What vitamin deficiency causes anemia


Anemia (Anemia): Deficiency of red blood pigment, hemoglobin and usually also of red blood cells in the blood. Anemia is the most common blood disease of all, affecting women more often than men. It is caused by the reduced formation or increased breakdown of red blood cells and blood loss. Therapy and prognosis depend on the cause of the anemia.

Leading complaints

Little or no discomfort with slow development


  • Fatigue, poor performance, dizziness
  • Pallor of the skin and mucous membranes, whereby the assessment of the mucous membranes is more reliable (too wide a range of "normal" skin color)
  • In the case of iron deficiency, dry skin (tears in the corners of the mouth), burning tongue and brittle nails are also the cause
  • Palpitation and shortness of breath on exertion
  • Additional side effects depending on the underlying disease, e.g. B. Heavy and / or frequent menstrual bleeding or black bowel movements

When to the doctor

For the next two weeks at uncharacteristic complaints related to anemia

In the next few days if In addition, palpitations, shortness of breath or very frequent dizziness occur even with light physical exertion

The illness

Depending on the underlying disease, anemia is divided into three groups:

  • Decreased production of functional red blood cells
  • Anemia due to the increased breakdown of red blood cells
  • Anemia due to blood loss

Whether someone has anemia can often be seen with the naked eye: on the far left a patient with anemia, for comparison in the middle a man without anemia. On the right is a method of recognizing possible anemia: If you pull the eyelid down, the many small blood vessels on the inside of the lid become visible. If these are bright red, there is most likely no anemia.

Decreased production of functional red blood cells

This group makes up the lion's share. Normally, the red blood cells are made in the bone marrow, provided that all the necessary building materials are available in sufficient quantities. If there is a lack of one of these starting materials (e.g. iron, vitamin B12), insufficient or dysfunctional blood cells are produced (Anemia due to erythropoietic disorder):

Lack of iron. Usually the bottleneck is iron, which is essential for the formation of the red blood pigment (hemoglobin). These Iron deficiency anemia accounts for 80% of all anemia cases. The iron deficiency in adulthood is often the result of chronic blood loss, for example through excessive menstrual bleeding in women or constant oozing bleeding from the stomach or intestines with gastrointestinal ulcers or tumors. Inadequate dietary iron intake also promotes iron deficiency anemia. Women are particularly at risk because their menstrual cycle means they have an increased need for iron. During pregnancy, the iron requirement doubles as what the pregnant woman has to consider in her diet. Blood donors also need more iron. More rarely, intestinal diseases or operations lead to insufficient iron absorption from the intestine despite normal iron intake. Most people with iron deficiency anemia only show the uncharacteristic symptoms of anemia described above.

As the figure shows, the daily iron intake roughly corresponds to the daily iron excretion - there is not an excessively large reserve in the iron balance. Therefore, even a relatively small increase in iron loss or iron requirement after a long period of existence leads to iron deficiency anemia.
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Further information on iron and iron requirements or Ferrum

Iron deficiency is not a diagnosis to be satisfied with, but a symptom whose cause must be clarified.

Deficiency in vitamin B12 and folic acid. In the case of a vitamin B12 and / or folic acid deficiency, the precursors of the red blood cells in the bone marrow do not mature properly, and as a result there are too few functional red blood cells. Due to the abnormal size of the blood cells formed, these forms of anemia are also summarized as megaloblastic anemia (mega = large; blast = preliminary stage of a cell).

A Folic Acid Deficiency Anemia occurs relatively often because the folic acid supply is usually poor and the body does not store the vitamin, so that even a slight malnutrition can lead to a relevant deficiency.

The Vitamin B12 Deficiency Anemia is most often caused by an autoimmune inflammation of the gastric mucosa, which leads to an impaired absorption of vitamin B12. This leads to anemia, combined with abnormal sensations (e.g. tingling) and gait disorders, as the nervous system also suffers from the vitamin deficiency. This form of vitamin B12 deficiency anemia is also called pernicious anemia (pernicious anemia). Intestinal diseases, e.g. B. chronic inflammatory bowel diseases, can lead to a vitamin B12 deficiency as well as a folic acid deficiency due to a reduced absorption of vitamins from the intestine. Gastric surgery or malnutrition are less common causes.

