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Anemia; Types, Causes, Symptoms, Diagnosis, Treatment

Anemia is a condition that develops when your blood lacks enough healthy red blood cells or hemoglobin. Hemoglobin is a main part of red blood cells and binds oxygen. If you have too few or abnormal red blood cells, or your hemoglobin is abnormal or low, the cells in your body will not get enough oxygen.

Anemia is defined as a hemoglobin below two standard deviations of the mean for the age and gender of the patient. Iron is an essential component of the hemoglobin molecule. The most common cause of anemia worldwide is an iron deficiency, which results in microcytic and hypochromic red cells on the peripheral smear. Several causes of iron deficiency vary based on age, gender, and socioeconomic status. The patient often will have nonspecific complaints such as fatigue and dyspnea on exertion. Treatment is a reversal of the underlying condition as well as iron supplementation. Iron supplementation is most often oral, but certain cases may require intravenous iron. Patients with iron-deficient anemia have been found to have a longer hospital stay along with a higher number of adverse events.[1],[2],[3]

Normal Hb-specific laboratory cut-offs will differ slightly, but in general, the normal ranges are as follows:

135 to 180 g/L in men
120 to 150 g/L in women
110 to 160 g/L in children
Varied in pregnancy depending on the trimester, but generally greater than 100 g/L

Types of Anemia

1. Iiron deficiency anemia

often falls into this category. In this case, the disorder is brought on by a shortage of iron, most often caused by blood loss.
When blood is lost, the body reacts by pulling in water from tissues outside the bloodstream in an attempt to keep the blood vessels filled. This additional water dilutes the blood, and, as a result, the red blood cells are diluted.
Blood loss can be categorized as acute and rapid or chronic. Rapid blood loss can include surgery, childbirth, trauma, or a ruptured blood vessel.
Chronic blood loss is more frequent among patients diagnosed with anemia. Here, the blood loss can be a result of stomach ulcers, cancer, or tumor.
Gastrointestinal conditions – such as ulcers, hemorrhoids, cancer, or gastritis
Use of non-steroidal anti-inflammatory drugs (NSAIDs) – such as aspirin and ibuprofen
Menstrual bleeding

2 .Anemia caused by decreased or faulty red blood cell productions

Located in the center of our bones is a soft, spongy tissue, called bone marrow, it is essential for the creation of red blood cells. Bone marrow produces stem cells, which develop into red blood cells, white blood cells, and platelets.
Bone marrow can be affected by a number of diseases, including leukemia, where abnormal white blood cells are produced in excess, which disrupts normal production of red blood cells.
Other examples of anemias caused by decreased or faulty red blood cells are:

3. Sickle cell anemia

Red blood cells are misshapen and break down abnormally quickly. The crescent-shaped blood cells can also get stuck in smaller blood vessels, causing pain.
Iron-deficiency anemia – not enough red blood cells are produced because not enough iron is present in the body. This can be because of a poor diet, menstruation, frequent blood donation, endurance training, certain digestive conditions, such as Crohn’s disease, surgical removal of part of the gut, and some foods.
Bone marrow and stem cell problems – for instance, aplastic anemia occurs when there are little or no stem cells present. Thalassemia occurs when red blood cells can’t grow and mature properly.

4. Vitamin deficiency anemia

Vitamin B-12 and folate are both essential for the production of red blood cells; therefore, if either is deficient, red blood cell production will be too low. Examples of this type of anemia are megaloblastic anemia and pernicious anemia.

5. Anemia caused by the destruction of red blood cells

Red blood cells typically have a life span of 120 days in the bloodstream, but they can be destroyed or removed beforehand.
One type of anemia that falls into this category is autoimmune hemolytic anemia, where the body’s immune system mistakenly identifies its own red blood cells as a foreign substance and attacks them. Excessive hemolysis (red blood cell breakdown) can occur for many reasons, including:
Infections
Certain drugs – some antibiotics, for instance
Snake or spider venom
Toxins produced through advanced kidney or liver disease
Autoimmune attack – for instance hemolytic disease
Severe hypertension
Vascular grafts and prosthetic heart valves
Clotting disorders
Enlargement of the spleen
There are a LOT of diseases and conditions which can lead to anemia. These diseases can be grouped together into four broad causes of having too few red blood cells (RBCs) in blood.

