Blood deficiency - anemia
Anemia means that you have too few red blood cells in your blood. The red blood cells are needed for the body's various organs to receive enough oxygen. Lack of blood can make you tired, dizzy and have a headache. It is often possible to restore the amount of red blood cells with the help of medicines.
There are different varieties of anemia. The most common are anemia due to too little iron and anemia caused by other diseases. Lack of vitamin B12 can also cause anemia. Anemia is the Latin name for blood deficiency.
Symptoms
The red blood cells have the task of transporting oxygen that you breathe in to all parts of the body. Oxygen is needed for most of the body's functions, for example blood formation, metabolism and energy production. This means that a lack of red blood cells can cause many different symptoms.
These are common symptoms of anemia:
• You feel tired and listless.
• You have difficulty concentrating.
• You feel dizzy.
• You feel that you are out of breath more easily than before.
• You have palpitations.
• You get a headache.
• You get tinnitus.
It is how severe the anemia is that determines how many symptoms you get. But the body can also adapt if the anemia increases slowly so that the symptoms are sometimes mild even though the anemia is severe. The ability to adapt is different from person to person.
When and where should I seek care?
Contact a healthcare center if you suspect you have anemia. You can contact many receptions by logging in.
Contact a health center or emergency clinic immediately if you have black or bloody stools. If it does not work or is closed at the health center or the on-call reception, seek care at an emergency department.
Call telephone number 1177 if you want healthcare advice. Then you can get help assessing symptoms or help with where to seek care.
Investigations and investigations
At the health center you can tell us about your symptoms. The doctor then performs a physical examination. You can tell us if you have had any previous illnesses, how you usually eat and if you take any medicines. The doctor also asks if there is anyone in your genetic family who has or has had any blood disease or other disease that has led to anemia. You can also tell us if you have seen blood in your stool or if you have other problems from the stomach and intestines or from the urinary tract.
You who have your period can tell us how often you have your period, how much you bleed and whether you have breakthrough bleeding.
Samples
You may also submit a blood sample. Then the concentration of hemoglobin in the blood is checked. It is usually abbreviated Hb and is also called blood value.
If the test shows that you are anemic, you must submit another blood sample. It is needed so that the doctor can get more information about the content of the blood. These tests will help find out what type of anemia you have.
You may sometimes give a stool sample because bleeding from the gastrointestinal tract is a common cause of anemia. Sometimes you are also examined in the rectum.
Other investigations
It is also possible that you need to be examined in the large intestine with a colonoscopy and in the stomach with a gastroscopy.
These tests are done especially if you have blood in your stool. The purpose of the examinations is to try to find out what it is that is bleeding. It could be, for example, a stomach ulcer or a tumor.
You may sometimes need to be examined in more ways than one. It depends on the type of anemia you have. You can sometimes get a referral at the health center to a doctor who is a specialist in, for example, blood diseases.
Treatment
It is the cause of the anemia that determines which treatment you receive. This means that the treatment cannot begin until the doctor knows what is the cause of the anemia.
You can, however, receive iron supplements at once if you are anemic due to too little iron.
Iron tablets or syringes with iron
Anemia caused by having too little iron can usually be treated with iron tablets.
It is common to get some side effects from iron tablets. It can be, for example, nausea, constipation or diarrhoea. To avoid the side effects, you can initially take the tablets after a meal. If it goes well, you should try taking them on an empty stomach, because more iron is then absorbed into the body. You can get injections of iron instead of iron tablets if you cannot tolerate them.
There are other medicines that can affect the absorption of iron. They should not be taken at the same time. Therefore, it is important that the doctor knows if you are using other medicines.
Treatment for chronic anemia
In some cases, the cause of the anemia is more permanent. For example, it could be because you bleed a lot when you have your period.
Temporary iron treatment is not enough if the cause of your anemia is menstrual bleeding, but you then need to receive maintenance treatment with iron. Your values for blood and iron also need to be measured regularly until your periods stop. For some, iron tablets a number of days per month are enough, while others may need larger supplements of iron.
There are several other types of chronic anemia that are treated in other ways.
Vitamin supplements
Anemia due to a lack of vitamin B12 or folic acid is treated with supplements of these substances. You can get B12 as injections or tablets. You can get folic acid as tablets.
Blood transfusions
You who have a very low blood count and severe symptoms can be treated with a blood transfusion. Then new blood is supplied to the body.
You may receive regular blood transfusions if the anemia is persistent and severe and cannot be treated in other ways. This applies above all to certain blood disorders. Blood transfusion is also given in case of large blood losses, for example in accidents.
Diseases that cause anemia are treated
Sometimes the anemia is due to a disease that affects how the blood is formed. Then you will receive treatment against the disease that causes the anemia and also against the anemia itself.
What can I do myself?
You can prevent anemia caused by a lack of iron or a lack of vitamin B12 and folic acid. For the vast majority of people, eating a varied diet is enough to get enough iron, B12 and folic acid. You do not need to take any dietary supplement unless a doctor has determined that you have an iron deficiency.
You who know that your iron levels are usually low should pay particular attention to whether what you eat contains enough iron. This also applies if you only eat vegetarian or vegan food. There is usually a lot of iron in food that comes from the animal kingdom. There is also iron in, for example, whole grain products, potatoes, spinach, bananas and peaches.
You need treatment with medicine if a doctor has determined that you have anemia. Then it is not enough to eat food with a lot of iron.
Over-the-counter iron supplements usually only contain small amounts of iron and are not effective if you are anemic. But there are also food supplements with a higher iron content. You should consult a doctor about what you need.
What causes anemia?
Anemia means that you have too few red blood cells in your blood. This means that you also have too little hemoglobin in the blood. Hemoglobin is the substance needed to transport oxygen around the body.
