Understanding Anaemia: Beyond Iron Deficiency

When most people hear the word anaemia, they immediately think of an iron deficiency. While that’s often true, anaemia is actually a much broader condition. It simply means your blood doesn’t have enough healthy haemoglobin (the protein that carries oxygen). And there are different types of anaemia, each with its own cause, symptoms, and treatment.

Let’s break them down.

Iron Deficiency Anaemia (The Most Common One)

This is the type most people are familiar with. It happens when your body doesn’t have enough iron to make healthy red blood cells.

Why does it happen?

• Heavy or prolonged periods in women
• Slow blood loss from the stomach or intestines (like ulcers, parasites, or other gut issues)
• Poor absorption of iron due to stomach problems (for example, very low stomach acid or chronic diarrhoea)

Common signs:

• Constant tiredness and low energy
• Pale skin and pale lips/nails
• Shortness of breath when you exert yourself
• Brittle nails
• Small, pale-looking blood cells (seen in tests)

Vitamin B₁₂ and Folate Deficiency Anaemias

Pernicious Anaemia (Vitamin B₁₂ Deficiency)

This happens when the body can’t absorb vitamin B₁₂ properly because it lacks a protein called intrinsic factor. Without B₁₂, red blood cells can’t develop normally.

Typical signs:

• Larger-than-normal red blood cells
• Tingling or numbness in hands and feet
• Fatigue
• More common in people over 60

Treatment: Usually lifelong vitamin B₁₂ injections, which work very well.

Folate Deficiency Anaemia

Folate (also called folic acid) is another B vitamin needed for red blood cell production. A lack of it leads to anaemia.

Who’s at risk:

• People not eating enough fresh fruits/vegetables
• Pregnant women (higher demand for folate)
• People with heavy alcohol use

Thankfully, in many countries, flour and cereals are fortified with folic acid, so it’s less common today.

Megaloblastic Anaemia

When both vitamin B₁₂ and folate are low, the bone marrow produces large, abnormal cells that don’t mature properly.

Effects:

• Low blood counts across the board (red cells, white cells, platelets)
• Folate deficiency ? gut-related symptoms
• Vitamin B₁₂ deficiency ? nerve-related symptoms

Hemolytic Anaemia (When Blood Cells Break Too Soon)

Here, red blood cells get destroyed faster than the body can replace them.

Causes:

• Inherited conditions like sickle cell anaemia, thalassemia, or spherocytosis
• Acquired causes such as antibodies, medications, or infections

Clues:

• Typical symptoms plus jaundice (yellow skin/eyes)
• Enlarged spleen
• In severe cases, heart and liver strain

Aplastic Anaemia (Bone Marrow Shutdown)

This is a rare but serious type, where the bone marrow stops producing enough blood cells.

Possible causes:

• Chemicals like arsenic
• Radiation exposure
• Sometimes unknown reasons

Signs:

• Low red blood cells (causing fatigue)
• Low white blood cells (more infections)
• Low platelets (easy bleeding/bruising)

Key Takeaways

• Anaemia is not just low iron; it has many types and causes.
• Iron deficiency anaemia is the most common, especially in women of reproductive age.
• Other forms, such as B₁₂/folate deficiency, hemolytic, or aplastic anaemia, require very different treatments.
• Proper diagnosis is important before starting supplements or treatment.

If you suspect anaemia, don’t self-medicate. Get a blood test and talk to a doctor. The right treatment depends on the cause, not just the symptoms.

Image by Tyli Jura from Pixabay