Information about folic acid in pregnancy

Other causes. The iron balance is also disturbed with long-lasting inflammations or tumors. In this anemia of the chronic disease, there is no iron deficiency, but the sufficient amount of iron is not properly incorporated into the red blood cells (iron utilization disorder).

The production of red blood cells is normally stimulated by the hormone erythropoietin, which is produced in the kidneys. In advanced kidney dysfunction (chronic kidney failure), there is too little of the hormone, and renal anemia (kidney-related anemia) is the result.

Anemia caused by damage to the blood stem cells in the bone marrow, known as aplastic anemia, is rare but serious. Only sometimes can a cause be found, such as certain drugs, poisons, rays or viruses. Often red and white blood cells and platelets are decreased, what the medical professionals then as Pancytopenia referred to as.

Anemia due to the increased breakdown of red blood cells

If the breakdown of red blood cells (hemolysis) is only moderately to slightly accelerated, the bone marrow can compensate for the loss through increased production. But if massive amounts of red blood cells perish prematurely and this loss is higher than the post-production in the bone marrow, one forms hemolytic anemia out. In severe cases, the affected person has a yellowish skin color, as the yellowish bile pigment bilirubin accumulates due to the increased breakdown of the red blood cells. In addition, there is an enlargement of the spleen.

Congenital hemolytic anemia. Most often, hemolytic anemia is congenital and shows up in childhood: characteristic of the Favism due to glucose-6-phosphate dehydrogenase deficiency - an inherited enzyme defect - is one in bursts Anemia, where the flare-ups are triggered by eating broad beans (fava beans, hence the name), certain medicines, or infections. In the Sphere cell anemia (Spherocytosis), defects in the outer “covering” (cell membrane) lead to a spherical shape of the otherwise rather flat red blood cells and thus to accelerated degradation. In the Sickle cell anemia and the Thalassemias "wrong" red blood pigments are formed. In sickle cell anemia, the red blood cells tend to have a sickle shape with the resulting circulatory disorders. Depending on its form and severity, thalassemia causes symptoms of very different severity, including severe anemia and bone changes. Sickle cell anemia and thalassemia are rare in Central Europe, they mainly affect Asians, Africans and residents of the Mediterranean countries.

Acquired hemolytic anemia. If hemolytic anemia does not develop until adulthood, it is usually caused by autoimmune diseases, drugs, infections or cancer, especially lymphomas.

Anemia due to blood loss

The third group of anemia is that Anemia due to blood loss (Bleeding anemia) e.g. B. after a difficult birth, after an accident or after an operation, if more than 1–2 liters of blood have been lost. So that the blood vessels, e.g. If you stay “filled” after an injury, for example, tissue water flows in and thins the blood, so that the level of red blood pigment and red blood cells in the blood drops - anemia occurs. As a result, the production of red blood cells is boosted to provide replacement. If a (relative) iron deficiency develops as part of this increase in production, one speaks - somewhat inconsistently - of iron deficiency anemia.

The doctor does that

The small blood count, or more precisely the hemoglobin value, not only secures the diagnosis of anemia, but also provides initial clues to the cause by providing information on the size and blood pigment load of the red blood cells.

The further narrowing down of the cause is first carried out by blood tests, e.g. B. by determining the reticulocytes (very young red blood cells) to estimate the rate of formation of red blood cells, by ferritin and transferrin determination to assess the iron balance, by vitamin level determination (folic acid; vitamin B12) or antibody search. In the further course, additional examinations may be necessary, for example a gastroscopy and / or colonoscopy to track down a source of bleeding in the case of iron deficiency anemia, a gastroscopy in the case of vitamin B12 deficiency anemia to confirm the gastric mucosal inflammation or a bone marrow puncture if a blood formation disorder is suspected as part of a bone marrow disease.

These examinations are necessary because the treatment of anemia is completely different depending on the cause:

  • At a Iron deficiency anemia a causal stomach or intestinal disease is treated (if necessary, removal of a source of bleeding) and the missing iron is supplied with tablets (e.g. Ferro sanol®, Lösferron®).
Iron tablets work best when swallowed on an empty stomach in the morning. However, many patients cannot tolerate this, and it is better to take the tablets at breakfast. The iron tablets must be taken with plenty of liquid and, if possible, with the upper body upright, so that they do not get stuck in narrow areas of the esophagus and cause ulcers there. Effervescent tablets are a good alternative. A time interval of two hours should be observed between other medications, because iron means that other medications are not properly absorbed by the intestine. Likewise, no large amounts of foods that inhibit iron absorption should be consumed near the time the tablets are taken. These include milk and dairy products, tea and legumes.

