Main symptoms that may appear in anemia The hand of a person with severe anemia (on the left, with ring) compared to one without (on the right) Anemia is considered to be the most common blood disorder. A person with anemia may not have any symptoms depending on the underlying cause, and no symptoms may be noticed, as the anemia is initially minor, and then the symptoms become worse as the anemia worsens. A patient with anemia may report feeling tired, weak, decreased ability to concentrate, and sometimes shortness of breath on exertion. If the anemia come on quickly, the symptoms often may include, feeling like one is going to pass out, confusion, chest pain, and increased thirstbut if the anemia continues slowly (chronic), the body may adapt and compensate for this change; in this case, no symptoms may appear until the anemia becomes more severe. If a person becomes anemic, a set of sign and symptoms may occur, such as feeling tired, weak, feeling like passing out, dizziness, headaches, lack of physical exertion (accompanied by shortness of breath and rapid heartbeat), breathlessness (rapid), difficulty concentrating, irregular heartbeat (fluttering, or rapid heartbeat), cold hands and feet, chest pain, constantly feeling cold, soreness of the tongue, pallor, nausea, poor appetite, easy bruising and bleeding, and muscle weakness. In more severe anemia, the body may compensate for the lack of oxygen-carrying capability of the blood by increasing cardiac output. The person may have symptoms related to this, such as palpitations, angina (if pre-existing heart disease is present), intermittent claudication of the legs, and symptoms of heart failure. On examination, the signs exhibited may include pallor (pale skin, mucosa, conjunctiva and nail beds), but this is not a reliable sign. A blue coloration of the sclera may be noticed in some cases of iron-deficiency anemia. There may be signs of specific causes of anemia, e.g. koilonychia (in iron deficiency), jaundice (when anemia results from abnormal break down of red blood cells – in hemolytic anemia), nerve cell damage (vitamin B12 deficiency), bone deformities (found in thalassemia major) or leg ulcers (seen in sickle-cell disease). In severe anemia, there may be signs of a hyperdynamic circulation: tachycardia (a fast heart rate), bounding pulse, flow murmurs, and cardiac ventricular hypertrophy (enlargement). There may be signs of heart failure. Pica, the consumption of non-food items such as ice, but also paper, wax, or grass, and even hair or dirt, may be a symptom of iron deficiency, although it occurs often in those who have normal levels of hemoglobin. Chronic anemia may result in behavioral disturbances in children as a direct result of impaired neurological development in infants, and reduced academic performance in children of school age. Restless legs syndrome is more common in people with iron-deficiency anemia than in the general population.
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