What Are the Symptoms of Anemia?

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Having anemia—a condition defined by not having enough healthy red blood cells—means that your organs and other tissues are not getting a normal amount of oxygen. This sounds significant, and it certainly can be. But symptoms of anemia vary depending on the extent of the condition, as well as the type of anemia you have.

Many people with mild anemia actually do not have any signs or symptoms at all. Or if they do, they may attribute some of them to other causes. Fatigue is an anemia symptom that's commonly overlooked.

But as anemia worsens or becomes severe, it can lead to a range of serious symptoms, such as dizziness or shortness of breath. Complications, such as heart problems, can become life-threatening.

This article explores the many signs and symptoms of anemia, including those that tend to only occur with certain types, and possible complications.

Woman with high fever at home.
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Common Symptoms

Anemia means there is a drop in red blood cells or the hemoglobin protein in those cells that's needed to carry oxygen throughout your body. The signs and symptoms of anemia tend to gradually increase as the anemia gets worse.

Common symptoms of any type of anemia include:

  • Tiredness or lack of energy
  • Weakness
  • Pale skin
  • Yellowish skin

These symptoms can occur regardless of the severity of the anemia, but they tend to occur more intensely with severe anemia.

As anemia progresses, you may experience other symptoms like:

  • Dizziness
  • Headaches
  • Increased thirst
  • Irritability
  • Easily bruising
  • Sore tongue
  • Cramps in the lower leg when exercising
  • Reduced tolerance of exercise

Since the symptoms of anemia are gradual and similar to the symptoms of other illnesses, they are often overlooked.

If you have severe anemia, you may also experience more serious symptoms such as:

Since anemia leads to a lack of adequate oxygen around the body, the brain may get deprived as well and this can sometimes lead to brain damage.

Recap

Common general symptoms, such as fatigue and weakness, tend to gradually increase as the anemia gets worse and can occur with any type.

Type-Specific Symptoms

There are also type-specific symptoms for iron deficiency anemia, or anemia due to a lack of iron, and many of the rarer types of anemia.

Iron Deficiency Anemia

Iron deficiency anemia is the most common form of anemia. Your body needs iron to make healthy red blood cells and a deficiency can occur due to blood loss, not eating enough iron-rich foods, or from conditions that affect iron absorption from foods.

Some additional symptoms that usually only occur in iron deficiency anemia are:

  • Cold hands and feet
  • Brittle nails
  • Pica, or the desire to eat non-food substances like paper, clay, and paint chips

Pernicious Anemia

Vitamin-deficiency anemia occurs when the body can't make enough healthy red blood cells due to low levels of certain vitamins. A rare form of vitamin-deficiency anemia called pernicious anemia is the result of an inability to absorb vitamin B12.

Pernicious anemia is often due to an autoimmune condition in which the immune system mistakenly attacks cells that line the stomach and make a protein needed to move and absorb B12.

Symptoms of pernicious anemia include:

  • Tingling, prickling feelings (also called "pins and needles" or paresthesia)
  • Muscle weakness
  • Ataxia: An inability to voluntarily coordinate and control your muscle movements, which can affect eye movement, speech, and swallowing
  • Digestive tract issues like bloating, nausea, and loss of appetite
  • An enlarged liver

Symptoms of severe pernicious anemia may also include:

  • Confusion
  • Depression
  • Memory problems or dementia

Hemolytic Anemia

Hemolytic anemia is when red blood cells are destroyed faster than they are made.

This rare form of anemia can be caused by inherited blood conditions, such as sickle cell anemia, or an immune reaction that leads to your immune system mistakenly attacking your red blood cells or healthy tissues.

Symptoms of hemolytic anemia include:

  • Upper abdomen pain
  • Brown or reddish looking urine
  • Chills

Aplastic Anemia

Aplastic anemia is when your blood-forming organs, such as bone marrow, stop producing enough red blood cells.

