Anaemia
Also known as: anaemia, anemia, low haemoglobin, low hemoglobin, reduced red blood cell mass, iron-deficiency anaemia, vitamin B12-deficiency anaemia, folate-deficiency anaemia, anaemia of chronic disease, anaemia of chronic inflammation, haemolytic anaemia, aplastic anaemia, renal anaemia, macrocytic anaemia, microcytic anaemia, normocytic anaemia
Anaemia is a condition in which the concentration of haemoglobin or the number of circulating red blood cells is below the expected range for the person's age, sex, pregnancy status and clinical circumstances. Because haemoglobin carries oxygen, anaemia can cause fatigue, weakness, reduced exercise tolerance, breathlessness, dizziness, headache, palpitations and pallor. Anaemia is a clinical and laboratory finding rather than a single diagnosis. It may result from blood loss, reduced red-cell production, increased red-cell destruction or a combination of these mechanisms. Common causes include menstrual or gastrointestinal blood loss, pregnancy-related iron requirements, inadequate iron intake, impaired absorption, vitamin B12 or folate deficiency, chronic kidney disease, inflammatory or autoimmune disease, infection, malignancy, bone-marrow disorders, haemoglobin disorders and medication effects. Investigation commonly includes a full blood count, red-cell indices, blood film, reticulocyte count, ferritin and iron studies, with additional tests guided by the presentation. Treatment must target the underlying cause and may include oral or intravenous iron, vitamin B12, folate, treatment of bleeding or inflammation, erythropoiesis-stimulating therapy, immunological or haematological treatment and, in selected severe or symptomatic cases, blood transfusion. Iron should not be prescribed automatically because anaemia is not always caused by iron deficiency and excess iron can be harmful. TCM differentiation commonly includes Spleen Qi deficiency, Qi and Blood deficiency, Spleen and Kidney Yang deficiency, Liver and Kidney Yin deficiency, Heart and Spleen deficiency, Blood stasis or Damp-Heat damaging the Blood. Acupuncture and Chinese herbal medicine may be considered only as adjunctive support after the type, severity and cause of anaemia have been appropriately investigated. [1][2][3][4][5][6][7][8]
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Lifestyle & Diet
- •Follow the medical plan for investigating and treating the cause of anaemia.
- •Take oral iron, vitamin B12, folate or other prescribed treatment exactly as directed.
- •Do not take iron solely because fatigue or pallor is present.
- •Keep iron supplements away from children because overdose can be fatal.
- •Iron tablets commonly cause nausea, abdominal discomfort, constipation and dark stools; discuss intolerable effects with the prescriber rather than stopping treatment without advice.
- •Black stools can be expected with oral iron, but tarry, sticky or blood-containing stools still require medical assessment.
- •Discuss the timing of iron relative to food, tea, coffee, calcium, antacids and other medicines with a pharmacist because absorption and interactions vary.
- •Attend repeat blood tests to confirm that haemoglobin and iron stores are responding.
- •Continue prescribed iron for the recommended period because haemoglobin may improve before iron stores are replenished.
- •Do not exceed the prescribed iron dose.
- •Eat a balanced diet containing appropriate iron, vitamin B12, folate, protein and energy.
- •Sources of haem iron include meat, poultry and seafood; non-haem iron is present in legumes, tofu, whole grains, nuts, seeds and leafy vegetables.
- •Vitamin C-containing foods may improve absorption of non-haem iron when consumed with meals.
- •People following vegetarian or vegan diets should ensure a reliable source of vitamin B12 and adequate iron intake.
- •Do not rely on dietary change alone when clinically significant deficiency requires supplementation or medical treatment.
- •Seek assessment for heavy menstrual bleeding rather than accepting it as normal.
- •Report gastrointestinal symptoms, black tarry stools, blood in the stool, difficulty swallowing or unexplained weight loss.
- •Avoid frequent blood donation until iron status and eligibility have been reviewed.
- •Increase physical activity gradually according to symptoms and medical advice.
- •Stop exercise and seek advice for chest pain, marked breathlessness, faintness or palpitations.
- •Pregnant patients should attend recommended antenatal blood testing and iron management.
- •Do not take folic acid alone for unexplained macrocytic anaemia until vitamin B12 deficiency has been considered.
- •Avoid unregulated blood-building supplements that may contain excessive iron, undeclared medicines or contaminated herbs.
- •Seek dietetic advice when anaemia coexists with food allergy, coeliac disease, inflammatory bowel disease, bariatric surgery, renal disease or an eating disorder.
Cautions & Contraindications
- •Do not treat anaemia without identifying or actively investigating its cause.
- •Do not prescribe iron automatically for every low haemoglobin result.
- •Do not delay investigation of gastrointestinal or uterine blood loss.
- •Do not use acupuncture or herbs instead of blood transfusion when transfusion is clinically required.
- •Do not use complementary treatment instead of urgent care for chest pain, severe breathlessness, syncope, major haemorrhage, sepsis or acute haemolysis.
- •Do not use bleeding, wet-cupping or bloodletting techniques in an anaemic patient.
- •Do not advise a patient to stop anticoagulants, antiplatelet medicines, renal therapy, chemotherapy or prescribed haematinics.
