Anaemia in Women: Understanding Low Blood Count

Anaemia, often called 'low blood count' or 'iron-poor blood', is a common condition where your blood doesn't have enough healthy red blood cells to carry oxygen effectively. It affects many women, especially during their reproductive years and pregnancy. Learn about its causes, symptoms, diagnosis, and how it's managed.

Published: October 27, 2023•Updated: October 27, 2023

What is Anaemia?

Anaemia is a condition where your blood lacks enough healthy red blood cells, or these cells don't have enough oxygen-carrying capacity. Red blood cells contain a protein called haemoglobin (Hb), which is responsible for transporting oxygen from your lungs to the rest of your body. When you have anaemia, your body doesn't get enough oxygen, leading to symptoms like tiredness and weakness.

The World Health Organization (WHO) defines anaemia based on haemoglobin levels. For women, these thresholds vary:

Non-pregnant women (15 years and older): Haemoglobin less than 12.0 g/dL
Pregnant women: Haemoglobin less than 11.0 g/dL
Postpartum women: Haemoglobin less than 10.0 g/dL (Note: Some guidelines may use slightly different thresholds for postpartum women, such as <11.0 g/dL or <12.0 g/dL depending on the time since delivery).

While often referred to as 'low blood count' or 'iron-poor blood' (especially for iron deficiency anaemia), it's important to remember that anaemia can have various causes beyond just iron.

Why is Anaemia Common in Women?

Women are particularly susceptible to anaemia due to several factors:

Heavy Menstrual Bleeding (Menorrhagia): This is the most common cause of iron deficiency anaemia in women before menopause. Significant blood loss each month can deplete iron stores.
Pregnancy: During pregnancy, your blood volume increases, and your body needs more iron to support the growing baby and placenta. Blood loss during delivery also contributes.
Recent Childbirth (Postpartum Period): Blood loss during delivery can lead to anaemia, and recovery takes time.
Dietary Factors: Not getting enough iron, vitamin B12, or folate from your diet, especially with vegetarian or vegan diets, can lead to anaemia.
Gastrointestinal Conditions: Conditions like celiac disease, inflammatory bowel disease, or even certain surgeries (like gastric bypass) can affect how your body absorbs nutrients.
Chronic Diseases: Long-term conditions such as kidney disease, cancer, or autoimmune disorders can also lead to anaemia.
Certain Medications: Some medicines, like NSAIDs (painkillers) can cause stomach bleeding, and proton pump inhibitors (for acidity) can reduce iron absorption.

What Causes Anaemia?

While iron deficiency is the most common cause, anaemia can stem from various issues:

Iron Deficiency Anaemia (IDA): This is the most prevalent type, especially in women. It happens when your body doesn't have enough iron to make haemoglobin. Causes include:
- Increased iron loss (e.g., heavy periods, gastrointestinal bleeding, childbirth).
- Increased iron requirements (e.g., pregnancy, lactation).
- Decreased iron intake or absorption (e.g., poor diet, malabsorption).
Vitamin Deficiency Anaemia: Lack of essential vitamins like Folate (Vitamin B9) or Vitamin B12 can lead to anaemia. This can be due to diet, malabsorption, or certain medical conditions.
Anaemia of Chronic Disease: This occurs with long-term inflammatory conditions, infections, or cancer. Your body has iron, but inflammation prevents it from being used effectively.
Haemolytic Anaemia: This is when red blood cells are destroyed prematurely. It can be inherited (like sickle cell disease or thalassemia) or acquired.
Anaemia due to Blood Loss: Acute or chronic blood loss from trauma, surgery, or heavy periods can lead to anaemia.

It's important to note that often, multiple factors can contribute to anaemia.

Symptoms to Look Out For

The symptoms of anaemia can vary depending on its severity and how quickly it develops. If anaemia develops slowly, your body might adapt, and you might not notice symptoms right away.

