

People following a vegan diet are particularly susceptible to B12 deficiency, and pregnant woman are prone to folate deficiency. 

Other causes of anaemia

There are many other reasons a person may become anaemic, including:

• Chronic diseases, such as rheumatoid arthritis or diabetes
• Underactive thyroid gland
• Haemolytic anaemia, where the body’s own immune system attacks the red blood cells
• Leukaemia and other disorders of the bone marrow
• Kidney disease
• Cancer
• Medications such as ibuprofen, aspirin and some antibiotics
• Chronic alcohol consumption
• Inherited conditions such as sickle cell disease and thalassaemia

As anaemia often develops slowly and gradually, symptoms can easily go unnoticed for some time. In fact, it’s often diagnosed incidentally following a routine blood test.

Also, the symptoms of anaemia can be quite vague and non-specific, and people often attribute them to other causes like stress or generally being ‘run down’.

Symptoms vary among different people, but the typical symptoms of anaemia include:

• Feeling tired and lacking in energy
• Pale skin
• Feeling weak
• Shortness of breath
• Headaches
• Dizziness or feeling faint
• Palpitations or a racing heart

Depending on the cause of the anaemia, other symptoms may also be present. At The London Clinic, we will carry out a thorough and methodical assessment to identify the exact type and cause of the anaemia.

The London Clinic offers a complete range of diagnostics to detect anaemia and identify the underlying cause to ensure our patients receive the best possible treatment.

Patients are seen in clinic by one of our specialist haematologists or by an experienced general practitioner, who will take a medical history and carry out a physical examination.

If anaemia is suspected, then one or more of the following investigations may be performed:

Blood tests

This will include a full blood count which measures the amount of haemoglobin in the blood, and shows the size and shape of the red blood cells. Iron, vitamin B12 and folate levels will be measured, and kidney function will be assessed. For many people, a blood test is all that will be needed.

Urine test

If bleeding is suspected as the cause for anaemia, a urine test to detect blood in the urine will be carried out.

Gastroscopy or colonoscopy

In some cases it may be necessary to examine parts of the gastrointestinal tract, to look for bleeding. 

Faecal occult blood test

This simple test allows blood to be detected in the stool, and may be performed in some people with anaemia.

Bone marrow biopsy

In a small number of people, where other investigations have suggested a problem with the bone marrow, where red blood cells are produced, it may be necessary to perform a bone marrow biopsy.

Once anaemia and its underlying cause have been diagnosed, a personalised treatment plan will be developed by one of our expert haematologists or GPs.

The treatment will entirely depend on the underlying cause, and for many, a dietary supplement will be the mainstay of treatment, along with dietary and lifestyle advice, and comprehensive monitoring and aftercare.

For others, more intensive treatment may be needed. Treatment may include any of the following:

Iron supplements

Iron deficiency anaemia is treated with iron supplements, usually taken orally, although in severe cases, iron injections may be recommended. Treatment will typically last several months so as to replenish the body’s stores of iron.

A diet more rich in iron will be recommended, and follow up blood tests will be arranged to check treatment is progressing well.

Vitamin B12 or folate supplements

Vitamin B12 or folate deficiencies are treated with supplements to restore healthy levels of these essential nutrients in the body.

These are typically taken orally, but vitamin B12 injections may be recommended for severe deficiencies and for the treatment of pernicious anaemia.

Treatment is likely to last for several months and dietary advice will be provided, along with follow up blood tests to monitor progress.

Medication adjustment

Where anaemia is being caused by medication, treatment may involve altering the types or amounts of certain medications, such as non-steroidal anti-inflammatory drugs for the treatment of pain.

In some cases, this will need to be discussed with other specialists, and our doctors at The London Clinic benefit from having leading experts in a comprehensive range of disciplines on hand at all times to discuss patient care.

Erthropoietin stimulating agents (ESA)

For some types of anaemia, where the body is not producing enough red blood cells, ESA injections may be recommended. They work by helping the bone marrow to produce more red blood cells.

Corticosteroids

In cases where anaemia is caused by an auto-immune process, where the body’s own immune system is responsible for the anaemia, treatment may require corticosteroid medication. This works by inhibiting the  ability of the immune system to attack the body’s red blood cells.

Immunosuppressive therapy

This type of therapy may be recommended in cases of severe anaemia where the bone marrow has stopped producing enough red blood cells. This is known as aplastic anaemia, and is rare.

Blood transfusion

In some severe cases of anaemia where symptoms are particularly troubling, a blood transfusion is an option. It involves receiving donated blood from a carefully selected donor, through a drip into a vein over several hours.

Anaemia from any cause can be treated this way, and symptoms improve quickly, but transfusions are usually only given as a last resort.

Surgery

If bleeding is the underlying cause of anaemia, for example from heavy menstrual periods, a stomach ulcer, a bleed from the colon, or haemorrhoids, then a surgical procedure may be advised.

Stem cell transplant

In rare cases of aplastic anaemia, where the bone marrow has stopped producing enough red blood cells, the bone marrow can be replaced with stem cells from a carefully matched donor.

The stem cells then produce new healthy bone marrow that’s capable of meeting the body’s demands for red blood cell production.

Splenectomy

This is surgery to remove the spleen, and is sometimes needed to treat anaemia that is caused by an auto-immune process where the immune system attacks the red blood cells, reducing their lifespan.

Further support

As treatment progresses, regular monitoring of symptoms and blood tests are likely to be needed. The London Clinic provides comprehensive and supportive aftercare and follow-up, meaning treatments can be actively adjusted and optimised in response to individual needs.

Patients are kept fully informed about treatment and follow-up plans. Clear aftercare instructions and guidance are provided with ample time for questions and discussion.