Anemia Isn't Just About 'Taking Iron': Different Types Need Different Treatments

Your health report shows: hemoglobin 105 g/L, reference range 110-150, followed by downward arrow.

Doctor glances at it and says: "Some anemia, take some iron." You go to pharmacy, buy iron supplements, take for several months, recheck hemoglobin still 105.

This isn't isolated case. Many people equate anemia with iron deficiency anemia, thinking iron supplements fix all anemia. But actually, anemia has different types, different types need different treatments. Blind iron supplementation might be ineffective, or even delay true disease treatment.

Anemia isn't independent disease but a symptom—hemoglobin concentration below normal value.

Hemoglobin is oxygen-carrying protein in red blood cells. Its content determines blood's oxygen-carrying capacity. When hemoglobin decreases, tissue organs don't get adequate oxygen, causing anemia symptoms: fatigue, weakness, shortness of breath after activity, pale complexion, dizziness, palpitations, poor concentration, cold extremities.

But anemia severity doesn't necessarily match symptoms. Mild anemia might have no obvious symptoms, long-term chronic anemia body might have adapted. Acute anemia (like sudden bleeding) even if hemoglobin not terribly low might cause severe symptoms.

WHO anemia criteria: adult men hemoglobin ＜130 g/L, adult non-pregnant women ＜120 g/L, pregnant women ＜110 g/L. But China's standards slightly more lenient: men ＜120, women ＜110. Both standards in use,具体 depends on laboratory.

Anemia has different types, by red cell size (MCV) can be divided into three categories:

Microcytic anemia (MCV ＜80 fl): red cells smaller than normal. Most common cause is iron deficiency anemia, also could be thalassemia, anemia of chronic disease.

Normocytic anemia (MCV 80-100 fl): red cell size normal. Could be acute blood loss, hemolytic anemia, bone marrow dysfunction, renal anemia.

Macrocytic anemia (MCV >100 fl): red cells larger than normal. Most common cause is megaloblastic anemia (B12 or folate deficiency), also could be hypothyroidism, liver disease, alcohol toxicity.

This is why just looking at hemoglobin isn't enough, need to look at MCV—mean corpuscular volume. MCV helps determine anemia type, thereby guiding further investigation and treatment.

Iron deficiency anemia is most common anemia type, accounting for about 50% of all anemia. When body lacks iron, cannot synthesize sufficient hemoglobin, red cells become smaller and paler (microcytic hypochromic anemia).

Iron deficiency anemia's typical blood picture: hemoglobin decreased, MCV decreased (microcytic), MCH decreased (hypochromic), MCHC decreased. Blood smear shows red cells with enlarged central pallor (like donuts).

Iron deficiency has three main categories: inadequate intake (vegetarians, picky eaters, malnutrition), malabsorption (post-gastrectomy, chronic diarrhea, taking acid suppressants), excessive loss (heavy menstrual bleeding, GI bleeding, hemorrhoids).

Treating iron deficiency anemia requires iron supplementation, oral iron first choice. More importantly, find the iron deficiency cause—especially for men and postmenopausal women, must rule out GI bleeding possibility, don't blindly supplement iron and delay GI tumor diagnosis.

Thalassemia is inherited hemoglobin abnormality, common in southern China (Guangdong, Guangxi, Fujian). Thalassemia minor (carrier) blood picture resembles iron deficiency anemia: microcytic, hypochromic, mildly decreased hemoglobin.

But thalassemia isn't real anemia—iron isn't lacking, just hemoglobin synthesis abnormal. Thalassemia carriers usually have no obvious symptoms, only discovered incidentally on routine checkup.

Key difference: thalassemia's serum iron and ferritin normal or elevated, iron deficiency anemia's serum iron and ferritin decreased. This is why anemia requires checking ferritin—it can distinguish true iron deficiency from thalassemia.

Thalassemia doesn't need iron supplementation, iron might cause iron overload. Thalassemia carriers usually don't need treatment, just need to know they're carriers, avoid marrying another carrier (or prenatal diagnosis), because thalassemia major is severe disease.

