Editing Anemia (section)

==Signs and symptoms==
[[File:Symptoms of anemia.png|thumb|upright=1.2|Main symptoms that may appear in anemia<ref name=":4">[http://www.emedicinehealth.com/anemia/page3_em.htm eMedicineHealth > anemia article] {{webarchive|url=https://web.archive.org/web/20090417032231/http://www.emedicinehealth.com/anemia/page3_em.htm |date=2009-04-17 }} Author: Saimak T. Nabili, MD, MPH. Editor: Melissa Conrad Stöppler, MD. Last Editorial Review: 12/9/2008. Retrieved on 4 April 2009</ref>]] [[File:Anemia.JPG|thumb|upright=1.2|The hand of a person with severe anemia (on the left, with ring) compared to one without (on the right)]]
A person with anemia may not have any symptoms, depending on the underlying cause, and no symptoms may be noticed, as the anemia is initially mild, and then the symptoms become worse as the anemia worsens. A patient with anemia may report [[Fatigue|feeling tired]], weak, decreased ability to concentrate, and sometimes [[shortness of breath]] on [[exertion]].<ref>{{cite web|title=Exercising With Anemia: Prescription for Health|url=http://www.medscape.com/viewarticle/719391|access-date=2022-01-08|website=Medscape|language=en}}</ref> These symptoms are unspecific and none of the symptoms alone or in combination show a good predictive value for the presence of anemia in non-clinical patients.<ref>{{cite journal |last1=Weckmann |first1=Gesine |last2=Kiel |first2=Simone |last3=Chenot |first3=Jean-François |last4=Angelow |first4=Aniela |date=2023-01-24 |title=Association of Anemia with Clinical Symptoms Commonly Attributed to Anemia – Analysis of Two Population-Based Cohorts |journal=Journal of Clinical Medicine |language=English |volume=12 |issue=3 |pages=921 |doi= 10.3390/jcm12030921 |pmid=36769569 |pmc=9918126 |doi-access=free }}</ref>

[[File:Symptoms of anemia are written in Bengali, Hindi and English language on a board at AIIMS Kalyani - 1.jpg|thumb|left|Symptoms of anemia are written in [[Bengali language|Bengali]], Hindi and English language on a board at [[All India Institute of Medical Sciences, Kalyani|AIIMS Kalyani]], [[West Bengal]].]]
Symptoms of anemia can come on quickly or slowly.<ref name=":0">{{cite web |date=2022-03-24 |title=What Are Symptoms of Anemia? |url=https://www.nhlbi.nih.gov/health/anemia/symptoms |access-date=2022-06-26 |website=National Heart, Lung, and Blood Institute.}}</ref> Early on there may be few or no symptoms.<ref name=":0" /> If the anemia continues slowly (chronic), the body may adapt and compensate for this change. In this case, no symptoms may appear until the anemia becomes more severe.<ref name=":4" /><ref name=":7">{{cite web |title=Anemia |url=https://www.hematology.org:443/education/patients/anemia |access-date=2022-01-08 |website=www.hematology.org |language=en}}</ref> Symptoms can include feeling tired, weak, [[dizziness]], headaches, [[Exercise intolerance|intolerance to physical exertion]], shortness of breath, difficulty concentrating, [[Arrhythmia|irregular]] or [[Tachycardia|rapid]] heartbeat, cold hands and feet, [[Cold sensitivity|cold intolerance]], [[pallor|pale]] or [[Jaundice|yellow]] skin, [[poor appetite]], easy bruising and bleeding, and [[muscle weakness]].<ref name=":0" /> 

Anemia that develops quickly, often, has more severe symptoms, including, [[Lightheadedness|feeling faint]], [[Angina|chest pain]], sweating, increased thirst, and confusion.<ref name=":0" /><ref>{{cite journal |last1=Stevens |first1=Gretchen A |last2=Finucane |first2=Mariel M |last3=De-Regil |first3=Luz Maria |last4=Paciorek |first4=Christopher J |last5=Flaxman |first5=Seth R |last6=Branca |first6=Francesco |last7=Peña-Rosas |first7=Juan Pablo |last8=Bhutta |first8=Zulfiqar A |last9=Ezzati |first9=Majid |title=Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data |journal=The Lancet Global Health |date=July 2013 |volume=1 |issue=1 |pages=e16–e25 |doi=10.1016/s2214-109x(13)70001-9 |pmc=4547326 |pmid=25103581}}</ref><ref>{{cite journal |last1=Balarajan |first1=Yarlini |last2=Ramakrishnan |first2=Usha |last3=Özaltin |first3=Emre |last4=Shankar |first4=Anuraj H |last5=Subramanian |first5=Sv |title=Anaemia in low-income and middle-income countries |journal=The Lancet |date=December 2011 |volume=378 |issue=9809 |pages=2123–2135 |doi=10.1016/s0140-6736(10)62304-5 |pmid=21813172 }}</ref><ref>{{Cite journal |last1=Haas |first1=Jere D. |last2=Brownlie |first2=Thomas |date=2001-02-01 |title=Iron Deficiency and Reduced Work Capacity: A Critical Review of the Research to Determine a Causal Relationship |journal=The Journal of Nutrition |volume=131 |issue=2 |pages=676S–690S |doi=10.1093/jn/131.2.676s |pmid=11160598 |doi-access=free }}</ref> There may be also additional symptoms depending on the underlying cause.<ref name="EBM2013" />

