Anemia means that there are too few red blood cells in the blood or that the red blood cells contain too little hemoglobin. Hemoglobin (Hb) is an iron-containing protein that is present in the red blood cells (erythrocytes) and ensures that oxygen can be bound and transported from the lungs.

Hemoglobin: too low

In a man, the number of red blood cells is approximately 5,200,000 per mm3 of blood, in women 4,700,000. A red blood cell has an average lifespan of 90 to 120 days. Old blood cells are removed via the liver and spleen. New red blood cells are constantly being produced in the bone marrow. This process is called erythropoiesis and it is controlled by the secretion of the hormone erythropoietin (EPO) by the kidneys. If your Hb level is too low, not enough oxygen can be transported by the red blood cells. Anemia is not an isolated disease, but like a fever rather an alarm signal that something is wrong.

  • normal Hb level: 7.3 - 10 mmol/l
  • anemia: below 7.3 mmol/l
  • Male:
  • normal Hb level: 7.8 - 10.8 mmol/l
  • anemia: below 7.8 mmol/l

Symptoms of anemia

  • Anemia can make you feel tired and weak.Anemia can make you feel tired and weak.
  • You become short of breath more quickly with exertion.
  • In addition, complaints can occur such as dizziness , the feeling of fainting, palpitations , sweating, headache and ringing in the ears .
  • Pallor does not appear until the hemoglobin level is greatly reduced.
  • Other possible complaints are lethargy, sleeping problems , concentration problems, stomach and intestinal disorders, feeling cold and in men impotence or less sense of sex.
  • Anemia due to a vitamin deficiency can also lead to inflammation of the mouth and/or tongue and neurological symptoms.

Mind you, anemia can also go unnoticed and be discovered by chance during a blood test.

Anemia in children

In children, anemia can lead to retardation of growth and mental development. In children there is a test to determine whether your child has anemia: pull down your child's lower eyelid and look inside. If the color is pale instead of pinkish red, it is likely that your child has anemia. Whether these complaints are caused by anemia can only be determined on the basis of an (extensive) blood test. This includes looking at the concentration of hemoglobin and ferritin in the blood. A low hemoglobin level alone does not necessarily mean that the body has too little iron. Is there really an iron deficiency ?, can only be determined by determining the so-called transferrin receptor in the blood. This shows to what extent the body 'asks' for iron.

What is the cause?

  1. Iron deficiency
    (= ferriprieve anemia)
    Iron is the main building block of hemoglobin. An iron deficiency can be caused by blood loss, an iron deficiency in the diet and a reduced absorption of iron in the intestine. The needs are greatest in relation to body weight during the first year of life, especially between 4 and 12 months. During the first 3 to 4 months, the newborn has a good iron reserve, mainly in the liver and red blood cells (about 50 mg per kg body weight). The high hemoglobin level at birth forms an important iron reserve, which is used during the first 6 to 8 weeks. This mechanism allows the hemoglobin level to be maintained at a level of 12 g per liter until the age of 3 to 4 months. The total iron reserve of the organism thus remains stable at about 250 mg,
    • From this age, an external iron intake of 1.7 mg per day is necessary to maintain hemoglobin at a normal level. In months 4 and 5 it is between 4.3 and 10 mg and from six months to 10 years that amount increases to 10 mg.
    • During the teenage years, growth increases significantly and the average iron requirement is about 11 mg per day for boys. For girls in puberty, the requirement is higher, namely 15 mg per day, because iron is lost during menstruation.
    • For adults, a daily recommended intake of 9 mg per day for men and 8 mg per day for women, increased by 12 mg per day to 20 mg per day to compensate for menstruation.
    • The iron intake of pregnant women should compensate for losses, meet placental and fetal needs and allow for the expansion of red cell mass. This amounts to a total of about 1 g for the entire gestational period. It is estimated that iron deficiency occurs in approximately 20% of pregnant women. Iron supplementation is therefore sometimes useful after the first trimester of pregnancy.
    • During breastfeeding, a recommendation of 10 mg per day applies.

  2. Blood loss

    For example, after an accident, surgery or childbirth, after a period of prolonged or heavy menstruation , or when you (unnoticed) lose small amounts of blood for a longer period of time, for example in your stomach or intestines. Such 'creeping' blood loss can occur with the use of certain painkillers (acetylsalicylic acid (aspirin), ibuprofen , naproxen, diclofenac ), with a disease of the stomach or intestines, or with intensive exercise (such as walking).

