Causes of anemia

Causes of Anemia: Why the Blood Runs Low

Every case of anemia traces back to one of three mechanisms: you are not making enough red cells, you are losing them, or they are being destroyed too fast. Finding which mechanism - and which cause within it - is the whole diagnostic game, per NHS guidance on iron-deficiency anaemia.

Cause Group 1: Not Enough Production

• Iron deficiency: the world's commonest cause. Iron is the core of hemoglobin; without enough, red cells come out small and pale. Causes: poor intake, poor absorption, or chronic loss
• Vitamin B12 deficiency: common in vegetarians, the elderly, and after stomach surgery - B12 shortage produces large, fragile red cells and can also damage nerves
• Folate deficiency: poor diet, pregnancy demand, certain medicines
• Chronic diseases: kidney disease (less erythropoietin hormone), chronic inflammation, cancers - the "anemia of chronic disease"
• Bone marrow problems: aplastic anemia, marrow infiltration - rare but serious

Cause Group 2: Blood Loss

• Heavy menstrual periods - the commonest cause in young women
• Gut losses: ulcers, piles, chronic gut conditions, regular painkiller use, and in some regions, hookworm
• Pregnancy and childbirth demands and losses
• Slow, invisible bleeding anywhere - which is why new anemia in older adults always gets investigated for a source

Cause Group 3: Increased Destruction (Hemolysis)

• Inherited: thalassemia, sickle cell disease, G6PD deficiency - red cells break down early
• Acquired: autoimmune hemolysis, certain infections and medicines

A Crucial Caution Before Any Iron Tablet

Small red cells on a report do not automatically mean iron deficiency. Thalassemia trait - common in Indian families - also produces small cells with normal or high iron stores. Giving iron to a thalassemia carrier who is not iron-deficient loads the body with iron it cannot use. The rule: ferritin first, iron second. Ask for the iron studies before starting supplements.

The Classical View of Causes

Charaka's nidana list for Pandu is remarkably mechanistic: excessive intake of sour, salty, alkaline and incompatible foods; suppression of natural urges; excessive exercise; day sleep; and Mrid-bhakshana - habitual clay eating (the pica still seen with iron deficiency today). The classical frame blamed digestive-fire disturbance and dosha-driven depletion of Rasa and Rakta dhatus - interpretive, but its practical advice (fix the diet, stop clay eating, restore digestion) aligns with modern deficiency correction.

Frequently Asked Questions

What is the commonest cause of anemia in Indian women? Iron deficiency - from a combination of menstrual losses, dietary shortfall, and pregnancy demands.

Can acidity medicines cause anemia? Long-term acid suppressors can reduce B12 and iron absorption - one of several medicine effects doctors check for.

My report says "microcytic anemia" - what does that mean? Small red cells - the pattern of iron deficiency OR thalassemia trait. Ferritin and, if needed, Hb analysis tell them apart.

Can worms really cause anemia? Yes - hookworm infestation causes slow gut blood loss and remains a real cause in many parts of India; a stool test checks for it.