Anemia

Background: What Is Anemia?

Red blood cells serve as the body’s primary vehicle for transporting oxygen. Hemoglobin, the oxygen-binding protein within RBCs, is critical for delivering oxygen to tissues and removing carbon dioxide. Anemia occurs when either RBC quantity or hemoglobin content is reduced below physiological requirements, resulting in tissue hypoxia and metabolic stress.

Anemia is not a diagnosis in itself but rather a manifestation of a broader physiologic disruption. These disruptions may stem from nutritional insufficiencies, systemic inflammation, chronic disease, bone marrow suppression, hemolytic processes, or genetic abnormalities.

A functional medicine lens emphasizes personalized investigation into the “why” behind anemia, rather than focusing solely on laboratory thresholds or symptomatic treatment.

Signs and Symptoms of Anemia

Anemia may present with a wide range of clinical features, many of which result from the body’s compensatory efforts to overcome reduced oxygen availability.

Common Symptoms Include:

• Fatigue and Weakness: Due to impaired oxygen delivery and mitochondrial energy production
  
• Pale or Yellow-Tinted Skin: Reflects reduced hemoglobin or hemolysis
  
• Shortness of Breath: Especially with exertion, due to increased oxygen demand
  
• Dizziness or Lightheadedness: Resulting from cerebral hypoxia
  
• Cold Hands and Feet: Peripheral vasoconstriction in response to low oxygen
  
• Tachycardia or Palpitations: Heart compensates for reduced oxygen carrying capacity
  
• Cognitive Difficulty: Brain fog, poor concentration, or memory impairment

These symptoms may develop gradually or acutely depending on the severity and etiology of the anemia.

Laboratory Evaluation of Anemia

Diagnosis and characterization of anemia rely on comprehensive blood testing, often supplemented by functional biomarkers to determine causative factors and guide management.

Primary Diagnostic Tests Include:

• Complete Blood Count (CBC):
  
  • Hemoglobin (Hgb) and Hematocrit (Hct)
    
  • Red Blood Cell Count (RBC)
    
  • MCV (Mean Corpuscular Volume)
    
  • MCH and MCHC
• Iron Studies:
  
  • Serum Iron
    
  • Ferritin
    
  • TIBC (Total Iron Binding Capacity)
    
  • Transferrin Saturation
• Vitamin B12 and Folate Levels (e.g., Methylmalonic Acid, Homocysteine)
  
• Reticulocyte Count
  
• Peripheral Blood Smear

Advanced Testing as Needed:

• Functional tests: Homocysteine and MMA for B12/folate status
  
• Renal Function (Creatinine, eGFR)
  
• Inflammatory Markers (CRP, ESR)
  
• Bone Marrow Biopsy

Functional medicine may also evaluate digestive function, nutrient absorption, toxin exposure, and gastrointestinal function when assessing persistent or unexplained anemia.

Causes of Anemia

Anemia has a multifactorial etiology. Identifying the root cause is essential for effective and sustainable intervention.

1. Iron Deficiency Anemia (IDA):
   
   • Chronic blood loss (e.g., menstrual, GI bleeding, ulcers, IBD)
     
   • Poor dietary intake or malabsorption (e.g., celiac disease, gastric bypass)
     
   • Increased requirements (e.g., pregnancy)
2. Vitamin Deficiency Anemia (Macrocytic):
   • [Vitamin B12] deficiency: Pernicious anemia, atrophic gastritis, metformin use
     
   • Folate deficiency: Poor intake, alcohol use, anticonvulsants
3. Anemia of Chronic Disease (ACD):
   • Chronic inflammation disrupts iron metabolism
     
   • Seen in renal disease, autoimmune diseases, cancer
4. Hemolytic anemia, bone marrow disorders, genetic hemoglobinopathies (e.g., thalassemia), and pregnancy-related dilutional anemia.

Associated Health Implications

Anemia can exacerbate or increase the risk of various health conditions, particularly when chronic or untreated.

Clinical Complications of Anemia:

• Cardiovascular Function Stress: Increased cardiac output → heart failure
  
• Pregnancy Risks: Low birth weight, premature delivery
  
• Cognitive Impairment: Memory, mood
  
• Growth Delays: Pediatric populations
  
• Impaired Immune Function: Leukocyte inefficiency

Subclinical anemia or functional deficiencies may contribute to chronic fatigue and impaired quality of life even before lab thresholds are met.

Interfering Factors in Anemia Evaluation

Several physiological and external factors can influence laboratory interpretation:

• Inflammation: Elevated CRP can falsely elevate ferritin
  
• Recent Transfusion: Masks root cause
  
• Altitude/Dehydration: Alters Hb/Hct
  
• Medications: PPIs, metformin → B12 absorption
  
• Hormonal Influences: Menstruation, pregnancy
  
• Diet: Vegetarian/vegan patterns

Contextualizing labs with history ensures accurate, individualized diagnosis.

Medications That May Influence Anemia

Medications can induce anemia or impair nutrient absorption:

• NSAIDs → GI bleeding
  
• PPIs → iron/B12 malabsorption
  
• Metformin → B12 deficiency
  
• Chemotherapy → marrow suppression
  
• Anticonvulsants → folate depletion

Reviewing medication history is integral to evaluation.

Functional Medicine Approach to Anemia

At Intercoastal Health, we move beyond symptom management to identify origins of hematologic disruption:

• Targeted Nutritional Support: Iron bisglycinate, methylated B12, folate, vitamin C, copper
  
• Digestive Optimization: Stomach acid support, treat dysbiosis
  
• Inflammation Reduction: Anti-inflammatory diet, gut healing
  
• Lifestyle & Environmental Assessment: Toxin exposure, menstrual health, stress physiology
• Monitoring: CBC and iron panel every 3–6 months; functional nutrient reassessment

Further Reading

• Camaschella C. “Iron-deficiency anemia.” N Engl J Med. 2015;372(19):1832–1843
  https://www.nejm.org/doi/full/10.1056/NEJMra1401038 (Iron-Deficiency Anemia | New England Journal of Medicine)
• Stabler SP. “Clinical practice. Vitamin B12 deficiency.” N Engl J Med. 2013;368(2):149–160
  https://www.nejm.org/doi/full/10.1056/NEJMcp1113996 (Clinical practice. Vitamin B12 deficiency – PubMed)
• Weiss G, Goodnough LT. “Anemia of chronic disease.” N Engl J Med. 2005;352(10):1011–1023
  https://www.nejm.org/doi/full/10.1056/NEJMra041809 (Anemia of Chronic Disease – The New England Journal of Medicine)
• Cappellini MD, Musallam KM, Taher AT. “Iron deficiency anaemia revisited.” J Intern Med. 2020;287(2):153–170
  https://onlinelibrary.wiley.com/doi/full/10.1111/joim.13004 (Iron deficiency anaemia revisited – PubMed)
• Hoffbrand AV, Steensma DP. Hoffbrand’s Essential Haematology, 8th Edition. Wiley-Blackwell; October 2019. 432 pp.

Conclusion

In conclusion, a comprehensive evaluation by a functional medicine telehealth provider in Florida facilitates identification of cellular-level and molecular imbalances driving hematologic dysfunction. By integrating evidence-based therapies with IV Therapy and Longevity Medicine, we offer patients a regenerative, preventive framework to rebuild resilience and optimize wellness. Call (904) 799-2531 or schedule online to request your personalized hematologic health assessment.