Common Symptoms:

Feeling unusually tired, weak, or lacking energy (fatigue, lethargy)
Shortness of breath, especially during physical activity
Pale skin, particularly noticeable in your eyelids, nails, and palms
Dizziness or lightheadedness
Headaches
Cold hands and feet

Less Common Symptoms:

Pica (craving non-food items like ice, dirt, or starch)
Restless legs syndrome
Brittle nails or spoon-shaped nails (koilonychia)
Sore or swollen tongue (glossitis)
Cracks at the corners of the mouth (angular cheilitis)
Hair loss
Difficulty concentrating
Ringing in the ears (tinnitus)
Palpitations (feeling a fast or irregular heartbeat)

When to Seek Immediate Medical Attention (Red Flag Symptoms):

If you experience any of these, please contact your doctor or seek emergency care:

Severe shortness of breath even at rest
Chest pain
Fainting or severe dizziness
Very rapid heart rate
Signs of significant, acute blood loss (e.g., vomiting blood, black tarry stools, very heavy vaginal bleeding)

How is Anaemia Diagnosed?

Diagnosing anaemia involves a combination of understanding your health history, a physical examination, and specific laboratory tests.

Your Doctor Will Ask About:

Menstrual History: How heavy and frequent your periods are.
Pregnancy History: Number of pregnancies, any complications like heavy bleeding after delivery.
Diet: Your eating habits, especially if you follow a vegetarian or vegan diet.
Symptoms: When your symptoms started and how they affect you.
Medical History: Any existing conditions like stomach issues, kidney disease, or autoimmune disorders.
Medications: Any medicines you are currently taking.
Family History: If inherited anaemias run in your family.

Physical Examination:

Your doctor will look for signs like pale skin, changes in your nails or tongue, and check your heart rate.

Laboratory Tests:

Complete Blood Count (CBC): This is the main test. It measures your haemoglobin level, red blood cell count, and the size of your red blood cells (MCV).
- Small red blood cells (low MCV) often suggest iron deficiency or thalassemia.
- Normal-sized red blood cells (normal MCV) can indicate anaemia of chronic disease or early iron deficiency.
- Large red blood cells (high MCV) might point to vitamin B12 or folate deficiency.
Iron Studies: If iron deficiency is suspected, tests like serum ferritin (which shows your body's iron stores) are crucial. A low ferritin level is a strong indicator of iron deficiency. (NICE, 2021)
Further Tests: Depending on the initial results, your doctor might order tests for vitamin B12 and folate levels, check for inflammation, or investigate for gastrointestinal bleeding.

Screening in Pregnancy:

Both the American College of Obstetricians and Gynecologists (ACOG) and the WHO recommend routine screening for anaemia with a CBC at your first prenatal visit and again between 24-28 weeks of pregnancy. (ACOG, 2021; WHO, 2016)

Treatment Options for Anaemia

The treatment for anaemia depends on its underlying cause and severity. Your doctor will create a personalized plan for you.

Lifestyle and Diet:

Iron-Rich Foods: Include red meat, poultry, fish (which contain easily absorbed heme iron), and plant-based sources like lentils, beans, tofu, spinach, and fortified cereals (non-heme iron).
Boost Iron Absorption: Eat foods rich in Vitamin C (like citrus fruits, bell peppers) alongside iron-rich meals, especially plant-based iron.
Avoid Inhibitors: Try to avoid drinking tea, coffee, or taking calcium supplements at the same time as iron-rich meals or iron supplements, as they can hinder iron absorption.

Medical Treatments:

Oral Iron Supplements: This is the most common first-line treatment for iron deficiency anaemia. (NICE, 2021) Your doctor will prescribe a specific type and dose. It's usually taken for several months, even after your haemoglobin levels normalize, to replenish your body's iron stores. Side effects can include constipation, nausea, and black stools, which can often be managed by adjusting the dose or taking it with food.
Intravenous (IV) Iron: If you can't tolerate oral iron, don't absorb it well, or need a rapid increase in iron levels (e.g., severe anaemia late in pregnancy), IV iron might be recommended. (ACOG, 2021; NICE, 2021)
Treating the Underlying Cause: Addressing the root cause is crucial. This might involve hormonal treatments for heavy menstrual bleeding or specific supplements for vitamin deficiencies.