First choice products are iron (II) sulfates, as they are directly absorbable. In the event of intolerance, it is possible to switch to trivalent iron (III) preparations, which, however, have to be reduced to bivalent ones by the body before absorption. In order to replenish the iron stores, the treatment must be carried out for several months (rule of thumb: after normalization of the blood count again for the same time). Don't be alarmed if your stool turns black - that's what comes from the iron tablets. In the event of an intolerance despite a change in preparation, iron can also be injected into the vein or given as a short infusion, which can be easily carried out in the family doctor's practice.

  • Also Vitamin B12 and Folic acid can be replaced with medication, with pernicious anemia requiring injections as vitamin B12 is not absorbed from tablets. Because of the increased risk of gastric cancer, the causative inflammation of the gastric mucosa requires annual check-ups by means of a gastroscopy.
  • In chronic disease anemia, treatment of the underlying disease is paramount. Is z. If, for example, the inflammation improves, the anemia disappears by itself. An iron dose is pointless, as the iron is not used.
  • Renal anemia can now be easily treated with genetically engineered erythropoietin (e.g. ERYPO®) that is injected under the skin.
  • For hemolytic anemia, treatment depends on the cause. In many congenital forms, removal of the spleen improves the symptoms - although it does not change the “weaving defect” in the red blood cells, it extends their survival time and thus improves the symptoms of anemia. In some adult haemolytic anemias and aplastic anemia, treatment can be very difficult and may require immunosuppression (suppressing the immune system) or, in extreme cases, a blood stem cell transplant.
  • Blood transfusions are only required in very severe anemia.

Complementary medicine

Herbal medicine offers many juice or tea cures, brewed from ferruginous plants such as nettle, dandelion, centaury, couch grass, blackberry (leaves) or field horsetail. However, these cannot compensate for an iron deficiency. But there is nothing to prevent it from being used as a support for drug treatment.

Your pharmacy recommends


An important source of iron is (red) meat, but eggs, poultry and fish also provide the important mineral. When it comes to iron, relying too heavily on meat is not healthy because of the high fat content of meat (with an unhealthy fatty acid profile at the same time). Whole grains, legumes, and green vegetables are also high in iron. To improve iron absorption from food, vegetable iron carriers should be eaten together with vitamin C (e.g. peas with potatoes or whole grain products with fresh orange juice or paprika). This enables you to achieve two things: The iron absorption is increased and a vitamin C deficiency is prevented, which can also lead to anemia (even if this is very rare in this country).

Folic acid.

A sufficient supply of folic acid is difficult even with a normal diet. Green vegetables, legumes, potatoes, whole grain products, milk, yeast, offal such as liver and kidney, egg and soy contain a lot of folic acid, but some of it is lost during cooking because folic acid is sensitive to heat and light.

Vitamin B12

occurs in meat, fish, eggs, milk and, in small quantities, in sauerkraut, legumes and root vegetables. However, due to the low requirement, a high storage capacity of the organism and probably also due to "secondary sources" such as unpeeled fruit, an insufficient supply of the vitamin is rare.


Iron. In terms of iron supply, a balanced diet including meat is best. However, renouncing meat does not have to lead to an iron deficiency if the food is carefully composed. Pregnant women, on the other hand, almost always have to take iron tablets - as the unborn child takes precedence, the mother practically always comes up short.

Folic acid. A folic acid deficiency increases the risk of spinal cord malformation (spina bifida) in the unborn child. Women who want to have children should take folic acid tablets as early as possible before conception, but no later than when pregnancy is recognized by the end of the third month, as these have been shown to reduce the risk of malformations.

Folic acid also plays a role in preventing cardiovascular disease. The additional administration of folic acid lowers the homocysteine ​​in the blood, an independent risk factor for the development of cardiovascular diseases.


Dr. med. Nicole menche, dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 15:26

Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.