Causes Associated diseases ,Decreased production of RBCs

6. Aplastic anemia

folic acid deficiency iron deficiency anemia kidney disease leukemia and myelodysplastic syndrome thalassemia
pernicious anemia (vitamin B12 deficiency)
chronic diseases (e.g. HIV, Crohn’s disease, etc…)( Increased destruction of RBCs
glucose-6-phosphate dehydrogenase deficiency

7. Hemolytic anemia

sickle cell anemia
transfusion reactions , Loss of RBCs (bleeding) ,gastrointestinal ulcers
major injuries or surgery menstruation , Dilution of RBCs (fluid overload) ,pregnancy

Causes of Anemia

Basically, only three causes of anemia exist: blood loss, increased destruction of RBCs (hemolysis), and decreased production of RBCs. Each of these causes includes a number of disorders that require specific and appropriate therapy. Genetic etiologies include the following:
Hemoglobinopathies
Thalassemias
Enzyme abnormalities of the glycolytic pathways
Defects of the RBC cytoskeleton
Congenital dyserythropoietic anemia
Rh null disease
Hereditary xerocytosis
Abetalipoproteinemia
Fanconi anemia
Nutritional etiologies include the following:
Iron deficiency
Vitamin B-12 deficiency
Folate deficiency
Starvation and generalized malnutrition
Physical etiologies include the following:
Trauma
Burns
Frostbite
Prosthetic valves and surfaces
Chronic disease and malignant etiologies include the following:
Renal disease
Hepatic disease
Chronic infections
Neoplasia
Collagen vascular diseases
Infectious etiologies include the following:
Viral – Hepatitis, infectious mononucleosis, cytomegalovirus
Bacterial – Clostridia, gram-negative sepsis
Protozoal – Malaria, leishmaniasis, toxoplasmosisa caused by blood loss

Symptoms of Anemia

The symptoms of iron deficiency anemia can be very mild at first, and you may not even notice them. According to the American Society of Hematology (ASH), most people don’t realize they have mild anemia until they have a routine blood test.

The symptoms of moderate to severe iron deficiency anemia include

general fatigue
weakness
pale skin
shortness of breath
dizziness
strange cravings to eat items that aren’t food, such as dirt, ice, or clay
a tingling or crawling feeling in the legs
tongue swelling or soreness
cold hands and feet
fast or irregular heartbeat
brittle nails
headachesHow likely

Warning Symptoms. Contact your doctor if you experience any of the following symptoms while being treated with an erythropoiesis-stimulating drug:

Pain or swelling in the legs
Worsening in shortness of breath
Increases in blood pressure (be sure to regularly monitor your blood pressure)
Dizziness or loss of consciousness
Extreme fatigue
Blood clots in hemodialysis vascular access ports

Diagnosis of Anemia

The doctor will perform a physical examination, and may find:

Heart murmur
Low blood pressure, especially when you stand up
Pale skin
Rapid heart rate

Some types of anemia may cause other findings on a physical exam.

Blood tests used to diagnose some common types of anemia may include:

Blood levels of iron, vitamin B12, folic acid, and other vitamins and minerals
Red blood count and hemoglobin level
Reticulocyte count

Other tests may be done to find medical problems that can cause anemia

Anemia can usually be confirmed with a CBC test. Your doctor might order additional blood tests to determine how severe your anemia is and help determine treatments. They may also examine your blood through a microscope. These blood tests will provide information including:
iron level in your blood
RBC size and color
RBCs are pale in color if they’re deficient in iron.
ferritin levels
Ferritin is a protein that helps with iron storage in your body. Low levels of ferritin indicate low iron storage.
total iron-binding capacity (TIBC)
Transferrin is a protein that transports iron. A TIBC test is used to determine the amount transferrin that’s carrying iron.

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Tests for internal bleeding

If your doctor is concerned that internal bleeding is causing your anemia, additional tests may be needed. One test you may have is fecal occult test to look for blood in your feces. Blood in your feces may indicate bleeding in your intestine.
Your doctor may also perform endoscopy, in which a small camera on a flexible tube is used to view the linings of your gastrointestinal tract. An EGD test (upper endoscopy) allows a doctor to examine the lining of the esophagus, stomach, and the upper part of the small intestine. A colonoscopy (lower endoscopy) allows a doctor to examine the lining of the colon, the lower portion of the large intestine. These tests can help identify sources of gastrointestinal bleeding.