Surgical Options:

Blood Transfusion: This is typically reserved for severe cases of anaemia, especially if you are experiencing significant symptoms like chest pain or fainting, or have acute, massive blood loss. (RCOG, 2015)
Surgery for Underlying Conditions: In some cases, surgery might be needed to manage conditions causing chronic blood loss, such as severe heavy menstrual bleeding or bleeding ulcers.

Follow-up:

Your doctor will monitor your progress with blood tests (CBC and ferritin) to ensure the treatment is working and to adjust your plan as needed. (NICE, 2021)

Potential Complications of Anaemia

Untreated anaemia can lead to various health issues, both in the short and long term, and can have specific impacts during pregnancy.

Short-Term Complications:

Reduced ability to exercise and perform daily physical activities.
Difficulty concentrating or 'brain fog'.
Increased risk of infections.
In very severe cases, it can strain your heart, potentially leading to heart failure.

Long-Term Complications:

Worsening of existing chronic conditions, especially heart or lung diseases.
Persistent restless legs syndrome.
Reduced overall quality of life.

Complications During Pregnancy (Maternal):

Increased risk of developing pre-eclampsia (a serious blood pressure condition).
Higher risk of maternal mortality.
Increased risk of heavy bleeding after childbirth (postpartum haemorrhage).
Higher chance of needing a blood transfusion.
Increased risk of postpartum depression.
Reduced physical and mental well-being after delivery.

Complications for the Baby (Neonatal):

Increased risk of preterm birth (baby born too early).
Increased risk of low birth weight.
Increased risk of the baby being small for gestational age.
Low iron stores in the infant, which can lead to anaemia in early childhood and potentially affect brain development.

Preventing Anaemia

Preventing anaemia often involves a combination of a healthy diet and, for some women, targeted supplementation.

Primary Prevention (General Health):

Balanced Diet: Ensure your diet is rich in iron, folate, and vitamin B12.

Supplementation for At-Risk Groups:

During Pregnancy: The WHO and ACOG recommend routine low-dose iron supplementation for all pregnant women to prevent iron deficiency anaemia. (WHO, 2016; ACOG, 2021) The exact dose may vary, but typically 30-60 mg of elemental iron daily is suggested.
Menstruating Women: In areas where anaemia is common, the WHO suggests intermittent iron and folic acid supplementation for menstruating adolescents and women. (WHO, 2011)

Secondary Prevention (Screening and Management):

Screening in Pregnancy: Universal screening for anaemia with a CBC is recommended at your first prenatal visit and again at 24-28 weeks. (ACOG, 2021)
Managing Underlying Conditions: Prompt and effective treatment of conditions like heavy menstrual bleeding or gastrointestinal disorders can prevent anaemia from developing or worsening.

What to Expect: Prognosis

The good news is that with proper diagnosis and treatment, the outlook for most common types of anaemia in women is excellent. Your symptoms should begin to improve within a few weeks of starting effective treatment.

Haemoglobin Levels: These usually return to normal within 1-2 months.
Iron Stores: It takes longer to replenish your body's iron stores (ferritin), typically 3-6 months. It's important to continue your treatment as advised by your doctor, even if you feel better.

Recurrence of anaemia is possible if the underlying cause, such as ongoing heavy menstrual bleeding or a consistently poor diet, is not fully addressed. In some cases, long-term, low-dose iron supplementation might be recommended to prevent it from coming back.

For anaemias linked to chronic diseases or bone marrow disorders, the long-term outlook depends on the management and prognosis of that specific underlying condition.

If you suspect you have anaemia or are experiencing any of the symptoms, please consult with your healthcare professional at Param Maternity & Surgical Nursing Home. They can accurately diagnose your condition and recommend the best course of action for you.

Frequently Asked Questions

What is the difference between anaemia and iron deficiency?

