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Anemia – Signs and Symptoms

January 23, 2013

240px-Symptoms_of_anemiaAnemia goes undetermined in many people, and symptoms can be minor or vague. The signs and symptoms can be related to the anemia itself, or the underlying cause.

Most commonly, people with anemia report feelings of weakness, or fatigue, general malaise (sense of feeling unwell) and sometimes poor concentration. They may also report dyspnea (shortness of breath) on exertion. In very severe anemia, the body may compensate for the lack of oxygen-carrying capability of the blood by increasing cardiac output. The patient may have symptoms related to this, such as palpitations, angina (if pre-existing heart disease is present), intermittent claudication of the legs, symptoms of heart failure (e.g. chest pains), cold hands and feet.

On examination, the signs exhibited may include pallor (pale skin, mucosal linings and nail beds), but this is not a reliable sign. There may be signs of specific causes of anemia, e.g., koilonychia (in iron deficiency), jaundice (when anemia results from abnormal break down of red blood cells in hemolytic anemia), bone deformities (found in thalassemia major) or leg ulcers (seen in sickle-cell disease).

In severe anemia, there may be signs of a hyperdynamic circulation: tachycardia (a fast heart rate), bounding pulse, flow murmurs, and cardiac ventricular hypertrophy (enlargement). There may be signs of heart failure.

Chronic anemia may result in behavioral disturbances in children as a direct result of impaired neurological development in infants, and reduced scholastic performance in children of school age. Restless legs syndrome is more common in those with iron-deficiency anemia.


Anemia is typically diagnosed on a complete blood count. Apart from reporting the number of red blood cells and the hemoglobin level, the automatic counters also measure the size of the red blood cells by flow cytometry, which is an important tool in distinguishing between the causes of anemia. Examination of a stained blood smear using a microscope can also be helpful, and is sometimes a necessity in regions of the world where automated analysis is less accessible.

In modern counters, four parameters (RBC count, hemoglobin concentration, MCV and RDW) are measured, allowing others (hematocrit, MCH and MCHC) to be calculated, and compared to values adjusted for age and sex. Some counters estimate hematocrit from direct measurements.

In the morphological approach, anemia is classified by the size of red blood cells; this is either done automatically or on microscopic examination of a peripheral blood smear. The size is reflected in the mean corpuscular volume (MCV). If the cells are smaller than normal (under 80 fl), the anemia is said to be microcytic; if they are normal size (80–100 fl), normocytic; and if they are larger than normal (over 100 fl), the anemia is classified as macrocytic.

This scheme quickly exposes some of the most common causes of anemia; for instance, a microcytic anemia is often the result of iron deficiency. The most common cause of macrocytic anemia is megaloblastic anemia. The cause is a deficiency of either vitamin B12, folic acid, or both. Deficiency in folate and/or vitamin B12 can be due either to inadequate intake or insufficient absorption. Folate deficiency normally does not produce neurological symptoms, while B12 deficiency does.



  1. I had anemia. My grandmother who lived to be 103 told me to cook with an iron skillet besides the particular foods she recommended. At least for me the combination worked. Very very good article, Emma.

    • Thanks. I am a bit puzzled though. What does the iron skillet do? And what kind of anemia does it help with?

      • Emma, this was something that my grandmother had told me when I told her that I had been told by my doctor that I was anemic due to an iron deficiency. She suggested that I cook using an iron skillet. and I did follower her advice. And over a year my anemia disappeared. I never did any personal research. After all it came from my grandmother who lived to be 103.

      • Much respect to your grandmother. The proof of the iron, was in the eating. Unfortunatly, for people with folate deficiency eating more ‘iron’ is the last thing that they want to do. It will cover their anemia, and they will suffer greatly despite bloodwork seemingly in order. So, those with folate deficiency should stay away from using an iron skillet. As far as I know, that is. Thanks for the reply.

      • Thank you too for your input and information in this area.

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