How likely you to get anemia

Anemia is the most common blood disorder affecting 1.6 billion people (1 in 4), with young children and pregnant women most at risk. The likelihood you could develop anemia depends on the underlying cause of the anemia. For example:

Iron deficiency anemia makes up for half of all anemias globally and is more common in women due to their menstrual cycle.
Sickle cell anemia affects 1 in 100 people in Africa, but 1 in 3000 in the United States. This is because sickle cell anemia is a genetic disease found in people of African heritage.

Vegetarians/vegans, pregnant mothers, and alcoholics have an increased risk for nutrient deficiency anemias

Vegetarians/vegans have an increased risk for iron deficiency anemia and vitamin B12 deficiency anemias because animal products contain these nutrients.
Pregnant women have increased iron and vitamin needs to help their fetus grow and are at an increased risk for iron, folate, and vitamin B12 deficiencies.
Alcohol impairs the ability of the liver to metabolize folate leading to folate deficiency anemia in alcoholics.

Treatment of Anemia

Comparison of intravenous iron preparations available in the USA.

	Iron dextran	Iron sucrose	Sodium ferric gluconate	Ferumoxytol
Infusion dose	100 mg	100 mg	125 mg	510 mg
Test dose required	Yes	No	No	No
Rate of injection^*	100 mg given over 2 min (50 mg/min)	100 mg given over 2–5 min (20–50 mg/min)	125 mg given over 10 min (12.5 mg/min)	510 mg given over 17 s (30 mg/s)
Rate of infusion (in 0.9% NaCl)^*	Not FDA approved	100 mg/100 ml 0.9% NaCl given over 15 min	125 mg/100 ml 0.9% NaCl over 1 h	Not FDA approved

^*Injection/infusion rates are based on studies in hemodialysis dependent-chronic kidney disease patients. FDA, US Food and Drug Administration.

The formula to calculate iron requirement to replete iron stores in adults.

Formula

Elemental iron (mg) = 50 × [0.442 (desired Hgb g/L minus observed Hgb g/L) × lean body weight (see below for men and women) + 0.26 × lean body weight]

Lean body weight

For men: lean body weight = 50 kg + 2.3 kg for each inch in height over 60 inches

For women: lean body weight = 45.5 kg + 2.3 kg for each inch in height over 60 inches

Note: use actual body weight if lean body weight is less than actual weight.

Intravenous iron preparations (mg elemental iron/ml)

Iron dextran = 50 mg

Iron sucrose: = 20 mg

Sodium ferric gluconate = 12.5 mg

Ferumoxytol = 30 mg

The formula was derived from: iron dextran injection calculator by David McAuley, GlobalRPh http://www.globalrph.com/irondextran.htm with permission

Intravenous Iron Preparations

Iron Formulation	Test Dose	Dose Per Session ^a
High-molecular-weight iron dextran	25 mg (0.5 mL) over 5 minutes, monitor 1 hour	100 mg of iron intravenously at <50 mg/min
Low-molecular-weight iron dextran	25 mg (0.5 mL) over 30 seconds, monitor 1 hour	100 mg of iron intravenously at <50 mg/min
Ferric carboxymaltose	No	750 mg of iron intravenously at 100 mg/min or infusion over 15 minutes. For patients weighing <50 kg (110 lb), maximum of 15 mg of iron per kilogram of body weight
Ferumoxytol	No	510 mg of iron intravenously at 30 mg/s or infusion over 15 minutes
Iron sucrose	No	100-200 mg intravenously over 2-5 minutes or infusion over 15 minutes
Sodium ferric gluconate complex	No	62.5-125 mg intravenously at 12.5 mg/min or infusion over 1 hour

^aDosing based on US prescription label. See label for details.

Oral iron supplements are the best way to restore iron levels for people who are iron deficient, but they should be used only when dietary measures have failed. However, iron supplements cannot correct anemias that are not due to iron deficiency.
Iron replacement therapy can cause gastrointestinal problems, sometimes severe ones. Excess iron may also contribute to heart disease, diabetes, and certain cancers. Doctors generally advise against iron supplements in anyone with a healthy diet and no indications of iron deficiency anemia.
Treatment of Anemia of Chronic Disease. In general, the best treatment for anemia of chronic diseases is treating the disease itself. In some cases, iron deficiency accompanies the condition and requires iron replacement. Erythropoietin, most often administered with intravenous iron, is used for some patients.

