Anemia - Introduction

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Bleeding Due to Other Medical Conditions. Iron deficiencies most commonly occur from internal blood loss due to other conditions that range in severity from hemorrhoids toheavy menstruation to benign colon polyps to colon cancer. Very heavy periods (menorrhagia) are the most common causes of anemia in premenopausal women. Cancers of the gastrointestinal tract account for 2% of cases of iron deficiency (the rate is higher when menorrhagia is excluded).

Pica. Pica is the craving for non-food substances such as ice, starch, or clay. It is a possible cause of iron deficiency, particularly in those who eat clay or starch, which interferes with iron absorption in the stomach. To complicate matters, pica (particularly ice cravings) may also be a symptom, rather than a cause, of anemia.

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Hookworm. Hookworm infects about 1 billion people worldwide and is a major cause of anemia in infested areas.

Click the icon to see an image of a hookworm.

Impaired Absorption of Iron. Certain intestinal diseases (inflammatory bowel disease, celiac disease) or surgical procedures that affect the gastrointestinal tract can impair the ability of the intestine to absorb iron. (Such conditions also often impair folic acid absorption as well.)

Click the icon to see an image of inflammatory bowel disease.

Genetic Causes. Some people are born with iron deficiency. Certain cases may be due to a mutation of the Nramp2 gene, which regulates a protein responsible for delivering iron to the cells.

Anemia of Chronic Disease (ACD)

Anemia of chronic disease (ACD), also called anemia of chronic inflammation (ACI), is a common condition associated with a wide variety of persistent inflammatory diseases. It can be very severe and require transfusions.

The Inflammatory Process and ACD. ACD is not completely understood. In ACD, iron is not efficiently recycled from blood cells, and red blood cell survival is reduced. In addition, there is impaired response to erythropoietin, the hormone that acts in the bone marrow to increase the production of red blood cells. (Abnormal function and low levels of erythropoietin, in fact, may be the most important factor in ACD, with iron insufficiencies being a consequence.)