Anemia: Symptoms, Causes, and When to Seek Treatment

Q: Anemia: Symptoms, Causes, and When to Seek Treatment

Dear Ms. <br>Peggy：<br>1. <br>Based on the blood report you provided, it indicates microcytic anemia. <br>The more common causes include iron deficiency anemia, thalassemia, anemia of chronic disease or inflammation, hemoglobinopathies, lead poisoning, copper deficiency, leukemia

Health examination issues (anemia/platelet abnormalities)

Hello, doctor! In the past, during health checks for high school and college admissions, I often had slightly low red blood cell counts indicating mild anemia.
However, I always happened to be on my menstrual period during these checks, and I thought this was the reason for the anemia results.
I tend to have a heavy flow during my periods, and in the early stages of menstruation, my cycles were frequent with significant amounts.
Later, my cycles stabilized to about every 25-30 days, still with a heavy flow.
I believed that my menstrual periods were causing the anemia, so I did not seek further treatment.

Recently, after graduating from college, I wanted to understand if I truly have anemia.
I chose to go for a health check one week after my menstrual period ended, and the results were as follows: (* indicates abnormal values) White Blood Cell Count (WBC) 4.42*, Red Blood Cell Count (RBC) 4.31, Hemoglobin (Hb) 10.6*, Hematocrit (Hct) 33.2*, Mean Corpuscular Hemoglobin (MCH) 24.7*, Mean Corpuscular Volume (MCV) 77.1*, Mean Corpuscular Hemoglobin Concentration (MCHC) 32.0, Platelet Count 412*, Monocytes 9.20*.
I would like to ask if this condition indicates that I need further treatment for anemia.
I usually feel particularly cold, and my hands and feet often cannot warm up.
Sometimes, my left ring finger becomes numb from the cold, and at night, my feet are often so cold that I cannot sleep.
Could these symptoms be caused by anemia, or are they simply due to poor peripheral circulation? Additionally, during my menstrual period, I feel especially drowsy.
I discussed my test results with my mother, and she believes that women naturally experience some anemia during their periods and thinks I shouldn't worry too much or seek further checks, suggesting that I just eat more pork liver and beef.
Therefore, I would like to consult you, doctor, on whether these symptoms require further medical follow-up or treatment.
Thank you for taking the time to respond!

Peggy, 20~29 year old female. Ask Date: 2021/04/17

Dr. Xiao Yongxun reply Family Medicine

Dear Ms.
Peggy:
1.
Based on the blood report you provided, it indicates microcytic anemia.
The more common causes include iron deficiency anemia, thalassemia, anemia of chronic disease or inflammation, hemoglobinopathies, lead poisoning, copper deficiency, leukemia, among others.
However, considering the red blood cell count, hematocrit, and mean corpuscular volume, along with the prevalence of various types of anemia, it is more likely to be iron deficiency anemia.
Nevertheless, a definitive diagnosis requires further examinations and tests for confirmation.
2.
Anemia can potentially cause cold extremities and peripheral circulation issues; however, cold hands and feet and peripheral circulation problems may not necessarily be caused by anemia, as many other factors can lead to similar symptoms.
3.
Your situation requires a consultation with your primary care physician for discussion; if necessary, further examination should be conducted.
Even if iron deficiency anemia is confirmed, it is essential to identify the underlying cause of the iron deficiency for a fundamental solution, rather than just supplementing with iron.
If you do not have a familiar primary care physician, you may directly visit the hematology outpatient department at a regional hospital or higher.

Reply Date: 2021/04/17

More Info

Understanding anemia is crucial, especially for individuals who experience symptoms that may indicate a deficiency in red blood cells or hemoglobin. Anemia can manifest in various forms and can be caused by a range of factors, including nutritional deficiencies, chronic diseases, and menstrual blood loss, among others.

Symptoms of Anemia
Common symptoms of anemia include:
- Fatigue or weakness
- Pale or yellowish skin
- Shortness of breath
- Dizziness or lightheadedness
- Cold hands and feet
- Chest pain (in severe cases)
- Irregular heartbeats
In your case, the lab results indicate that you have low hemoglobin (10.6 g/dL) and hematocrit (33.2%), which are indeed suggestive of anemia. The red blood cell count (RBC) is also on the lower side (4.31 million cells/mcL), and the mean corpuscular volume (MCV) of 77.1 indicates that your red blood cells are smaller than average, which is often seen in iron deficiency anemia.

Causes of Anemia
Given your history of heavy menstrual bleeding, it is plausible that your anemia could be related to this condition, known as menorrhagia. Heavy menstrual periods can lead to significant blood loss, which may deplete your iron stores and lead to anemia. Other potential causes of anemia include:
- Iron deficiency: This is the most common cause of anemia, particularly in women of childbearing age due to menstrual blood loss.

- Vitamin deficiencies: Deficiencies in vitamin B12 or folate can also lead to anemia.

- Chronic diseases: Conditions such as kidney disease or inflammatory disorders can affect red blood cell production.

- Bone marrow disorders: These can impact the production of red blood cells.

When to Seek Treatment
You should consider seeking further evaluation and treatment if you experience:
- Persistent fatigue or weakness
- Symptoms that interfere with daily activities
- Worsening symptoms, such as increased shortness of breath or dizziness
- Symptoms that suggest more severe anemia, such as chest pain or fainting

Your Symptoms
The symptoms you describe, such as feeling cold, having numbness in your fingers, and experiencing excessive sleepiness during your menstrual period, could indeed be related to anemia. Cold extremities can be a sign of poor circulation, which can occur in anemia due to reduced oxygen delivery to tissues. However, these symptoms can also be indicative of other conditions, such as peripheral vascular disease or even anxiety.

Recommendations
1. Dietary Adjustments: Continue to consume iron-rich foods such as red meat, poultry, fish, beans, lentils, and fortified cereals. Pairing these with vitamin C-rich foods can enhance iron absorption.

2. Follow-Up Testing: It would be prudent to follow up with your healthcare provider for a complete blood count (CBC) and possibly iron studies to assess your iron levels and determine the underlying cause of your anemia.

3. Monitor Symptoms: Keep track of your symptoms and any changes in your menstrual cycle. If your symptoms worsen or do not improve with dietary changes, further medical evaluation may be necessary.

4. Consider Professional Guidance: Consulting with a hematologist or a primary care physician can provide you with tailored advice and treatment options based on your specific situation.

In summary, while your symptoms and lab results suggest anemia, it is essential to investigate the underlying causes further. Your healthcare provider can guide you through the necessary steps to manage your condition effectively.

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