Oral Iron Suppliment

Supplement Forms. There are two forms of supplemental iron: ferrous and ferric. Ferrous iron is better absorbed and is the preferred form of iron tablets. Ferrous iron is available in three forms: ferrous fumarate, ferrous sulfate, and ferrous gluconate.
The label of an iron supplement contains information both on the tablet size (which is typically 325 mg) and the amount of elemental iron contained in the tablet (the amount of iron that is available for absorption by the body.) When selecting an iron supplement, it is important to look at the amount of elemental iron.

A 325 mg iron supplement contains the following amounts of elemental iron depending on the type of iron:

Ferrous fumarate. 108 mg of elemental iron
Ferrous sulfate. 65 mg of elemental iron
Ferrous gluconate. 35 mg of elemental iron

Dosage. Depending on the severity of your anemia, as well as your age and weight, your doctor will recommend a dosage of 60 – 200 mg of elemental iron per day. This means taking one iron pill 2 – 3 time during the day. Make sure your doctor explains to you how many pills you should take in a day and when you should take them. Never take a double dose of iron.

Side Effects and Safety. Common side effects of iron supplements include

Constipation and diarrhea are very common. They are rarely severe, although iron tablets can aggravate existing gastrointestinal problems such as ulcers and ulcerative colitis.
Nausea and vomiting may occur with high doses, but can be controlled by taking smaller amounts. Switching to ferrous gluconate may help some people with severe gastrointestinal problems.
Black stools are normal when taking iron tablets. In fact, if they do not turn black, the tablets may not be working effectively. This tends to be a more common problem with coated or long-acting iron tablets.
If the stools are tarry looking as well as black, if they have red streaks, or if cramps, sharp pains, or soreness in the stomach occur, gastrointestinal bleeding may be causing the iron deficiency and the patient should call the doctor promptly.
Acute iron poisoning is rare in adults but can be fatal in children who take adult-strength tablets. Keep iron supplements out of the reach of children. If your child swallows an iron pill, immediately contact a poison control center.

Other Tips for Safety and Effectiveness. Other tips for taking iron are as follows

For best absorption, iron should be taken between meals. Iron may cause stomach and intestinal disturbances, however. Low doses of ferrous sulfate can be taken with food and are still absorbed but with fewer side effects.)
Drink a full 8 ounces of fluid with an iron pill. Taking orange juice with an iron pill can help increase iron absorption. (Some doctors also recommend taking a vitamin C supplement with the iron pill.)
If constipation becomes a problem, take a stool softener such as docusate sodium (Colace).
Certain medications, including antacids, can reduce iron absorption. Iron tablets may also reduce the effectiveness of other drugs, including the antibiotics tetracycline, penicillamine, and ciprofloxacin and the Parkinson’s disease drugs methyldopa, levodopa, and carbidopa. At least 2 hours should elapse between doses of these drugs and iron supplements.
Avoid taking milk, caffeine, antacids, or calcium supplements at the same time as an iron pill as they can interfere with iron absorption.
Tablets should be kept in a cool place. (Bathroom medicine cabinets may be too warm and humid, which may cause the pills to disintegrate.)

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Full recovery takes 6 – 8 weeks. Recovery will take longer in people with internal bleeding that is not under control. Iron replacement therapy must continue for about 6 months, even if anemia has been reversed. Treatment must be continued indefinitely for people with chronic bleeding; in such cases, iron levels should be closely monitored.

Intravenous or Injected Iron

In some cases, iron is administered through muscular injections or intravenously. Intravenous iron has the advantage of causing less gastrointestinal discomfort and inconvenience. It may be in the form of iron dextran (Dexferrum, InFed), sodium ferric gluconate complex in sucrose (Ferrlecit), or iron sucrose (Venofer). Ferrlecit or Venofer are proving to be at least equally effective and safer than iron dextran.

