Anemia

Anemia is very common. It's especially common in women who have periods or are pregnant, in older adults, and in people with long-term conditions like kidney disease.

• Iron deficiency anemia: the most common type. It comes from blood loss (heavy periods, bleeding in the stomach or bowel), not getting or absorbing enough iron, or pregnancy.
• Vitamin B12 or folate deficiency anemia: the body makes large, poorly working red cells. Low B12 can also affect the nerves.
• Anemia of chronic disease (inflammation): linked to long-term conditions such as infections, autoimmune disease or cancer.
• Anemia of chronic kidney disease: the kidneys make less of the hormone that tells the body to make red cells.
• Other types: blood loss, inherited conditions like sickle cell or thalassemia, red cells breaking down too early, or bone marrow problems.

• Heavy menstrual periods or pregnancy
• Bleeding from the stomach or intestines, sometimes from ulcers, pain relievers like Advil (ibuprofen), or colon polyps or cancer
• A diet low in iron, B12 or folate (for example, a strict vegan diet without supplements)
• Conditions that affect absorption, such as celiac disease, weight-loss surgery or long-term acid-reducing medicine
• Chronic kidney disease, long-term inflammation or cancer
• Heavy alcohol use
• Family history of inherited blood conditions

Mild anemia may cause no symptoms. As it gets worse, you may notice:

• Feeling tired or weak
• Shortness of breath with activity
• Pale skin, gums or inside the eyelids
• Dizziness or lightheadedness
• Fast or pounding heartbeat
• Cold hands and feet, or headaches
• Craving ice or non-food items (with low iron), brittle nails, or restless legs
• Numbness or tingling, or a sore, smooth tongue (with low B12)
• At your visit, your provider checks your heart rate and blood pressure, looks for paleness in your skin, nails and eyelids, listens to your heart, checks your belly, and asks about bleeding, diet and medicines.

Anemia is found with a complete blood count (CBC), which measures hemoglobin and the size of your red cells.

Other lab tests your provider may order include: ferritin and iron studies (iron, TIBC, transferrin saturation), vitamin B12 (sometimes methylmalonic acid), folate, a reticulocyte count, a blood smear, a comprehensive metabolic panel (kidney and liver function), thyroid tests, and a stool test for hidden blood. Some people need tests for celiac disease or inherited conditions.

If blood loss from the stomach or bowel is possible, you may be referred for an endoscopy or colonoscopy. We don't do imaging or procedures at our office; we refer you to a trusted partner and review the results with you.

Treatment depends on the type and cause:

• Iron deficiency: iron pills (often taken every other day, with vitamin C or on an empty stomach if tolerated) or iron through an IV for some people (we refer you out for IV iron; it isn't given at our office), plus finding and treating the source of blood loss.
• B12 deficiency: B12 shots (given in our office) or high-dose pills. Folate deficiency: folic acid pills.
• Heavy periods: treatment may include a hormone pill or a progesterone shot to lighten bleeding.
• Anemia of kidney disease: managing kidney disease; some people need injections that help make red blood cells, given by a specialist.
• Anemia of chronic disease: treating the underlying condition.
• Eating iron-rich foods (lean meat, beans, lentils, leafy greens, fortified cereals) and foods with B12 and folate.
• Repeat blood tests to make sure treatment is working.
• Severe anemia may need a blood transfusion in a hospital.

Many types of anemia improve once the cause is found and treated. Iron levels can take a few months to fully refill.

Some types, like anemia from kidney disease or inherited conditions, need ongoing care. Results vary depending on the cause.

Your primary care team at Moaddel Medical orders the blood tests to find the type and cause of anemia, starts treatment and rechecks your levels.

We refer you to hematology, gastroenterology or kidney specialists when needed and keep your care connected.

We're at 7230 Medical Center Dr, Suite 100, West Hills, CA 91307.