Most anemias are reversible or preventable; vitamin and iron supplements often correct anemia, but some forms may require more complex treatment

Most anemias are reversible or preventable; vitamin and iron supplements often correct anemia, but some forms may require more complex treatment

Anemia is often thought of simply as an iron deficiency, which in turn leads to a drop in oxygen-carrying red blood cells. But a low red blood cell count also can result from many other conditions, ranging from reduced vitamin B12 concentrations to ulcers and tumors, according to hematologist Orli Etingin, MD, director of the Iris Cantor Women’s Health Center at Weill Cornell Medical College.

An estimated 13 percent of older Americans have some form of anemia. By age 75, about 10 percent of women have anemia, but by age 85, the rate jumps to more than 20 percent, according to the 2006 National Health and Nutrition Examination Survey. Early diagnosis and prompt treatment are critical -anemia doubles the risk of older adults being unable to live independently due to physical decline, the National Institute on Aging reported in 2003.

“The vast majority of anemias are reversible,” says Dr. Etingin, editor-in-chief of Women’s Health Advisor. “For many people, iron supplements will take care of it. If it’s blood loss due to an ulcer, you can cure that.”

Common symptoms and causes

Because anemia’s most common symptoms-fatigue and shortness of breath-are also signs of other conditions such as heart failure, it’s not always the first explanation we suspect when we start to feel poorly. But a complete blood count (CBC), obtained through a routine blood test, can easily point to anemia.

“A CBC can definitely tell you if you have anemia, but it doesn’t tell you the cause,” Dr. Etingin says.

Most types of anemia fall into one of two categories: blood loss and underproduction of red blood cells.

“With older patients, we’re especially concerned about blood loss,” Dr. Etingin says. “It’s often in the gastrointestinal tract. The first thing you look for is the source of blood loss. What we’re looking for are ulcers or tumors, or intense inflammation that could cause bleeding. That’s the most common anemia in older adults.”


If blood loss is ruled out, a doctor will look for the underproduction of red blood cells, often caused by nutritional deficiencies such as low levels of iron and vitamin B12. The CBC can sometimes help guide a physician to the source, Dr. Etingin explains, noting that very small red blood cells tend to be related to low iron levels, while very large red blood cells are usually associated with vitamin B12 deficiency.

Rare forms

A third category of anemia, the hyperdestruction of red blood cells, is rarer and can be acquired or hereditary, Dr. Etingin says. Certain anemias can be acquired after exposure to infections such as hepatitis or diseases such as lymphoma and leukemia. In rare cases, even medications such as penicillin and acetaminophen can lead to anemia.

One genetic form of the disease is sickle-cell anemia, in which abnormally shaped red blood cells can clump together and have a harder time moving through blood vessels, Dr. Etingin says. The lifelong condition often includes pain, infection, and organ damage. Blood transfusions are among the treatments that can effectively reduce the risk of stroke and other complications of sickle-cell anemia.

A relatively uncommon form of anemia is hemolytic anemia, caused when the destruction of red blood cells exceeds production. In some cases, it is also treated with blood transfusions. In extreme cases, a splenectomy–removal of the spleen–is performed when the spleen is removing too many red blood cells.

Prevention and treatment

People who don’t eat red meat, the richest source of dietary iron, may be at a greater risk of iron deficiency. Iron and vitamin-related anemias usually can be prevented and treated with multivitamins that include iron supplements.

Dr. Etingin urges older women to have blood work done annually in order to stay on top of any changes in their red blood cell count. She also notes that some medications may interfere with the body’s production of red blood cells and recommends informing your doctor of all drugs and supplements you currently take if you find your red blood cell count dropping.

If an ulcer is the cause of anemia, first-line treatments usually include either H2 receptor antagonists such as famotidine (Pepcid) or cimetidine (Tagamet), or proton pump inhibitors such as omeprazole (Prilosec) or lansoprazole (Prevacid).


* Have blood work done annually to monitor your red blood cell levels.

* Talk to your doctor about taking a multivitamin with iron. Some people have too much iron and do not need a supplement.

* Tell your doctor if you have symptoms such as fatigue, inability to perform regular daily activities, shortness of breath, pale skin color, or a rapid heartbeat.

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