💉 Men's Health

Anaemia — Types & Causes (Nigeria Guide)

Q: Is Guinness stout good for anaemia?

This is a very common belief in Nigeria — that Guinness stout supplements iron. Guinness does contain very small amounts of iron, but not enough to treat deficiency. The alcohol in Guinness also reduces iron absorption. It is not a treatment for anaemia. Iron tablets prescribed by a doctor are far more effective.

Q: Why isn't my haemoglobin rising despite taking iron tablets?

Common reasons: still actively losing blood (heavy periods, hookworm — the cause must be treated), taking iron with tea or milk (blocks absorption), not taking supplements consistently, wrong diagnosis (not actually iron deficiency), or malabsorption. Review with your doctor if no improvement after 4 weeks.

Q: Can I get anaemia from donating blood?

Healthy people recover from blood donation within 4–8 weeks. The blood bank checks your haemoglobin before donation and will not take blood if you are anaemic. If you donate regularly, ensure your diet is iron-rich and consider iron supplementation. You cannot donate if you are pregnant, have SCD, or have a very low haemoglobin.

Q: How is anaemia different in pregnant women?

Pregnancy causes a physiological dilution of blood (plasma volume rises more than red cell mass) — so haemoglobin normally drops slightly in pregnancy (to ~10.5–11 g/dL). True anaemia in pregnancy is Hb <10 g/dL in the first and third trimesters, <10.5 g/dL in the second. Iron and folate demand rises significantly — supplementation is essential from the first visit.

Understanding why your blood count is low — iron deficiency, malaria, B12, and beyond

Anaemia — defined as haemoglobin below 12 g/dL in women and 13 g/dL in men — is extremely common in Nigeria. It is not a diagnosis in itself but a symptom of an underlying cause. Getting the cause right determines the treatment. Iron deficiency anaemia (from poor diet, hookworm, heavy periods) is the most common type, but malaria-related haemolysis, chronic disease, vitamin B12 deficiency, sickle cell disease, and aplastic anaemia are all important in the Nigerian context. Treating anaemia without identifying the cause is dangerous — haematinics given for chronic disease anaemia or haemolytic anaemia can cause harm.

Signs and Symptoms

✓ Fatigue, weakness, and reduced exercise tolerance

✓ Pallor — pale conjunctivae (inner eyelids), pale palms, pale tongue

✓ Breathlessness on exertion

✓ Palpitations and awareness of heartbeat

✓ Dizziness, light-headedness, and headache

✓ Cold intolerance

✓ Angular cheilitis (cracked corners of the mouth) — iron or B12 deficiency

✓ Koilonychia (spoon-shaped nails) — severe iron deficiency

Risk Factors

Heavy menstrual bleeding — the most common cause of iron deficiency in women
Poor dietary iron intake — low meat and legume diet
Hookworm infection — causes chronic GI blood loss; very common in rural Nigeria
Malaria — causes haemolysis and bone marrow suppression
Pregnancy — increased iron and folate demand
HIV and AIDS — anaemia of chronic disease, drug side effects (zidovudine)
Chronic kidney disease — reduced erythropoietin production
Vegetarian/vegan diet — B12 deficiency (animal products are the only dietary source)

When to Seek Help

EmergencySevere anaemia with breathlessness at rest, rapid heart rate, or heart failure signs — may require blood transfusion

UrgentHaemoglobin <6 g/dL or rapidly falling haemoglobin in any patient

SoonAnaemia in pregnancy — untreated anaemia increases risk of preterm birth and maternal death

RoutineAny symptomatic anaemia — blood test to confirm and identify cause before treatment

RoutineAnaemia not responding to iron supplements after 4 weeks — wrong diagnosis or ongoing blood loss

Tests & Diagnosis

🧪 Full blood count (FBC) with indices

Haemoglobin, MCV (mean cell volume — small = microcytic, normal = normocytic, large = macrocytic). Key first step in classifying anaemia

🧪 Peripheral blood film

Sickle cells (SCD), target cells (thalassaemia, iron deficiency), hypersegmented neutrophils (B12/folate deficiency), malaria parasites

🧪 Serum ferritin

Most sensitive marker of iron stores. Ferritin <12 µg/L = depleted iron stores. Ferritin is an acute phase protein — may be falsely elevated in infection/inflammation

🧪 Serum vitamin B12 and folate

For macrocytic anaemia (elevated MCV). B12 deficiency: vegans, gastric atrophy, pernicious anaemia. Folate deficiency: poor diet, malabsorption, pregnancy

🧪 Malaria blood film or RDT

For normocytic/haemolytic anaemia with fever — malaria is a very common cause of anaemia in Nigeria

🧪 Reticulocyte count

High = haemolytic or recovering from blood loss. Low = bone marrow failure or aplastic crisis

🧪 Haemoglobin electrophoresis

For suspected haemoglobin disorders — sickle cell, thalassaemia. Essential investigation in Nigeria

🧪 Stool microscopy for ova and parasites

Hookworm — a frequently missed cause of iron deficiency anaemia in rural Nigeria

Treatment Options

Iron deficiency anaemia — oral iron

Ferrous sulphate 200 mg twice or three times daily (take on an empty stomach if tolerated, or with food to reduce GI side effects). Take with vitamin C (orange juice) to enhance absorption. Avoid taking with tea, milk, or antacids. Continue for 3 months after haemoglobin normalises to replenish stores. Expected rise: 1–2 g/dL per week

IV iron (for severe deficiency or intolerance)

Iron sucrose or ferric carboxymaltose — given intravenously in hospital. Faster repletion than oral. Indicated for severe anaemia in pregnancy, CKD, or intolerance to oral iron

Folate deficiency

Folic acid 5 mg daily for 4 months. Always check B12 before starting folate — treating folate alone in B12 deficiency can precipitate subacute combined degeneration of the spinal cord

Vitamin B12 deficiency

Hydroxocobalamin 1 mg IM injection every other day for 2 weeks, then every 3 months lifelong if due to pernicious anaemia. Oral B12 in high doses (1000 µg daily) works if absorption is intact

Malaria-associated anaemia

Treat the malaria with appropriate artemisinin-based combination therapy. Iron supplements after malaria is treated (not during active malaria — iron promotes parasite growth)

Anaemia of chronic disease

Treat the underlying condition. Erythropoiesis-stimulating agents (ESA) for CKD anaemia. Blood transfusion if severely symptomatic. Iron supplements only if also iron deficient

Hookworm treatment

Albendazole 400 mg single dose or mebendazole 100 mg twice daily for 3 days. Repeat FBC 4–6 weeks later. Iron supplementation. Improved sanitation prevents reinfection

Blood transfusion for severe anaemia

For Hb <6–7 g/dL with symptoms of cardiac compromise, respiratory failure, or in pregnancy. Packed red cells 1 unit (expected rise 1 g/dL per unit). Consider diuretic cover (furosemide 20 mg) in cardiac disease

Frequently Asked Questions

Is Guinness stout good for anaemia?

This is a very common belief in Nigeria — that Guinness stout supplements iron. Guinness does contain very small amounts of iron, but not enough to treat deficiency. The alcohol in Guinness also reduces iron absorption. It is not a treatment for anaemia. Iron tablets prescribed by a doctor are far more effective.

Why isn't my haemoglobin rising despite taking iron tablets?