The body's red blood cells carry oxygen from the lungs to all the other tissues in the body. When there aren't enough red cells or when they're small or misshaped and can't function fully, that's anemia. And when the body can't get the oxygen it needs, symptoms develop.

  • Looking pale
  • Tiredness
  • Feeling weak
  • Easily out of breath
  • Poor concentration
  • Increased infections (later)
  • Changes in the tongue and fingernails (later)


Nutritional Deficiencies

Iron :Needed for the structure of the Hemoglobin that actually holds the oxygen within the red cells. When iron is low, the red cells are small and their oxygen carrying capacity is reduced. Growing infants, children and teens need to build the amount of iron in their blood cells and are often low in iron when they don't get red meat and other sources in their diets. Women need to compensate for their monthly losses, and pregnant women need to recognize that some of their accumulated iron will be transferred to their infants and they need to replenish their stores.

Vitamin B12 and Folic Acid: These two B vitamins are involved in forming the red cells themselves. When either is reduced, the cells balloon to a larger size. These cells too have difficulty transporting oxygen. B12 is present in animal meats, fish, and is primarily absorbed in the lower intestine, as long a substance from the stomach, Intrinsic Factor is present to assist the absorption. If the lower intestine  has been removed (in Crohn's disease and other conditions) or B12 is not supplemented when on a strict vegetarian diet, deficiency can arise. Folic acid is found in numerous foods, especially green leafy vegetables, but also many other vegetables and fruits,  but extra is needed when taking certain medications.

Vitamin E: An antioxidant, Vitamin E protects the red cell from being destroyed. When there's more poly-unsaturated fats (like vegetable oils) in the diet, the need for Vitamin E increases, but that's also where Vitamin E comes from, so this is rarely a problem except in premature infants and those who don't absorb fats well.

Vitamin B6: Needed to create hemoglobin and the cell itself. But because so many foods are good sources of B6 and it is often stored in the body, this is a rare problem that mainly occurs with certain genetic diseases. Babies who have the anemia also usually have prolonged diarrhea, distension and even seizures.

Copper, Vitamins A, C  (much less common): Vitamins A and C both seem to increase the effectiveness of iron either by increasing its absorption (C) or working with the iron to increase the hemoglobin levels. Long term copper deficiency can result in anemia, but this is rare in the developed world now unless a child has chronic diarrhea.

Non-Nutritional Anemia

Other causes for anemia include genetic disorders that affect the hemoglobin (Sickle cell anemia, for example); intestinal or internal bleeding; heavy menstrual bleeding; poor nutrient absorption; bone marrow problems with production; cancer and certain chronic illnesses and conditions. 


Hemoglobin and the hematocrit measure the amount and size of the red blood cell population.

A blood smear shows the size of the red cells. when iron is low, the cells are small. They enlarge with B12 or folate deficiency.

The reticulocyte count measures how frequently red blood cells are being pumped into the blood stream from the bone marrow.

Serum iron measures the amount of iron in the bloodstream.

The iron binding capacity measures how much of the iron is bound to proteins, though the amount of the protein (transferrin) that's being manufactured influences the results.

Ferritin reflects the body's iron stores. The result is decreased when there's a deficiency but goes up when there's too much iron, which can be a sign of potential liver and heart damage. However, inflammation (in rheumatoid arthritis and IBD) can cause an increase as well.

Vitamins A, B6, B12 and folate levels can be measured in the blood.

While Vitamin E can be measured, it sometimes has to be compared to certain fat levels in order to be interpreted correctly.

Copper can be measured in the blood.

Various tests are needed to determine whether B12 deficiency is due to its lack in the diet, a problem with absorption, or a decrease in Intrinsic factor, which is needed to assist with B12 absorption.

Stool test for blood (guaiac, hemoccult, others) can indicate whether blood is being lost.


Treatment for anemia depends on how severe the situation is, the cause and whether ongoing problems are suspected. When the situation is dire, blood cell transfusions or intravenous iron may be needed. With mild anemias,  patients may need to be placed on iron or a vitamin with iron and monitored.

Iron is available without prescription. However, it should not be routinely taken without being monitored because the iron can overload the heart and liver beyond their storage capacity. B12 and folic acid can also be given as part of a routine vitamin or as a separate prescription (though folic acid has to be in chewable or pill form). When B12 can't be absorbed, a monthly shot can be given. The other vitamins and minerals are also included as part of routine vitamins or they can be given separately, but if deficiencies are present, their use should be guided by a knowledgeable physician or pediatric dietitian.