Treatment of Anemia: Considerations, Nutrition Therapy and Recommended Foods

A condition in which the blood does not have enough healthy red blood cells.

Focus considerations

The purpose of establishing the etiology of an anemia is to allow the selection of a specific and effective therapy. For example, corticosteroids are useful in the treatment of autoimmune hemolytic anemia .

Therapy and medical care vary considerably in the group of hereditary disorders. Splenectomy has been advantageous in hereditary spherocytosis and hereditary elliptocytosis, in some of the unstable hemoglobinopathies and in certain patients with deficiency of pyruvic kinase.

It has little value in most other hereditary hemolytic disorders.

Drugs and chemicals capable of causing aplasia or stopping the maturation of erythroid precursors should be suspended or avoided.

Similarly, diseases known to be associated with anemia should be treated appropriately. Guidelines for the treatment of anemia associated with chemotherapy are available.

Surgery is useful to control bleeding in anemic patients. More commonly, bleeding comes from the gastrointestinal tract, uterus or bladder. Patients must be hemodynamically stable before and during surgery. A blood transfusion may be necessary.

Management of beta-thalassemia major and major hemoglobinopathies

Patients with beta-thalassemia major and the major hemoglobinopathies associated with sickle hemoglobin (Hb) generally require medical attention at frequent intervals for the treatment of anemia, infection, pain and leg ulcers due to the severity of these diseases.

On the contrary, many of the other hereditary anomalies have minimal or no clinical manifestations; the patient just needs tranquility.



Surgical consultation is indicated to control bleeding, for splenectomy when necessary and for biopsies to establish the presence of neoplasia.

A consultation with gastroenterologists is often sought to identify a site of bleeding in the intestine. Urological consultation may be necessary to investigate hematuria.


Patients with chronic anemia can usually be treated on an outpatient basis. Follow-up care is necessary to ensure that therapy is continued and to evaluate the effectiveness of the treatment.


The transfusion of packed red cells (RBC) should be reserved for patients who are actively bleeding and for patients with severe and symptomatic anemia. Transfusion is palliative and should not be used as a substitute for specific therapy.

In chronic diseases associated with anemia of chronic disorders, erythropoietin may be useful to prevent or reduce transfusions of packed red blood cells.

Hemolytic transfusion reactions and the transmission of infectious diseases are risks of transfusions of blood products. Patients with autoimmune antibodies against red blood cells have an increased risk of a hemolytic transfusion reaction due to the difficulty of cross-matching blood.

Occasionally, the blood of patients with autoimmune hemolytic anemia can not be cross-linked in vitro.

In these cases, patients require a cross-comparison in vivo, in which the incompatible blood is transfused slowly and periodic determinations are made to ensure that the patient does not develop hemoglobinemia.

This method should be used only in patients with significant hypoxia of anemia or evidence of coronary insufficiency.

Iron supplementation:

Adequate treatment of anemia due to blood loss is correction of the underlying condition and oral administration of ferrous sulfate until the anemia is corrected and for several months afterwards to ensure that the body stores are filled with iron.

There are relatively few indications for the use of parenteral iron therapy, and blood transfusions should be reserved for the treatment of shock or hypoxia.

Although the traditional dose of ferrous sulfate is 325 mg (65 mg of elemental iron) orally three times a day, lower doses (for example, 15-20 mg of elemental iron per day) can be as effective and cause less side effects.

To promote absorption, patients should avoid tea and coffee and can take vitamin C (500 units) with the iron pill once a day.

If ferrous sulfate has unacceptable side effects, ferrous gluconate, 325 mg daily (35 mg elemental iron) is a possible alternative for patients who can not tolerate ferrous sulfate.

A study in Iran showed that iron supplements at low doses once a week can be effective in improving iron status and treating iron deficiency anemia.

Mozaffari-Khosravi randomly selected and assigned 193 adolescents between 14 and 16 years of age to receive 150 mg of ferrous sulfate once a week for 16 weeks or without iron supplements.

Before and after the intervention, the percentage of anemia, iron deficiency anemia and iron deficiency was measured in both groups of girls.

Although the parameters measured before the intervention were not significantly different, at the end of the 16 weeks, the group that received the ferrous sulfate had a significant improvement in the same parameters. In addition, all cases of iron deficiency anemia were resolved in the group that received the low dose of iron

Nutrition Therapy and Food Considerations

Nutritional therapy is used to treat iron, vitamin B-12, and folic acid deficiencies. Pyridoxine may be useful in the treatment of certain patients with sideroblastic anemia, although this is not a deficiency disorder. A strict vegetarian diet requires iron supplements and vitamin B-12.

Iron deficiency anemia prevails in geographic locations where there is little meat in the diet.

Many of these places have enough dietary inorganic iron to match the iron content in people who live in countries where meat is eaten. However, heme iron is absorbed more efficiently than inorganic iron for food.

Folic acid deficiency occurs among people who consume few leafy vegetables. The coexistence of iron and folic acid deficiency is common in developing nations.

Food for anemia

What foods are high in iron?

Iron in food comes from two sources: animals and plants. Iron from animal sources is known as heme iron and is found in various meats and fish.

The iron in plants is known as non-heme iron, and is found in certain vegetables and iron-fortified foods, such as breakfast cereals. Heme iron is better absorbed by the body than non-heme iron. The following foods are good sources of iron heme (of animal origin):

  • Chicken’s liver.
  • Oysters.
  • Clams
  • Cow liver.
  • Beef (grilled chulet, lean ground beef).
  • turkey leg
  • Tuna.
  • Eggs
  • Shrimp.
  • Leg of lamb.

The following foods are good sources of non-heme iron (from plants):

  • Raisin bran (enriched).
  • Instant oatmeal
  • Beans (lime, Marina).
  • tofu.
  • Lentils
  • Molasses.
  • Spinach.
  • Pan integral.
  • Peanut butter.
  • Integral rice.

Try combining non-heme iron foods with vitamin C (for example, a glass of orange juice) to increase iron absorption. Talk to your health care provider to determine the amount of iron you need every day.