Friday, July 26 2019 7:48

Is Your Teenager Just Tired or Could it be Anemia?

Written by Dr. Joannie T. Yeh, Main Line Health

Anemia is the most common blood condition, affecting more than three million Americans.

Dr. Yeh: “Hi Mrs. Smith and Tanya, do you have any questions or concerns during your well visit today?”

Tanya, the 15 year old: “No.”

Mrs. Smith: “Well, actually, Tanya seems very pale and tired to me. I’m worried that she has anemia because I am anemic, too.”

This is a very typical conversation in my office. While many people can be at risk for anemia due to poor diet, intestinal disorders, infections, chronic diseases and other issues, teenage girls and women who experience heavy periods are at higher risk than most. While the general prevalence of anemia in the United States is 5.6%, the prevalence among women of reproductive age—ages 15 to 49—is 13.3%.


Anemia 101

Anemia occurs when the number of red blood cells in the body is too low. Red blood cells carry hemoglobin, an iron-rich protein that attaches to and delivers oxygen throughout the body. Without enough oxygen, the body can’t function properly, which affects the heart, brain and other vital organs.

There are three primary categories of anemia—blood loss, low or abnormal production of red blood cells, and the body’s destruction of red blood cells. With blood loss, this can be caused by bleeding in the gastrointestinal tract, or in many cases, heavy menstruation. Issues with red blood cell production may be related to an infection or virus, or a nutritional deficiency such as iron or vitamin B12. There are instances when anemia is caused by a more serious condition, such as kidney disease or cancer, but the most common cause worldwide is iron deficiency anemia.


Recognizing the Symptoms

The symptoms of anemia vary, and may include any of the following:

  • Fatigue
  • Weakness
  • Persistent or severe dizziness
  • Moodiness
  • Weight loss
  • Pale or yellow skin
  • Pale or yellow eyes
  • Cold hands or feet
  • Headaches
  • Shortness of breath
  • Fast or irregular heartbeat
  • Chest pain
  • Pounding or “whooshing” in your ears

With so many teenagers exhausted by hectic schedules and poor sleep habits—and potentially moody as a result of hormones and other factors—how are parents to know when their daughter is anemic rather than simply exhibiting typical teenage behavior or other problems?


Diagnosing Anemia

When anemia is suspected, a doctor might begin by asking the patient a lot of questions about specific symptoms, diet and genetic diseases in the family. The next step might be to check the vital signs such as blood pressure and heart rate, and carefully examine the skin, eyes, heart, pulses and abdomen. The exam might be followed by a blood test to measure hemoglobin and other important levels.

In some medical offices, the hemoglobin level (a protein to check for anemia) can be measured with a simple prick of a finger. For Tanya, who vehemently denies her mom’s concerns, her level was normal and her mom was reassured.

If the level is low, which could be indicative of anemia, if the physician has some other concerns, or if the prick test is not available in the office, the patient will be directed to the lab for further testing. Typically, a complete blood count (CBC) will be ordered to check the levels of red blood cells, white blood cells, hemoglobin, size of the red blood cells, and platelets.

Sometimes iron and vitamin levels may be ordered as well. And in some cases, additional tests may be ordered to identify or rule out other diseases.



Treatment for anemia depends on the cause. For teenage girls and women who are anemic due to heavy menstrual flow, doctors will often recommend taking birth control pills to lighten the menstrual flow.

If anemia is due to a nutritional deficiency, then a change in diet or taking nutritional supplements can be the answer. In more complicated cases, the physician might suggest a visit to a hematologist—a physician who specializes in blood disorders.


When to Seek Immediate Care

Be sure to contact your child’s doctor right away when there is shortness of breath, severe dizziness, irregular heartbeat or yellowing of the skin or eyes.



By far, the two most common causes of anemia in teenage girls are nutritional deficiencies and heavy menstrual cycles. In terms of prevention, we should all be eating a well-balanced diet that provides the nutrients our bodies need to function properly. Eat iron-rich foods such as red meat, pork, poultry, seafood and dark leafy greens like spinach, kale, collard greens and Swiss chard.

Vegetarians and vegans can turn to iron fortified foods, nutritional yeast—a non-meat source of vitamin B12—and sometimes vitamin supplements, whole-grain breads, pasta, rice, and multi-grain cereal or bran flakes.

A healthy lifestyle can be the best form of prevention for many medical problems.

The best way to approach suspected anemia is identification of diagnosis. While the cause of fatigue in teenagers can very well be related to too many activities and too little sleep—including late night social media sessions—if you’re concerned that your daughter might have anemia, make an appointment with your child’s primary care physician for a thorough evaluation.


Joannie T. Yeh, M.D., is a pediatrician with Nemours duPont Pediatrics Media. Her practice is located at Riddle Hospital, part of Main Line Health. Dr. Yeh received her medical degree from the University of Illinois at Chicago, and completed her residency at Nemours Alfred I. duPont Hospital in Wilmington. She is a member of the American Academy of Pediatrics, and is fluent in English, Chinese and Mandarin.

Tagged under: anemia, Health, Women's Health