In more severe anemia, the body may compensate for the lack of oxygen-carrying capability of the blood by increasing [[cardiac output]]. The person may have symptoms related to this, such as [[palpitations]], [[angina]] (if pre-existing [[heart disease]] is present), intermittent [[claudication]] of the legs, and symptoms of [[heart failure]].<ref>{{cite journal |last1=De Franceschi |first1=Lucia |last2=Iolascon |first2=Achille |last3=Taher |first3=Ali |last4=Cappellini |first4=Maria Domenica |title=Clinical management of iron deficiency anemia in adults: Systemic review on advances in diagnosis and treatment |journal=European Journal of Internal Medicine |date=July 2017 |volume=42 |pages=16–23 |doi=10.1016/j.ejim.2017.04.018 |pmid=28528999 }}</ref>

On examination, the signs exhibited may include [[pallor]] (pale skin, [[mucosa]], [[conjunctiva]] and [[nail beds]]), but this is not a reliable sign. 

Iron-deficiency anemia may give symptoms that can include [[Koilonychia|spoon-shaped]] nails, restless legs syndrome, and pica (the medical condition indicates the desire for things that are not food, such as ice, dirt, etc.).<ref name=":6" /> A blue coloration of the [[sclera]] may be noticed in some cases of iron-deficiency anemia.<ref>{{cite book |last1=Weksler |first1=Babette |url=https://books.google.com/books?id=FTwtDwAAQBAJ&pg=PT105 |title=Wintrobe's Atlas of Clinical Hematology |date=2017 |publisher=Lippincott Williams & Wilkins |isbn=9781451154542 |page=PT105 |language=en}}</ref> Vitamin B<sub>12</sub> deficiency anemia may result in decreased ability to think, memory loss, confusion, personality or mood changes, depression, difficulty walking, blurred vision, and irreversible nerve damage.<ref>{{Cite journal |last=Hector |first=M. |last2=Burton |first2=J. R. |date=December 1988 |title=What are the psychiatric manifestations of vitamin B12 deficiency? |url=https://pubmed.ncbi.nlm.nih.gov/3057051/ |journal=Journal of the American Geriatrics Society |volume=36 |issue=12 |pages=1105–1112 |doi=10.1111/j.1532-5415.1988.tb04397.x |issn=0002-8614 |pmid=3057051}}</ref><ref name=":5" /> Other specific causes of anemia may have signs and/or complications such as, [[jaundice]] with the rapid break down of [[Red blood cell|red blood cells]] as with [[hemolytic anemia]], bone abnormalities with [[Beta thalassemia|thalassemia major]], or leg [[Ulcer|ulcers]] as seen in [[sickle cell disease]].

In severe anemia, there may be signs of a [[hyperdynamic circulation]]: [[tachycardia]] (a fast heart rate), [[bounding pulse]], [[Functional murmur|flow murmurs]], and [[cardiac]] [[ventricular hypertrophy]] (enlargement). There may be signs of [[heart failure]].
[[Pica (disorder)|Pica]], the consumption of non-food items such as ice, paper, wax, grass, hair or dirt, may be a symptom of iron deficiency;<ref name=":6">{{cite web |title=Mental Health and Pica |url=https://www.webmd.com/mental-health/mental-health-pica |access-date=2022-04-26 |website=WebMD |language=en}}</ref> although it occurs often in those who have normal levels of [[hemoglobin]]. Chronic anemia may result in behavioral disturbances in children as a direct result of impaired neurological development in infants, and reduced academic performance in children of school age. [[Restless legs syndrome]] is more common in people with [[iron-deficiency anemia]] than in the general population.<ref>{{cite journal |last1=Allen |first1=Richard P. |last2=Auerbach |first2=Sarah |last3=Bahrain |first3=Huzefa |last4=Auerbach |first4=Michael |last5=Earley |first5=Christopher J. |title=The prevalence and impact of restless legs syndrome on patients with iron deficiency anemia |journal=American Journal of Hematology |date=April 2013 |volume=88 |issue=4 |pages=261–264 |doi=10.1002/ajh.23397 |pmid=23494945 |s2cid=35587006 |doi-access=free }}</ref>