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Anemia: what it means, symptoms, treatment and prevention

Anemia is a pathology that is characterized by an abnormal decrease in the concentration of hemoglobin in the blood, resulting from the lack of one or more essential nutrients. Gynecologist and obstetrician Cassiana Giribela explains that anemia occurs when, whatever the cause, blood hemoglobin levels are below: < 12g/dL in women; < 13g/dL in men and < 11g/dL in pregnant women.

“Most of the time, anemia develops from insufficient iron intake (iron deficiency anemia)”, highlights the doctor. However, it can come from the deficiency of several nutrients, such as zinc, vitamin B12 and proteins.

Rodolfo Cançado, Prof. assistant and head of the discipline of Hematology and Oncology at the Faculty of Medical Sciences of Santa Casa de São Paulo and hematologist at Hospital Samaritano/São Paulo, emphasizes that anemia is not “normal” in any age group. “It’s always a warning sign that something is not going well with that person’s health,” he says.

“It is estimated that iron deficiency is present in 1/3 of the world’s population. This means that about 2 billion people are iron deficient”, emphasizes Cançado.

Are there risk groups?

Cassiana highlights that there are some situations that are more conducive to the development of anemia:

  • Insufficient amount of iron in the diet, or forms that are difficult to absorb.
  • Increased needs: childhood, adolescence and pregnancy.
  • Situations that make iron absorption less effective: gastrectomies, bariatric surgeries, cancer, celiac disease.
  • Blood loss, physiological (menstruation) or postpartum, or pathological.
  • Any bleeding, whether acute or chronic.

Cançado points out that the people most at risk (most vulnerable) of iron deficiency are: children (especially children under three years of age), women of reproductive age and pregnant women.

The main symptoms of anemia

Cassiana explains that anemia is associated with depression, reduced performance at work and in sport, as well as impaired cognitive and intellectual functions. “Insufficient iron levels were associated with symptoms such as apathy, irritability, fatigue and difficulty concentrating,” she says.

Cançado points out that people with iron deficiency can feel: easy and constant tiredness for no apparent reason, headache, dizziness, irritability, lack of attention.

“Children can have learning difficulties, not do well in school; infections more frequently and growth retardation. Adults tolerate less exercise, have lower performance at work, may have palpitations, shortness of breath, discouragement, sometimes even simulating depression. Hair loss, weaker and brittle nails are also symptoms”, adds Cançado.

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The hematologist also comments that the person with iron deficiency may have an appetite for non-food things or substances, such as earth, ice, raw pasta, lemon, chalk, etc.

Anemia diagnosis

The diagnosis of anemia is generally made by observing laboratory (hematological) indicators.

Cassiana explains that you can dose several parameters:

  • Hemoglobin dosage is the main parameter.
  • Ferritin: assesses the levels of iron in your deposit.
  • Transferrin saturation index: amount of iron that is bound to transferrin (iron transport protein). Indicates whether the mobilization of iron by the body is efficient.
  • MCV (mean corpuscular volume) indicates the size of circulating red blood cells. If the size is small, it means that there is little hemoglobin inside.
  • Free Iron: Indicates the levels of free iron in the blood. It may be helpful in determining the cause of anemia.

Cançado comments that the investigation of anemia is as important as its treatment. “Because, it is worth remembering, anemia is always a warning sign that something is wrong with a person’s health. Often the first sign of a stomach or bowel (colon) tumor is anemia. Therefore, if we do not investigate the person with anemia, we may be missing the chance to make the diagnosis of a tumor at a stage that is still potentially curable”, he explains.

“You need to seek medical help. The diagnosis of anemia is important, but the person should not remain calm until the cause of anemia is clarified”, warns Cançado.

possible complications

Cassiana highlights as possible problems resulting from anemia:

  • In the central nervous system: irritability, emotional lability, decreased concentration and memory, headache, ataxia (loss or irregularity of muscle coordination), paresthesias (abnormal and unpleasant sensation on the skin that takes different forms) and sleep disturbances.
  • Skin and mucous membranes: fragility of nails and hair and mouth fissures.
  • Circulatory system: tachycardia and dyspnea.

Anemia during pregnancy: what are the risks?