Anaemia is a condition where your blood doesn't have enough healthy red blood cells or haemoglobin. Iron deficiency means your body doesn't have enough iron. Iron deficiency is the most common cause of anaemia, but you can have iron deficiency without being anaemic yet, or you can have anaemia due to other causes (like vitamin deficiencies or chronic diseases) even if your iron levels are normal.

How long will it take for my iron supplements to work?

You might start feeling better and notice an improvement in symptoms like fatigue within a few weeks of starting iron supplements. Your haemoglobin levels usually normalize within 1-2 months. However, it takes longer, typically 3-6 months, to fully replenish your body's iron stores (ferritin). It's important to continue taking your supplements as prescribed by your doctor, even after your haemoglobin is normal, to build up these stores.

What are the side effects of iron pills and how can I manage them?

Common side effects of oral iron pills include constipation, nausea, abdominal pain, and black stools. To manage these, your doctor might suggest taking the iron with food (though this can sometimes reduce absorption), starting with a lower dose and gradually increasing it, or trying an alternate-day dosing schedule. Drinking plenty of water and increasing fiber in your diet can help with constipation. If side effects are severe, discuss them with your doctor, as they might suggest a different formulation or intravenous iron.

Can I get enough iron from my diet alone to treat my anaemia?

While a diet rich in iron is crucial for prevention and maintenance, it's often not enough to treat existing anaemia, especially if it's moderate to severe. Iron supplements provide a much higher dose of iron than you can typically get from food alone. Once your iron levels are restored, maintaining a healthy iron-rich diet becomes very important to prevent recurrence.

Which foods are highest in iron?

Foods highest in iron include red meat, poultry, and fish (which contain heme iron, easily absorbed). Plant-based sources (non-heme iron) include lentils, beans, tofu, spinach, fortified cereals, nuts, and dried fruits. Remember to pair non-heme iron sources with Vitamin C-rich foods (like citrus fruits, bell peppers) to enhance absorption.

Do I need to take my iron supplement with food?

Taking iron supplements on an empty stomach can improve absorption, but it can also increase side effects like nausea and stomach upset. If you experience these, taking your iron with a small amount of food (avoiding dairy, tea, or coffee) might help. Always follow your doctor's specific instructions.

Can my heavy periods be causing my anaemia?

Yes, heavy menstrual bleeding (menorrhagia) is the most common cause of iron deficiency anaemia in premenopausal women. Significant blood loss each month can deplete your body's iron stores faster than they can be replenished through diet. If you have heavy periods and symptoms of anaemia, it's important to discuss this with your doctor.

Is it safe to take iron supplements during pregnancy?

Yes, it is generally safe and often recommended. Both the WHO and ACOG recommend routine low-dose iron supplementation for all pregnant women to prevent iron deficiency anaemia. (WHO, 2016; ACOG, 2021) Your doctor will advise on the appropriate dose and type of supplement for you.

Can anaemia cause hair loss?

Yes, anaemia, particularly iron deficiency anaemia, can contribute to hair loss. Iron is essential for many bodily functions, including healthy hair growth. As your iron levels improve with treatment, you may notice a reduction in hair loss.

Why am I still tired even though my blood count is normal now?

Even after your haemoglobin levels normalize, it takes time to fully replenish your body's iron stores (ferritin). Low iron stores can still contribute to fatigue. Other factors like sleep quality, stress, or other underlying health conditions can also cause tiredness. Discuss persistent fatigue with your doctor.

What is a ferritin level and what should it be?

Ferritin is a protein that stores iron in your body, so your serum ferritin level is a good indicator of your body's iron stores. A low ferritin level is diagnostic of iron deficiency. (NICE, 2021) The exact threshold for 'low' can vary slightly between guidelines, but often a level below 30 µg/L is considered indicative of iron deficiency.

Is intravenous (IV) iron better than oral iron pills?