- •Do not recommend folate alone when vitamin B12 deficiency has not been excluded in macrocytic anaemia.
- •Do not assume a ferritin result is definitive without considering inflammation and the wider iron profile.
- •Do not claim that acupuncture or herbal medicine raises haemoglobin, corrects iron stores or treats bone-marrow disease without reliable evidence.
- •Do not interpret worsening fatigue, dizziness, jaundice or palpitations as a healing response.
- •Fù Zǐ must be correctly processed and professionally prescribed because of cardiotoxic and neurotoxic risk.
- •Hé Shǒu Wū has recognised hepatotoxicity risk.
- •Dāng Guī, Chuān Xiōng, Dān Shēn, Táo Rén, Hóng Huā and Niú Xī require pregnancy, anticoagulant and bleeding-risk review.
- •Gān Cǎo may cause hypertension, fluid retention, hypokalaemia and medicine interactions.
- •Bàn Xià must be correctly processed because the raw herb is toxic.
- •Avoid animal-derived, endangered-species, contaminated, adulterated or incorrectly identified ingredients.
- •Screen all herbal prescriptions for pregnancy, breastfeeding, childhood use, liver or kidney disease, allergies, cancer treatment and medicine interactions.
- •Avoid rich tonic formulas when they significantly worsen nausea, bloating or diarrhoea.
- •Do not use oral herbs in a patient who cannot swallow safely.
Frequently Asked Questions
What is anaemia?+
Anaemia occurs when haemoglobin or circulating red blood cells are below the expected range, reducing the blood's capacity to carry oxygen [3].
Is anaemia a single disease?+
No. Anaemia is a clinical and laboratory finding with many possible causes, including bleeding, nutritional deficiency, chronic disease, kidney disease, haemolysis and bone-marrow disorders [3].
What symptoms can anaemia cause?+
Symptoms may include fatigue, weakness, pallor, breathlessness, dizziness, headache, reduced exercise tolerance and palpitations. Mild anaemia may cause few symptoms [3].
Is all anaemia caused by iron deficiency?+
No. Iron deficiency is common, but vitamin B12 deficiency, folate deficiency, inflammation, kidney disease, haemolysis, genetic conditions and bone-marrow disease can also cause anaemia [3].
Should everyone with anaemia take iron?+
No. Iron should generally be used when iron deficiency is confirmed or when specifically recommended by a clinician. Excess iron can be harmful [3].
How is anaemia investigated?+
Assessment commonly includes a full blood count, red-cell indices, blood film, reticulocyte count and iron studies, with additional tests selected according to the suspected cause [3].
Why must the cause of iron deficiency be investigated?+
Iron deficiency may result from heavy menstruation, pregnancy, gastrointestinal bleeding, dietary insufficiency or impaired absorption. Treating iron alone may miss ongoing bleeding or significant disease [3].
What TCM patterns may be considered?+
Traditional patterns may include Spleen Qi deficiency, Qi-Blood deficiency, Heart-Spleen deficiency, Spleen-Kidney Yang deficiency, Liver-Kidney Yin and Blood deficiency, Blood stasis and Damp-Heat damaging Blood [9].
Can acupuncture correct anaemia?+
There is insufficient evidence that acupuncture reliably corrects low haemoglobin or replenishes iron, vitamin B12 or folate. It may only be used as adjunctive supportive care [9].
When is anaemia an emergency?+
Emergency assessment is required for chest pain, breathlessness at rest, collapse, major bleeding, severe weakness, acute haemolysis, severe sickle-cell symptoms or cardiovascular instability [3].
Can folic acid be taken for macrocytic anaemia?+
Vitamin B12 deficiency should be considered before folic acid is used alone because folate may improve the blood count while neurological injury from B12 deficiency continues [3].
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Sources & Further Reading
Clinical guidance, red flags and safety notes on this page draw on the following current sources alongside the classical references above.
- Healthdirect Australia · 2025
Australian overview of anaemia symptoms, causes, testing and the importance of treating the underlying cause.
- Healthdirect Australia · 2026
Australian guidance explaining iron studies, low iron, blood loss and risks associated with excessive iron.
- World Health Organization · 2025
International definition, causes, symptoms and health effects of anaemia.
- World Health Organization · 2024
Evidence-informed guidance on haemoglobin thresholds used to assess anaemia.
- National Health Service · 2026
Clinical information on symptoms, blood-loss causes, pregnancy, iron treatment and follow-up.
- Merck Manual Professional Edition · 2026
Professional approach to classification, laboratory evaluation and investigation of anaemia.
- Merck Manual · 2026
Overview of blood loss, impaired red-cell production, nutrient deficiency and haemolysis.
- Australian Red Cross Lifeblood · 2026
Australian information on anaemia, oxygen transport, transfusion and major anaemia types.
- World Health Organization · 2008
Standardised acupuncture-point nomenclature and anatomical-location methodology.
- World Health Organization · 2020
International benchmarks for acupuncture education, competency and clinical safety.
Educational reference for licensed practitioners. Not a substitute for individual clinical assessment. Refer to conventional care for any red-flag or undiagnosed presentation.