Why You Feel So Tired – The Blood Tell
Pale, exhausted, breathless on stairs, heart racing with minimal exertion, dizzy, unable to concentrate – anaemia is one of the most common blood disorders worldwide, yet it is frequently an incidental finding rather than a proactively investigated cause of symptoms. At our practice in Zürich Seefeld, I screen for anaemia and its underlying causes as part of my systematic approach to fatigue and related symptoms.
What Is Anaemia?
Anaemia means your blood does not carry enough oxygen, either because you have too few red blood cells or because your haemoglobin (the oxygen-carrying protein) is too low. The consequences affect every organ system – your brain, heart, muscles, and immune system all suffer when oxygen delivery is compromised.
Types and Causes
Iron deficiency anaemia: The most common type worldwide. Caused by blood loss (menstruation, gastrointestinal bleeding), inadequate dietary intake, or poor absorption (coeliac disease, low stomach acid, gut inflammation). Ferritin drops long before haemoglobin, which is why I check ferritin in all fatigued patients.
Vitamin B12 deficiency anaemia: Causes large, dysfunctional red blood cells (megaloblastic anaemia). Common in vegans, older adults (reduced intrinsic factor), and PPI users. Can cause neurological damage if untreated.
Folate deficiency anaemia: Also megaloblastic. Often related to dietary insufficiency, alcoholism, or increased demand (pregnancy).
Anaemia of chronic disease: Chronic inflammation (autoimmune disease, chronic infection, cancer) traps iron in storage, making it unavailable for red blood cell production. Hepcidin, the iron-regulating hormone, is the key mediator.
Haemolytic anaemias: Red blood cells are destroyed faster than produced. Causes include autoimmune conditions, inherited disorders, and certain medications.
Thalassaemia and other genetic conditions: Inherited haemoglobin disorders that affect red blood cell production and lifespan.
Our Diagnostic Approach
I start with a full blood count, reticulocyte count, iron studies (ferritin, transferrin saturation, serum iron, TIBC), vitamin B12, folate, and inflammatory markers. The pattern of results – cell size (MCV), iron parameters, and reticulocyte response – points to the underlying cause. If gastrointestinal blood loss is suspected, I arrange appropriate investigation.
What We Do: Treating the Cause, Not Just the Number
Iron repletion: Oral iron supplementation (with vitamin C for absorption) for mild deficiency. Intravenous iron for severe deficiency, poor absorption, or when oral iron is not tolerated – IV iron achieves faster, more reliable repletion.
B12 and folate replacement: Injections or high-dose oral supplementation depending on the cause and severity.
Identify and treat the source: If iron is being lost, where is it going? If absorption is impaired, why? Addressing the root cause prevents recurrence.
Monitor and maintain: Follow-up blood work to confirm repletion and maintenance strategies to prevent recurrence.
Conclusion
Anaemia is common, has many causes, and is highly treatable once properly diagnosed. If fatigue, breathlessness, or pallor are affecting your life, a thorough blood evaluation at our practice in Zürich Seefeld can identify and correct the problem.
