Patients often wrongly assume anemia is diet-related

As a doctor, Jonathan Polikoff often sees the same reaction from patients when they learn they’re anemic: many immediately assume something is lacking in their diets.

But that’s not always the case, said Polikoff, an adult hematologist and oncologist at Kaiser Permanente, San Diego.

“There are hundreds of causes of anemia,” he said. “It runs the gamut.”

Anemia is a condition resulting from a reduced number of red blood cells or hemoglobin, the main protein in red blood cells that carries oxygen. It can manifest itself at birth, in older adults or at any point in between.

While patients commonly assume it’s diet-related, doctors such as Rafael Bejar, an assistant professor in the division of hematology and oncology at UCSD Moores Cancer Center, liken the condition to a fever.

“All sorts of things can cause anemia,” he said.

Anemia in newborns

According to Dr. Michael Nelson, a staff pediatrician at Kaiser Permanente San Diego, there are genetic forms of the condition that can be present at birth, including sickle cell anemia and thalassemia.

Sickle cell results

when there are too few healthy red blood cells to carry ample oxygen throughout the body. The blood cells are shaped like crescents and become rigid, which can lead them to get stuck in small blood vessels, slowing or blocking blood flow and oxygen to some areas.

With thalassemia, the body makes an abnormal form of hemoglobin — the red blood cell protein that transports oxygen — and results in excessive destruction of red blood cells.

Other forms of anemia can result from the interaction of a fetus and mother’s red blood cells. If a mother and fetus have different blood types, an interaction can cause the baby to be anemic.

Anemia in babies and toddlers

Nelson said the most common cause of anemia in babies during their first year of life stems from inadequate iron intake, which he said could result from drinking too much cow’s milk. This is why moms are discouraged from giving infants cow’s milk in bottles. Only after one year, he said, are breast-feeding and bottle-feeding moms encouraged to switch their toddlers to cow’s milk, which has little iron and can block absorption of iron in younger babies. He said many pediatricians begin blood tests to scan for anemia when babies are 9 to 12 months old and often do annual screenings thereafter. After a year of age, most toddlers are able to digest cow’s milk and need the proteins and calcium it contains.

Children in this age range who live in older homes with aging paint also can become anemic. Cracked or flaked lead-based paint chips in older homes often end up in toddlers’ mouths, he said, which can lead to anemia because lead blocks iron absorption.

School age to adolescents

Nelson said anemia among kids and teens is rare and is becoming more so. When the condition does occur, he said, the main cause is usually linked to iron deficiency resulting from poor eating habits, drinking too much milk or not eating enough fruits and vegetables. The first step in screening for anemia for kids and teens is often asking parents about their child’s diet.


