Anemia due to lack of haemoglobin or RBCs in blood may be an acute (rapid-onset) or chronic (slow onset) condition.

In drastic blood loss after an injury or major surgery there may be an acute anemia precipitation.

In chronic cases there may be commonly iron deficiency anemia that usually displays few signs or symptoms.

Who is affected by anemia?

Anyone can develop anaemia. Most often it affects women of childbearing age, pregnant women, men and women over 75, growing children and teenagers and new born babies. (1-5)

Common symptoms of iron deficiency anemia

The most common features or symptoms of iron deficiency anemia include (1, 3, 4):

• Weakness, dizziness or tiredness
• Lack of energy
• Shortness of breath
• Palpitations and rapid heart rate
• Headache
• Tinnitus - perception of a noise in one or both ears that may be like ringing
• Taste sense alterations and soreness of the tongue
• Pica – desire to eat non-food materials like mud, chalk, paper, clay or ice
• Hair loss
• Dry nails and skin and itchiness
• Difficulty in swallowing
• Loss of appetite
• Changed appearance including a pale complexion, decreased pinkness of the lips and nailbeds, smooth and red tongue, painful ulcers called cheilosis at the corners of the mouth, dry, spoon shaped nails etc.
• In infants and preschoolers who have iron deficiency anemia can have developmental delays and behavioral disturbances. This could include decreased motor activity and problems with social interactions with peers and decreased focus and attention to tasks
• Susceptibility to infections

Common symptoms of anemia due to Vitamin B12 or folate deficiency

In patients with anemia due to Vitamin B 12 or folate deficiency there may be common symptoms of anemia along with few other tell-tale signs. These include (2):

• Yellowish tinge of the skin
• Sore, red and smooth tongue called glossitis
• Ulcers in the mouth
• Altered or reduced sense of touch
• Reduced ability to feel pain
• Disturbed vision
• Irritability
• Depression
• Psychosis or derangement of behavior and thoughts
• Dementia or decline of mental abilities, such as memory, judgement and understanding
• Muscle weakness

Symptoms of anemia due to excessive destruction of RBC’s

If anemia is caused due to excessive destruction of RBCs like in haemolytic anemias the symptoms may include the common features and some other symptoms as well. These include (4, 5) –

• Jaundice causing yellowing of the whites of the eyes and dark tea-colored urine.

  Jaundice occurs because the rapid breakdown of abnormal red blood cells leads to a build-up of a fluid normally present in the body called bilirubin.

  The build-up of bilirubin often leads to the formation of small crystals or gall stones in the gall bladder. This may lead to abdominal pain and nausea.

• An enlarged spleen

  The spleen is a fist sized organ located in the abdomen (upper left corner). It helps filter harmful bacteria and viruses from the blood.

  The dead RBCs tend to accumulate in the spleen causing it to enlarge in size.

• Sickle cell crisis

  These are episodes of excessive pain. It is triggered when the abnormal blood cells block the small blood vessels that supply the body’s tissues. This causes the cells in the affected tissue to be damaged, resulting in swelling that further irritates the nerves leading to pain.

  Young children may develop painful swelling in their hands or feet. Common areas of pain include ribs, spine, pelvis, breast bone, abdomen and long bones of the legs and arms. This may be a throbbing, sharp and shooting or throbbing pain.

  Symptoms can be severe and episodes can last from a few minutes to several weeks with an average duration of around 5-7 days. A sickle cell crisis is brought about by change in temperatures, dehydration or sudden stress like infections etc.

• Children with sickle cell anaemia are more vulnerable to infection like pneumonia, or lung infection, osteomyelitis or bone infections or meningitis or brain infections.
• Leg ulcers may also be seen in sufferers of sickle cell anemia. The ulcers usually develop close to the ankle. Leg ulcers often develop after a skin infection or injury.
• Growth retardation or delayed growth in children with haemolytic anemias.