Cassiana highlights as maternal repercussions of anemia:

  • Impairment of physical and mental performance and emotional instability;
  • Preeclampsia, cardiovascular changes;
  • Decreased immune function;
  • Changes in thyroid function and catecholamines;
  • Hair loss, weakening of nails;
  • Risk of postpartum anemia.

In relation to fetal compromise, according to the doctor, the following can be highlighted:

  • Pregnancy losses (abortions, intrauterine death);
  • Fetal hypoxemia, prematurity, premature rupture of membranes;
  • Infectious frames;
  • Fetal growth restriction;
  • Anemia in the first year of life, due to low iron stores in the newborn.
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Cançado comments that people with iron deficiency (FD) are one step away from having iron deficiency anemia. “For example, in a woman with SCD who becomes pregnant, the chance of developing anemia in the last 3 months of pregnancy reaches 70%. Because? Because the child needs a lot of iron to grow inside the mother, and obviously it takes from the mother everything she has,” she says.

Is anemia in pregnancy serious? According to the hematologist, yes. “It increases the risk of miscarriage, prematurity, of the child having low birth weight and, in some cases, it even poses a risk of death for both the mother and the child,” he says.

how to treat anemia

The best option for iron replacement is orally, according to Cassiana. “There are several products on the market for oral administration with different iron salts, differences in absorption and tolerability. The four main iron supplements sold in Brazil are: ferrous sulfate, polymaltose iron complex (ferripolymaltose), aminochelated iron (bisglycinate iron) and carbonyl iron. The last three in the form of ferric salt. And, currently, the most modern is liposomal iron”, he says.

For Cançado, two more important issues that should be discussed are: the treatment time and the side effects of iron-based drugs. “The treatment takes at least 90 days, and can extend up to 6 months. This is what explains some people who improve their symptoms stop taking the medicine after 20 or 30 days; and, thus, the anemia returns soon”, he comments.

And why do some people stop treatment? “People treated by the SUS receive ferrous sulfate, which is a very good, effective drug, but with many side effects (nausea, vomiting, diarrhea, constipation), which makes the person stop treatment early. In these cases, ferric salts, such as ferripolymaltose, have fewer side effects, which determines better adherence to treatment and, therefore, better results”, he says.

For all these reasons, the best treatment, taking into account the particularities of each case, should naturally be indicated by the doctor; and it is essential that the patient follows the guidelines given by the professional to the letter.

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Cançado also comments that the bioavailability of iron is the efficiency with which the body uses iron from the diet. “There is a lot of talk about how to improve the diet, that is, provide a diet richer in iron; but very little is said about the use of iron-based medicines, which are essential. Diet is important for the prevention of iron deficiency, but for those who already have iron deficiency and, above all, for those with iron deficiency anemia, diet helps, but medicines with iron help much more”, he explains.


Cassiana highlights that, in women, especially losses should be treated when excessive in menstruation. “In pregnant women, iron supplements should be used, especially from the 20th week of pregnancy onwards”, she says.

Yes, diet is also important for prevention. “A diet richer in iron (iron sources) means a greater supply of meat-based foods, which are rich in heme iron, such as viscera (liver), heart, fish (canned sardines) and chicken”, says Cançado.

“Non-heme iron, present in beans, lentils and dark vegetables (kale, broccoli, watercress, arugula, spinach, beets) is much less absorbed (5-10%) than iron in meats (30%), but also helps”, highlights the hematologist.

What can enrich and improve the absorption of iron, according to Cançado, is: cooking in an iron pan and having a glass of citrus fruit juice (orange, lemon, acerola) before or during food. “Vitamin C contributes to increasing the absorption of non-heme iron and canceling the effect of factors that inhibit iron absorption. The addition of 50 mg of vitamin C is able to double the absorption of non-heme iron present in the same meal”, he says.

But, it is worth remembering, anemia should be treated with medical advice. Because diet is, yes, important for prevention, but those who already have iron deficiency and those who already have iron deficiency anemia also need treatment based on iron medications, as Cançado emphasizes.

Being attentive to health as a whole, taking care of food in general and, whenever you notice symptoms, seeking medical help, is the best way to avoid anemia and any other health problem.

The information contained on this page is for informational purposes only. They do not replace the advice and follow-up of doctors, nutritionists, psychologists, physical education professionals and other specialists.

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