Quick Answer
A practical guide to anaemia, iron deficiency, haemolysis and marrow causes.
Medically reviewed by Dr. Sachita Baniya • NMC 20158 • Kathmandu Neurology Clinic & Cognitive Center
Anaemia means a low haemoglobin level. It is one of the most common findings in clinical practice, but it is not a diagnosis — it is a sign of an underlying problem. The evaluation aims to find the cause and treat it.
How anaemia is classified
Anaemia is classified by the size of the red cells. Microcytic anaemia suggests iron deficiency or thalassaemia. Normocytic anaemia suggests chronic disease, blood loss, early deficiency or marrow disease. Macrocytic anaemia suggests B12 or folate deficiency, alcohol, thyroid disease or marrow disorders.
Why iron tablets alone are not enough
Iron deficiency is common, but the reason for the deficiency matters. In men and postmenopausal women, gastrointestinal blood loss must be excluded. Coeliac disease, heavy periods, pregnancy and malabsorption are other causes. Treating with iron without investigating the cause can delay diagnosis.
Tests that may be needed
- Full blood count and red cell indices
- Reticulocyte count
- Peripheral smear
- Ferritin, serum iron and transferrin saturation
- Vitamin B12 and folate
- Haemolysis markers
- Kidney, liver and thyroid function
- Bone marrow examination in selected cases
When to worry
Seek urgent care for chest pain, breathlessness at rest, fainting or active bleeding. Unexplained anaemia with weight loss, black stools or a family history of gastrointestinal cancer needs prompt investigation.
Treatment
Treatment depends on the cause. Iron replacement, B12 or folate supplementation, treatment of blood loss, disease-specific therapy or transfusion may be needed. Response is monitored with repeat blood counts.
The bottom line
Anaemia is a clue. A careful evaluation identifies the cause and prevents both under-treatment and unnecessary treatment.
Frequently asked questions
Answers reviewed by Dr. Jitendra Prasad Yadav • MBBS, MD (Internal Medicine), FICN (Neurology), FCNV, FIHM • NMC 8029
Iron treats the deficiency but not the cause. Unexplained iron deficiency, especially in men and postmenopausal women, needs investigation for gastrointestinal blood loss.
Usually for several months after haemoglobin normalises to replenish iron stores. The duration depends on the cause and response.
Trait carriers usually have mild or no anaemia. Disease occurs when both genes are affected and can require lifelong transfusion.
Repeated transfusions cause iron overload, which can damage the heart, liver and endocrine organs. Chelation removes excess iron.
Progressive tingling starting in both feet, especially with diabetes, B12 deficiency or chemotherapy history, suggests peripheral neuropathy. Dr. Jitendra evaluates distribution (glove-stocking), underlying cause labs, and NCS/EMG when indicated. Burnout or anxiety alone rarely causes persistent stocking numbness — tar…
More: All FAQs → · Ask Dr. Jitendra →
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References & Review
Reviewed by Dr. Jitendra Prasad Yadav • Last reviewed: 2026-11-10
- International Classification of Headache Disorders, 3rd edition (ICHD-3).
- Harrison's Principles of Internal Medicine — Neurology sections.
- American Academy of Neurology guidelines for selected conditions (where applicable).
Content is educational and aligns with standard medical references; individual evaluation may vary. External links provide context and do not imply endorsement.