Megaloblastic anemia is B12 or folate deficiency. These vitamins needed for DNA synthesis, when deficient red cell nucleus division impaired, but cytoplasm continues synthesis, causing cells to become large but dysfunctional (macrocytic anemia).

Megaloblastic anemia's typical blood picture: hemoglobin decreased, MCV increased (macrocytic), MCH increased. Blood smear shows oval macrocytes, neutrophil hypersegmentation.

Vitamin B12 deficiency possible causes: strict vegetarians (B12 only in animal foods), post-gastrectomy (intrinsic factor deficiency causing malabsorption), long-term metformin or proton pump inhibitor use.

Folate deficiency possible causes: inadequate dietary intake (not eating vegetables, fruits), malabsorption (celiac disease, certain meds), increased requirement (pregnancy, malignancy, hemolysis).

Treatment requires supplementing appropriate vitamins. But need to note: B12 deficiency sometimes causes neurological injury, this damage might be irreversible. So confirmed B12 deficiency requires prompt treatment, don't delay.

Anemia of chronic disease is chronic inflammation, infection, or tumor causing anemia. These conditions cause body to produce inflammatory cytokines (like IL-6), stimulating liver to produce hepcidin, which "locks up" iron, preventing iron utilization for hemoglobin synthesis.

Anemia of chronic disease characteristics: usually mild to moderate anemia, MCV normal or slightly decreased, serum iron decreased but ferritin normal or elevated.

Treatment key is treating underlying disease—control inflammation, treat infection, remove tumor. Iron supplementation has poor effect because iron isn't lacking, just can't be utilized.

Hemolytic anemia is shortened red cell lifespan, increased destruction. Normal red cell lifespan about 120 days, hemolysis might shorten to only days or weeks.

Hemolytic anemia characteristics: anemia severity doesn't match jaundice, hepatosplenomegaly (anemia not severe but jaundice obvious), significantly elevated reticulocytes (bone marrow compensatory hematopoiesis), elevated LDH, elevated indirect bilirubin.

Hemolysis causes many: hereditary (like hereditary spherocytosis, G6PD deficiency), autoimmune (autoimmune hemolytic anemia), mechanical (like valvular heart disease, vasculitis), infectious (like malaria).

Treatment needs addressing specific cause. Autoimmune hemolytic anemia needs steroids or immunosuppressants, hereditary hemolytic anemia might need splenectomy.

Anemia needs attention, but most anemia is benign, treatable. Truly concerning situations:

Anemia severe (hemoglobin ＜70 g/L) might need transfusion, needs immediate medical attention.

Anemia progressing rapidly (hemoglobin significantly dropping over weeks). Could be acute blood loss or acute hemolysis, needs immediate medical attention.

Anemia with other abnormalities (white cell abnormalities, platelet abnormalities). Could be bone marrow dysfunction, needs hematology consultation.

Anemia with symptoms (palpitations, shortness of breath, chest pain, syncope). Could already be severe anemia, needs immediate medical attention.

Anemia is just one part of health report. Use our Blood Panel Interpreter tool below to comprehensively understand CBC, including anemia type determination, possible causes, recommended further tests.

Enter your hemoglobin, MCV, MCH, MCHC indicators, and the system will analyze your anemia type and possible causes.

Anemia isn't simple "blood deficiency," but a symptom with multiple possible causes. Iron deficiency anemia is most common, but not only. Blind iron supplementation might be ineffective, even harmful, delaying true disease treatment.

Next time checkup shows anemia, don't rush to pharmacy for iron. Look at your MCV—mean corpuscular volume, this helps determine anemia type. Then check ferritin, B12, folate and other indicators to find anemia's true cause.

Remember, different anemia types need different treatments. Targeted treatment is effective, blind treatment might delay disease.

Use our Blood Panel Interpreter tool above to start understanding your anemia type. Health begins with understanding, treatment starts with accurate diagnosis.