There are three different types of anemia:
• Anemia due to loss of blood, i.e. bleeding.
• Anemia due to the body not producing enough red blood cells.
• Anemia due to the red blood cells falling apart prematurely.
Bleeding
The most common cause of anemia is blood loss. Menstruation is the most common cause of iron deficiency and anemia. You may be anemic if your period is heavy. But you can get anemic even if your periods are not heavy. Then it is because you are not getting enough iron with food.
Anemia can also be caused by tumors in the intestine or stomach, chronic intestinal diseases, stomach ulcers and major bleeding in accidents, for example. Anemia due to bleeding leads to iron deficiency, as the red blood cells contain a lot of iron.
Iron deficiency without bleeding
You can also become anemic if you have too little iron in your body for any other reason. Iron is needed for the body to produce hemoglobin. Hemoglobin is the substance that gives blood its red color. Hemoglobin captures oxygen and transports it from the lungs and further out into the body. A lack of iron leads to a lack of hemoglobin. This means that the body does not get enough oxygen.
You can have iron deficiency without bleeding in the following situations:
o You need more iron than before, for example if you are pregnant.
o Your body cannot absorb iron from food, for example if you have an intestinal disease such as celiac disease or Crohn's disease.
If you have a chronic inflammatory disease, iron can get stuck in the liver so it's not available to make red blood cells. It is called functional iron deficiency.
Lack of vitamin B12
Vitamin B12 is necessary for red blood cells to form. Vitamin B12 cannot be formed in the body, but you get it through the food you eat. Lack of B12 can occur in several ways.
Pernicious anemia is a special type of blood deficiency that causes you to have antibodies against a protein that is needed to be able to absorb B12 from food.
The deficiency can also occur if you have a disease that results in poorer absorption of several different nutrients, such as celiac disease. Then it is common to have a combination of iron deficiency and lack of vitamin B12.
The production of red blood cells is too low
The bone marrow is the organ that produces red blood cells. Anemia can therefore occur in certain diseases of the bone marrow or if the bone marrow is affected by other diseases.
Examples of bone marrow diseases are leukemia and other blood diseases. The diseases can interfere with the formation of all types of blood cells.
Many other types of disease can impair the bone marrow's ability to make red blood cells. This applies, for example, to rheumatoid arthritis, chronic intestinal diseases, chronic kidney diseases and most cancers.
Anemia can occur if you have a chronic kidney disease. The kidneys produce the hormone that controls the formation of red blood cells. The hormone is called erythropoietin and is abbreviated Epo. To compensate for the lack of blood, the body wants to increase the production of Epo, but it does not work well if you have chronic kidney disease.
Diseases where the red blood cells break down prematurely
An unusual type of anemia is caused by the red blood cells breaking down prematurely. This is called hemolysis.
A red blood cell usually has a lifespan of about 120 days. Then it breaks down. A blood deficiency called hemolytic anemia occurs if the red blood cells are broken down so quickly that your body cannot make new ones. This is often due to the body forming antibodies against its own red blood cells. This is called an autoimmune reaction and means that the immune system perceives some type of cells in the body as foreign and forms antibodies against them. It is a very common cause of various diseases in the body. There are several different types of hemolytic anemia. Some of them are due to genes.
Hereditary anemia diseases
There are also some inherited anemia diseases that cause the red blood cells to break down prematurely but are not autoimmune diseases. An example is thalassemia, which means that certain parts of the hemoglobin are not formed correctly. The disease is uncommon in Sweden, but common, for example, in the Middle East. You should tell your doctor if anyone in your genetic family has thalassemia.
Read more about thalassemia on the National Board of Health and Welfare's page with unusual diagnoses.
Anemia is more common in certain groups
Anemia is more common in people who are menstruating, are pregnant or have gone through childbirth and are then due to blood loss or increased need. Anemia is also more common in people who are older. This is because some get a slightly reduced blood formation with increasing age. It is also because many of the diseases that cause anemia are more common in the elderly.
What happens in the body?

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Almost one tenth of the body weight is made up of blood. Blood consists of blood cells and blood plasma. Barely half of the blood's volume is blood cells.
Blood consists of plasma and blood cells
Blood mainly consists of two components, plasma and blood cells. A little more than half of the blood consists of plasma. It is a clear yellow liquid that contains nutrients, proteins, hormones, salts and other substances. Almost half of the blood consists of blood cells, i.e. red blood cells, white blood cells and platelets. The red blood cells make up the largest part of these.
The red blood cells transport the body's oxygen
The red blood cells are formed in the bone marrow and are needed for the body's various organs to get enough oxygen. The most important component of red blood cells is hemoglobin. It is an iron-containing substance that gives blood its red color. The hemoglobin captures and transports oxygen from the lungs out to the body's cells. Oxygen is necessary in many processes in all cells of the body. This applies to both nutrient metabolism, muscle functions and mental functions. The red blood cells also transport carbon dioxide to the lungs. Then the carbon dioxide disappears from the body with the air you exhale.
The body regulates the production of red blood cells so that there are always enough for the transport of oxygen to work well, but not so many that the blood becomes too viscous.
The body senses the need for oxygen
The body's system senses that the oxygen content in the blood decreases if, for example, you become anemic or stay at a high altitude. Then a signal is sent to special cells in the kidneys to increase the production of a hormone called Epo. It stimulates the bone marrow to increase the production of red blood cells.
Influence and participate in your care
You can seek care at any health center or open specialist clinic you want throughout the country. Sometimes a referral to open specialized care is required.
In order for you to be able to participate in your care and treatment, it is important that you understand the information you receive from the healthcare staff.
You have the option of getting help from an interpreter if you do not speak Swedish. You also have the option of getting help from an interpreter if you have a hearing loss.
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