Candidates. The injected or intravenous forms should be limited to the following patients with iron deficiency:

People with iron deficiency anemia in whom oral therapy has clearly failed.
Patients with bleeding disorders in which blood loss continues to exceed the rate at which oral iron is absorbed.
In emergencies, when people need red blood cells but transfusion is not appropriate or available.
In people with serious gastrointestinal disorders, such as inflammatory bowel disease, who cannot take iron therapy by mouth.
People undergoing hemodialysis who receive supplemental erythropoietin therapy. Sodium ferric gluconate complex in sucrose (Ferrlecit) or iron sucrose (Venofer) is specifically approved as first-line therapy for these patients.

Certain patients, even if they meet these qualifications, may not be appropriate candidates or should be monitored closely for complications. They include:

Patients with any underlying autoimmune disease.
Malnourished patients who also have an underlying infection.
Patients who are at risk for iron overload.

Side Effects. Some side effects differ depending on how the iron is administered and include the following:

Muscular injections include pain at the site.
Intravenous administration can cause pain in the vein, flushing, and metallic taste, all of which are brief.

For both methods, side effects and serious complications can include:

Blood clots
Fever
Joint aches
Headache
Rashes
A delayed reaction of joint and muscle aches, headache, and malaise occurs 1 – 2 days after the infusion (most commonly with iron dextran) in about 10% of patients. These symptoms respond quickly to NSAIDs, such as ibuprofen or naproxen, in most people.
Iron toxicity. Symptoms include nausea, dizziness, and a sudden drop in blood pressure. Sodium ferric gluconate in sucrose (Ferrlecit) or iron sucrose (Venofer) may pose a lower risk for toxicity than iron dextran.
Allergic reactions. Allergic reactions that occur with intravenous iron can be very serious and, in rare cases, even fatal. Iron dextran appears to pose a much higher risk than sodium ferric gluconate complex in sucrose or iron sucrose, although allergic reactions can also occur with the latter forms.

Oral and injected iron should never be given at the same time. Intravenous iron therapy may be appropriate for some pregnant women who meet these requirements, depending on the pregnancy term and other factors.

Blood Transfusions

Transfusions are used to replace blood loss due to injuries and during certain surgeries. They are also commonly used to treat severely anemic patients who have thalassemia, sickle cell disease, myelodysplastic syndromes, or other types of anemia. Some patients require frequent blood transfusions. Iron overload can be a side effect of these frequent blood transfusions. If left untreated, iron overload can lead to liver and heart damage.
Iron chelation therapy is used to remove the excess iron caused by blood transfusions. Patients take a drug that binds to the iron in the blood. The excess iron is then removed from the body by the kidneys. For many years, deferoxamine (Desferal) was the only drug used in chelation therapy. This drug is usually injected intravenously, using an infusion pump. The infusion can last 8 – 12 hours and may be needed 5 – 7 days a week until iron levels are normal.
A new drug, deferasirox (Exjade), was approved in 2005 for children and adults as a once-daily treatment for iron overload due to blood transfusions. It does not require injections. Patients mix the deferasirox tablets in liquid and drink the medicine. However, deferoxamine can cause gastrointestinal tract ulcerations and hemorrhage and patients should be carefully monitored. Deferoxamine can interact with certain types of medications such as nonsteroidal anti-inflammatory drugs, corticosteroids, bisphosphonates, and anticoagulants.

Erythropoiesis Stimulating Drugs

Erythropoietin is the hormone that acts in the bone marrow to increase the production of red blood cells. It has been genetically engineered as recombinant human erythropoietin (rHuEPO) and is available as epoetin alfa (Epogen, Procrit, and Eprex). Novel erythropoiesis stimulating protein (NESP), also called darbepoetin alfa (Aranesp), lasts longer in the blood than epoetin alfa and requires fewer injections. These medications are also called “erythropoiesis-stimulating drugs.”
Levels of erythropoietin are reduced in anemia of chronic disease. Injections of synthetic erythropoietin can help increase the number of red blood cells in order to avoid receiving blood transfusions. Erythropoietin is used to treat anemia. It does not help improve anemia symptoms, fatigue, or quality of life for patients with cancer or HIV. This drug can cause serious side effects, including blood clots, and is approved only for treating patients with anemia related to the following conditions:

