Red blood cells carry oxygen in the blood. Low red blood cells (anemia) mean the body may not be getting the oxygen it needs.
Treatment for low red blood cells depends on the type of anemia.
If low red blood cells are caused by iron deficiency, the first step is to determine what is causing the low iron. If low iron is due to blood loss, such as from stomach ulcers or bowel problems, those issues need to be treated.
People with iron deficiency anemia need additional iron. Eating foods high in iron is not sufficient. Iron supplementation may be given:
- Orally as pills or liquid
A blood transfusion may be indicated in cases of severe iron deficiency.
For some cases of anemia of inflammation, erythropoietin or erythropoiesis-stimulating agents (ESAs) may be used to help the body produce more red blood cells.
Autoimmune hemolytic anemia is treated with:
- Treating the underlying condition such as lupus or chronic lymphocytic leukemia (CLL)
- Blood transfusions
- Surgery to remove the spleen (splenectomy)
Treatment for aplastic anemia depends on the cause and may include:
- Stopping medicines that caused the problem
- Never stop taking a prescribed medication without first talking to your doctor
- Avoiding toxic chemicals
- Antiviral medicines
- Immunosuppressive medicines
- Red blood cell or platelet transfusions
- Bone marrow transplant (“stem cell transplant”)
What Are Symptoms of Low Red Blood Cells?
Many people with low red blood cells (anemia) have no symptoms. When symptoms occur, they may include:
- Chest pain or trouble breathing
- Difficulty exercising (due to shortness of breath, rapid heartbeat)
- Abnormal cravings for non-food items, such as clay or dirt, paper products, or cornstarch (pica)
- Abnormal craving to eat ice (pagophagia)
- Brittle nails
- Sore tongue
- Pale skin or a pale color in the tissue that lines the inside of the eyelids
- Restless legs syndrome
- Muscle pains
- Reddish or brown urine (autoimmune hemolytic anemia)
- More bruising or bleeding than normal (aplastic anemia)
- More frequent infections (aplastic anemia)
What Causes Low Red Blood Cells?
Causes of low red blood cells (anemia) include:
- Iron deficiency anemia
- Loss of large amounts of blood: most common cause of iron deficiency anemia
- Decreased iron absorption from food: frequently due to stomach or intestinal surgery
- Inadequate dietary iron intake: seen more often in developing countries where there is a lack of foods containing iron, though it can also occur in infants who drink milk without iron
- Pregnancy and the postpartum period: may occur due to the increased iron requirements of a growing fetus and placenta and blood loss during delivery
- Anemia of inflammation or anemia of chronic disease
- Autoimmune hemolytic anemia
- A result of problems with the body's immune system in which the immune system mistakenly attacks and destroys red blood cells
- The cause is often unknown but may be related to:
- Infections such as pneumonia and mononucleosis (“mono”)
- Certain medications, including some antibiotics
- Certain types of cancer, including chronic lymphocytic leukemia (CLL), multiple myeloma, and lymphoma
- Autoimmune diseases such as lupus
- Aplastic anemia
- Caused by damage to bone marrow
- Some people are born with damaged bone marrow
- The cause is often unknown but other causes may include:
- Some medications
- Infections from certain viruses
- Certain chemicals
- Immune system dysfunction
How Is Low Red Blood Cells Diagnosed?
Low red blood cells (anemia) are diagnosed with a medical history, physical examination, and blood tests.
Blood tests used to diagnose low red blood cells (anemia) include:
- Complete blood count (CBC)
- Serum iron
- Total iron binding capacity (TIBC or transferrin)
- Transferrin saturation (TSAT)
For aplastic anemia, tests may also include a bone marrow biopsy.
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United States. Wolters Kluwer. UptoDate.com. Mar 16, 2022. "Patient education: Anemia caused by low iron in adults (Beyond the Basics)." https://www.uptodate.com/contents/anemia-caused-by-low-iron-in-adults-beyond-the-basics?search=low%20hemoglobin&topicRef=15339&source=see_link
United States. Wolters Kluwer. UptoDate.com. Feb 4, 2022. "Anemia of chronic disease/anemia of inflammation." https://www.uptodate.com/contents/anemia-of-inflammation-the-basics?search=low%20hemoglobin&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
United States. Wolters Kluwer. UptoDate.com. https://www.uptodate.com/contents/autoimmune-hemolytic-anemia-the-basics?search=low%20hemoglobin&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2