What might be causing my anemia?
Ask the doctor
Q. I just found out that I have a low red blood cell count. This is the first time in my life I have had this problem. I thought I was healthy. What might be causing my anemia?
A. There are many possible causes for a low red blood cell count (anemia). The list is too long to go over here. Instead, let's talk about the approach I normally use in cases like yours.
My first suspicion is blood loss through the gastrointestinal tract, especially if blood testing suggests iron deficiency. This is a common reason for anemia in adults over age 50. Most often, I recommend a colonoscopy to look at possible problems in the lower intestine, and an upper endoscopy to look at the stomach and upper intestine.
If these tests are normal, then I try to determine what the anemia is related to. It could be from
- blood loss from some other place in the body, such as the bladder
- bone marrow making fewer than normal red cells
- red blood cells getting destroyed prematurely.
If the bone marrow is making fewer red blood cells, I first look for nutritional deficiencies. I start with ordering blood tests to see if you have enough iron, and if you have enough vitamin B12 and folic acid circulating in your blood. You need all three to make red blood cells.
If the anemia is from iron deficiency, you are most likely losing blood from somewhere in your gastrointestinal tract or urinary tract. That's because it is unusual to develop iron deficiency due to a poor diet in women of your age and men of all ages.
When the source is not seen on colonoscopy or upper endoscopy, finding the bleeding source can be challenging.
If the anemia is not due to iron, vitamin B12, or folic acid deficiency, I request that the lab perform other tests on the blood. These tests would help determine if the bone marrow no longer is producing red blood cells normally, or if the problem is that the red blood cells are being destroyed before their normal 120-day life span.
Now I have a better picture of whether the problem is
- nutritional
- blood loss from an undefined source
- underproduction of red blood cells by the bone marrow
- premature destruction of red blood cells.
This allows me to narrow my search for the specific condition causing the anemia.
Image: © Westend61/Getty Images
About the Author
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles.
No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