Cancer. For select patients, erythropoietin is used to treat the anemia associated with chemotherapy.
Chronic kidney failure. Erythropoietin is an important anemia treatment for patients with chronic kidney failure, including those on dialysis.
HIV/AIDS. Erythropoietin helps treat the anemia caused by zidovudine (AZT) therapy.
Erythropoiesis-Stimulating Drugs and Cancer. Erythropoietin should be used only to treat anemia caused by chemotherapy — not anemia due to other causes in patients with cancer. Erythropoietin treatment does not help prolong survival. In fact, these drugs can shorten survival time and cause tumors to grow faster. Discuss with your doctor whether an erythropoiesis-stimulating drug is appropriate for you.
Survival and tumor growth risks are especially pronounced for patients with advanced breast, head and neck, lymphoid, or non-small cell lung cancer when dosing attempts to achieve a hemoglobin level of 12 g/dL or greater. However, there may be similar risks for patients dosed to less than 12 g/dL. (The American Society of Clinical Oncology and the American Society of Hematology recommend starting erythropoietin when a patient’s hemoglobin level falls to less than 10 g/dL.) The doctor should use the lowest effective dose and erythropoietin treatment should be stopped as soon as the chemotherapy course is completed.
Erythropoiesis-Stimulating Drugs and Chronic Kidney Failure. For patients with chronic kidney failure, the FDA recommends that erythropoiesis-stimulating drugs be used to maintain hemoglobin levels between 10 – 12 g/dL. (The exact level within this range varies by individual.) There is a greater risk of death and serious cardiovascular events, such as heart attack, stroke, and heart failure when these drugs are used to achieve higher hemoglobin levels (13.5 – 14g/dL) compared to lower hemoglobin levels (10- 11.3 g/dL).

In 2007, the Food and Drug Administration (FDA) made major changes to the prescribing information for erythropoiesis-stimulating drugs. The new labels describe in detail the risks that Aranesp, Epogen, and Procrit can pose to patients with cancer and chronic kidney disease. The FDA has also established separate dosing recommendations for each of these conditions.

What foods are high in iron?

The following foods are good sources of iron:

Oysters
Kidney beans
Beef liver
Tofu
Beef (chuck roast, lean ground beef)
Turkey leg
Whole wheat bread
Tuna
Eggs
Shrimp
Peanut butter
Leg-of-lamb
Brown rice
Raisin bran (enriched)
molasses

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Home Remedies for Anemia

Red blood cells contain hemoglobin, an iron-based protein that helps blood cells carry oxygen. When you are anemic, your blood can’t deliver the proper oxygen supply to your organs and tissues.

According to the World Health Organization, males who have less than 13 grams of hemoglobin per deciliter are anemic. For women, the criteria is less than 12 grams of hemoglobin per deciliter.

Anything that disrupts the normal life span of the red blood cells may cause anemia, including a decrease in red blood cell production, an increase in destruction of red blood cells or excessive blood loss. There are different types of anemia, depending on their cause.
Women and people with chronic diseases are at highest risk for anemia. Some of the conditions that may cause it are heavy blood loss during menstruation, pregnancy, ulcers, intestinal disorders, cancer, bleeding disorders, other chronic diseases, or a deficiency of iron, folic acid, vitamin B12. Certain types of anemia can also be inherited.
Symptoms vary depending on the cause and may range from mild to severe. Common symptoms are fatigue, pale skin, a fast or irregular heartbeat, shortness of breath, chest pain, dizziness, cognitive problems, headaches, cold hands and feet, lack of energy, hair loss and high or low blood pressure.
You can easily treat and prevent some types of anemia at home with some simple home remedies. Follow any of these remedies until your hemoglobin level becomes normal.

Home Treatment.

Beetroot

Beetroot is highly beneficial for those who suffer from anemia due to iron deficiency, which is the most common of all types of anemia. It has high iron content, along with fiber, calcium, potassium, sulfur and vitamins.

In addition to providing nutrition, beetroot helps cleanse the body and supply more oxygen throughout the body. This in turn helps increase the body’s red blood cell count.

Blend one medium-size beetroot, three carrots and one-half of a sweet potato in a juicer. Drink this juice once daily.
You can also eat beetroots as a cooked vegetable or in a salad. Eat the peel along with the beetroot for maximum nutritional value.