  3. Dietary iron deficiency

    A normal, balanced diet generally contains just enough iron. The typical Western diet provides about 6 mg of heme and non-heme iron per 1000 kcal. A recent study examining daily dietary iron intake in Belgium shows that the average intake for adults is 11.3 +/- 4.4 mg per day, which is above the recommended daily intake for men, but below the recommended amount for menstruating women.

    Vegetarians also need to pay attention to their iron intake. Iron from animal products is better absorbed than iron from plant products. The absorption of iron from vegetable products can be improved by taking these products simultaneously with vitamin C-rich products such as orange juice, a kiwi, green vegetables or vitamin C in tablet form. The simultaneous use of coffee, tea and dairy products can actually inhibit the absorption of iron from the gastrointestinal tract . If someone tends to have a low iron supply, then these drinks should not be taken during an (iron-rich) meal.

  4. Iron absorption is not optimal

    Iron is only partially absorbed by the body in the gastrointestinal tract. This absorption can be disturbed by various factors: peptic ulcer , celiac disease , some drugs such as non-steroidal anti-inflammatory drugs (such as aspirin)...

  5. Vitamin B12 deficiency or folic acid deficiency

    Anemia due to a lack of vitamin B12 in the diet occurs exceptionally if no animal products have been included in the diet for a long period of time. This can occur in strict vegetarians and in alcoholics. Usually, anemia due to lack of vitamin B12 is the result of a disease of the stomach or intestines that prevents vitamin B12 from being absorbed by the body. Anemia due to a lack of folic acid is usually due to a deficiency in the diet. This can occur in alcoholics and in people following a strict diet.

  6. Chronic illness

    • Many chronic diseases such as rheumatism , (repeated) infections or cancer can disrupt the production of hemoglobin. The red blood cells are probably also broken down faster (Hemolytic anemia)
    • Sometimes the kidneys do not make enough erythropoietin (EPO). That is the substance that stimulates the bone marrow to make red blood cells and hemoglobin. An EPO deficiency is usually a result of chronic diseases or cancer treatment .
    • Sometimes an inherited abnormality of the hemoglobin can cause anemia. The red blood cells can then carry less oxygen and are broken down faster. Examples of these abnormalities are thalassemia (occurring almost exclusively in people from the Mediterranean region) and sickle cell disease (occurring exclusively in black people).

What should you do?

Treatment, of course, depends on the cause.

Nutrition: You will only be advised to take extra iron, vitamin B12 and folic acid-rich products in addition to a healthy diet if you have a seriously deviating diet or an increased need for nutrients (for example, in growing children or in women during pregnancy). to use.

Iron-rich products are:

  • almost all meat
  • certain fish (cod, herring, and sardines)
  • certain seafood (shrimp, mussels, and oysters)
  • legumes such as kidney and white beans, lentils and soybeans
  • almost all nuts
  • bead
  • dried fruit, especially apricots and figs
  • canned or jarred fruit (such as raspberries, redcurrants and cherries)
  • certain vegetables, in particular endive, artichoke, broccoli, zucchini, green peas, grape leaves, purslane, tomato paste, turnip greens and salsify
Vitamin B12 is only found in animal foods such as meat, fish and dairy products.
Folic acid is mainly found in liver, asparagus, spinach, whole grain products and legumes.

  • For example, blood loss during menstruation can be reduced by using the contraceptive pill .
  • Sometimes the use of painkillers (such as acetylsalicylic acid, aspirin, ibuprofen, naproxen, or diclofenac) can damage the gastric mucosa and cause anemia. In that case it is better to switch to a painkiller such as paracetamol.
  • If a lack of iron is the cause of anemia, and good nutrition has not been able to prevent this, you need extra iron in the form of tablets or drink (preferably ferrous fumarate). These agents can cause stomach upset, constipation and black stools. Simultaneous use of vitamin C promotes the absorption of iron in the intestine. After four weeks, the iron level is checked again. After normalization of the iron content, the treatment is continued for another two months.
  • Folic acid is available in the form of tablets.
  • People with an absorption disorder for vitamin B12 can be given this by injection.
  • Extra red blood cells are sometimes given only in very severe anemia ( blood transfusion ).
  • In case of a shortage of EPO, such as in kidney and cancer patients, EPO will be administered.