IV iron is not necessarily 'better' but is used in specific situations. Oral iron is the first-line treatment for most cases of iron deficiency anaemia. (NICE, 2021) IV iron is considered when oral iron isn't tolerated (due to severe side effects), isn't effective (due to malabsorption), or when a rapid correction of anaemia is needed (e.g., severe anaemia late in pregnancy). It bypasses the digestive system, delivering iron directly into the bloodstream.

How does anaemia affect my baby during pregnancy?

Anaemia during pregnancy can increase the risk of several complications for your baby, including preterm birth, low birth weight, and being small for gestational age. It can also lead to low iron stores in the infant, potentially causing anaemia in infancy and affecting neurodevelopment. This is why screening and treating anaemia during pregnancy are so important. (ACOG, 2021)

Will I need a blood transfusion?

Blood transfusions are typically reserved for severe cases of anaemia, especially if you are experiencing significant symptoms like chest pain or fainting, or have acute, massive blood loss. For most cases of anaemia, oral or intravenous iron therapy is sufficient. Your doctor will assess your specific situation to determine if a transfusion is necessary. (RCOG, 2015)

Can anaemia cause anxiety or depression?

While anaemia is not a direct cause of anxiety or depression, its symptoms, such as chronic fatigue, weakness, and poor concentration, can significantly impact your mood and overall well-being, potentially worsening or contributing to feelings of anxiety and depression. Treating anaemia can often improve these symptoms.

Does coffee or tea make anaemia worse?

Coffee and tea contain compounds called tannins that can inhibit the absorption of non-heme iron (the type found in plant-based foods and supplements). While they don't directly 'make anaemia worse,' consuming them with iron-rich meals or iron supplements can reduce the amount of iron your body absorbs. It's generally recommended to consume coffee and tea at least an hour or two before or after iron-rich meals or supplements.

Should I be screened for anaemia if I don't have symptoms?

For non-pregnant women without symptoms, routine universal screening for anaemia is not universally recommended. However, screening should be considered if you have risk factors such as heavy menstrual bleeding, a vegetarian/vegan diet, or certain gastrointestinal conditions. During pregnancy, universal screening is recommended at your first prenatal visit and again at 24-28 weeks. (ACOG, 2021)

Can my birth control method affect my iron levels?

Yes, some birth control methods can affect iron levels. Hormonal birth control methods, such as oral contraceptive pills or hormonal IUDs, are often used to reduce heavy menstrual bleeding, which can help improve or prevent iron deficiency anaemia. Conversely, non-hormonal IUDs can sometimes increase menstrual bleeding, potentially worsening iron levels in some women.

What is the difference between heme and non-heme iron?

Heme iron is found in animal products like red meat, poultry, and fish. It is more easily absorbed by the body. Non-heme iron is found in plant-based foods (like lentils, spinach, fortified cereals) and also in animal products. Non-heme iron absorption can be influenced by other foods; it's enhanced by Vitamin C and inhibited by compounds in tea, coffee, and calcium.

How often do I need to get my blood levels checked?

The frequency of blood tests depends on your specific situation, the severity of your anaemia, and the treatment plan. Typically, your doctor might check your Complete Blood Count (CBC) 2-4 weeks after starting iron therapy to see if your haemoglobin is rising. Ferritin levels (iron stores) are usually rechecked after about 3 months of treatment. Your doctor will provide a personalized schedule for follow-up.

Can anaemia cause restless legs syndrome?

Yes, iron deficiency anaemia is a known cause or contributing factor to restless legs syndrome (RLS). RLS is a condition that causes an uncontrollable urge to move your legs, often accompanied by uncomfortable sensations. Treating the iron deficiency can often significantly improve or resolve RLS symptoms.

Is my vegetarian/vegan diet causing my anaemia?

Vegetarian and vegan diets can be healthy, but they require careful planning to ensure adequate iron intake, as plant-based (non-heme) iron is less readily absorbed than heme iron from animal sources. If your diet is not well-balanced, it can contribute to iron deficiency or vitamin B12 deficiency (which is found almost exclusively in animal products). If you follow such a diet and have anaemia, discuss it with your doctor or a dietitian to ensure you're getting all necessary nutrients.