Blackstrap Molasses

Blackstrap molasses is considered a nutritional powerhouse, especially for those who are anemic.

It is a good source of iron, B vitamins and other essential minerals that help increase red blood cell production. A tablespoon of blackstrap molasses supplies almost 15 percent of your daily iron needs.

Mix one tablespoon of blackstrap molasses in a cup of hot water or milk. Drink this once or twice daily. This drink is highly beneficial for pregnant women.
Another option is to combine two teaspoons each of blackstrap molasses and apple cider vinegar in one cup of water. Drink this once daily.

Spinach

A diet rich in green leafy vegetables like spinach is one of the best home cures for anemia. Spinach is rich in iron as well as vitamin B12 and folic acid, energy-boosting nutrients that the body needs to recover from anemia.

A one-half cup of spinach provides almost 35 percent of your daily value of iron and 33 percent of your daily value of folic acid.

Drink spinach soup twice daily. To prepare the soup, take 1 cup of blanched spinach and puree it by adding a little water. Heat 1 teaspoon of extra-virgin olive oil in a pan, sauté some chopped garlic cloves and onion in it until brown. Add the pureed spinach and a little salt and cook on low heat for 5 – 10 minutes.
Mix two teaspoons of honey in a glass of fresh spinach juice. Drink this once daily.

Follow either of these remedies for at least one month.

Pomegranate

Pomegranate is rich in iron and other minerals, such as calcium and magnesium. It also contains vitamin C, which helps improve the body’s absorption of iron. This results in more red blood cells and an increase in the hemoglobin level.

Mix one cup of pomegranate juice, one-fourth teaspoon of cinnamon powder and two teaspoons of honey. Drink this daily with your breakfast.
Alternatively, take two teaspoons of dried pomegranate seed powder with a glass of warm milk one or two times daily.
You can also eat a medium-size pomegranate every morning on an empty stomach.

Sesame Seeds

Sesame seeds are also great for treating anemia due to their high iron content. One-fourth cup of sesame seeds provides almost 30 percent of the daily iron requirement.

Soak two tablespoons of black sesame seeds in water for two to three hours. Strain and make a paste of the soaked seeds. Add one tablespoon of honey and mix well. Have this mixture twice daily.
Soak one teaspoon of black sesame seeds in warm water for two hours. Grind the mixture into a paste and then strain it to get the emulsion. Mix the emulsion in a cup of warm milk, add honey or jaggery and drink it once daily.

Dates

Dates are a rich source of iron as well as vitamin C that plays an important role in the body’s absorption of iron.

Soak two dates in a cup of milk overnight. The next morning, eat the dates and drink the milk on an empty stomach.
Alternatively, you can eat some dry dates on an empty stomach in the morning, followed by a cup of warm milk.

Apple

Being rich in nutrients including iron, apples help a lot in treating anemia.

Eat at least one apple daily. If possible, opt for green apples and eat them with their skin.
You can also mix equal parts of fresh apple juice and beetroot juice and a little honey. Drink this juice twice daily.

Banana

High in iron, banana stimulates the production of hemoglobin and many other enzymes that are essential for the formation of red blood cells. Also, it is a good source of magnesium that aids in hemoglobin synthesis.

Eat one ripe banana along with one tablespoon of honey twice daily.
Alternatively, mix one mashed ripe banana and one tablespoon of Indian gooseberry (amla) juice. Eat this two or three times daily.

Dried Black Currant

Due to its high concentrations of iron and vitamin C, dried black currant has been found to be a very effective treatment for anemia. Vitamin C enhances the body’s ability to absorb the iron, increasing red blood cells and hemoglobin.

Soak 10 to 12 dried black currants in water overnight.
The next morning, remove them from the water and remove the seeds.
Eat them daily before eating your breakfast.
Follow this remedy for a few weeks.

Fenugreek

The high iron content in fenugreek will help maintain the iron in your blood. It also aids new red blood cell production. Both the leaves and seeds of fenugreek can be used in the treatment of anemia.

Cook one cup of rice with two teaspoons of fenugreek seeds. Add some salt and eat it once daily for at least two to three weeks.
You can also use fenugreek leaves in your cooking, especially in soups or salads.

These home remedies are great for restoring a healthy red blood cell count in people who have anemia. Following a well-balanced diet is essential to prevent a recurrence.