Aplastic anemia also has its own distinctive and uncommon signs and symptoms. These can range from mild to very serious. They include:

  • Frequent infections
  • Easily bleeding
  • Fevers
  • Tiny, circular red spots on the skin caused by bleeding from small blood vessels (petechiae)
  • Nosebleeds
  • Blood in stool
  • Heavy bleeding during menstrual periods
  • Nausea
  • Skin rashes
  • Abnormally formed kidneys, heart, lungs, digestive tract, arms, and hands (specific to Fanconi anemia, a form of aplastic anemia)

Recap

Signs and symptoms vary widely based on the type and severity of the anemia. A desire to eat non-food substances and brittle nails can be signs of iron deficiency anemia. Muscle weakness or tingling can happen with pernicious anemia.

Complications

Red blood cells serve an important role of supplying oxygen throughout your body so when their levels drop, it can lead to a range of complications, especially if the anemia becomes severe.

Anemia can also worsen other underlying medical conditions and lessen the efficacy of treatments for them.

Heart Problems

In anemia, the heart has to work harder than normal to compensate for the lack of hemoglobin-rich red blood cells.

It pumps harder in order to make sure oxygen-filled blood is moved around the body.

This extra work can put a strain on your heart and lead to complications like heart murmurs, cardiac hypertrophy (increase in the size of the heart's muscle), and heart failure.

Issues With Pregnancy

In addition, anemia during pregnancy is not uncommon especially in the second and third trimesters. 

However, if it is severe and not managed well it can lead to having a low-birth-weight baby or a preterm birth.

It can also increase your baby’s risk of having anemia during their infancy. Further, anemia can put you at risk of experiencing blood loss during labor.

Depression

The nerve damage in some form of anemias like pernicious anemia can lead to depression.

Women who have iron deficiency anemia during pregnancy also have an increased risk of developing postpartum depression, or depression that occurs within a year after giving birth.

Weakened Immune System

Iron deficiency anemia can cause your immune system to be compromised, leaving you more open to infections and reducing your body's ability to fight them.

Restless Legs Syndrome

Restless legs syndrome, also called Willis-Ekbom disease, is a complication of iron deficiency anemia in particular.

This is a nervous system condition which produces the irresistible urge to move your legs. This is usually felt in the evening and nighttime.

Impaired Development

Many studies show that iron is needed for the brain to develop properly. Having severe iron deficiency anemia in infancy and childhood can lead to mental, cognitive, and motor developmental delays.

Recap

Anemia, especially if it's severe, can strain your heart, weaken your immune system, and lead to other complications. It can cause pregnancy complications or developmental problems in infancy and childhood.

When to See a Healthcare Provider

If you’ve been diagnosed with anemia and you experience a worsening of symptoms like chest pain, trouble breathing, fast or irregular heartbeat, head to the hospital immediately. If possible, get someone else to drive you. You may be experiencing heart problems, including heart failure.

Beyond that, the following warrant making an appointment to see your healthcare provider:

  • You’ve already been diagnosed with an underlying condition that can lead to anemia (e.g., kidney disease, HIV/AIDS, cancer, or Crohn's disease) and you notice signs or symptoms of anemia
  • You have a family history of inherited anemia (consider undergoing genetic testing and counseling for it)
  • You're experiencing a number of anemia symptoms; this could be a sign of a more serious or chronic condition like cancer or chronic internal bleeding

Summary

Anemia can lead to a range of signs and symptoms depending on the type, cause, and severity.

Symptoms may include tiredness, weakness, pale or yellowish skin, feeling cold, or dizziness.

If you have signs or symptoms of anemia, seek medical attention, especially with any serious symptoms, such as difficulty breathing or fainting.

A Word From Verywell

Anemia can be a serious condition and it is important that you follow your healthcare provider's instructions and recommendations on diet, medication, exercise, and other lifestyle choices to prevent its complications from occurring.

If you've been diagnosed with anemia, inform your healthcare provider if you have any new symptoms, or are experiencing a significant increase in your existing ones.

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