Blood simple

God bless the Queen Mother, as she sails apple-cheeked towards her 101st birthday this Saturday, when there will doubtless be much merriment and flag-waving outside Clarence House. The only sour note in the week's celebrations came yesterday, when she was admitted to London's King Edward VII hospital suffering from severe anaemia. Although she has staunchly pledged to be up and at 'em by Saturday, doctors say she has had to have a blood transfusion to pep her up. Fingers crossed.

As with so many things, what's good enough for the royals is good enough for the rest of us, and anaemia is no exception. The condition is simply a lack of red blood cells in your blood. It leaves you feeling tired and sloth-like and sometimes a little breathless, because your body is being starved of oxygen - it's the red blood cells that lug it all about.

But the causes of the condition aren't quite so simple. It can sometimes be attributed to the body not making enough red blood cells, as in the case of leukaemia or a vitamin deficiency, or your body losing them in a rather careless, down-the-back-of-the-sofa fashion - perhaps because of a stomach ulcer or heavy periods.

To manufacture red blood cells, the body needs iron, vitamin B12 and folic acid, and a deficiency of any of these can lead to anaemia. Premature babies can sometimes suffer from iron deficiency because it is only in the latter part of pregnancy that the unborn child is able to store the necessary quantities of iron for good, rich blood. In pregnant women and growing children, where the body's cells are rapidly dividing, there may also be a lack of iron in the blood as the body scurries around attempting to share it out amongst all of the new cells. It's like feeding the 5,000.

"Elderly people are more at risk of anaemia," says Dr Marc Turner, consultant haematologist at Edinburgh's blood transfusion clinic. "They have more underlying conditions, such as bone marrow problems and ulcers, and traditionally they don't eat very well either."

But, more particularly, it is women who are most at risk. They require more iron than men - 14.8mg a day, compared to a paltry 8.7mg for the gents - yet consume a mere 5mg of iron per 1,000 calories. Studies suggest that 30% of women are deficient in iron, and that 6% of these women have iron-deficiency anaemia, but the real figures are probably much higher.

Of course the menstrual cycle plays its part of this - there's no denying women lose valuable red blood cells, and therefore iron, with every period - but only 10% of cases can be put down to heavy bleeding. What marks women out for anaemia is their decidedly shoddy approach to eating. Women, silly things, skip breakfast, forgoing all of the iron-rich goodness contained in a hearty bowl of fortified crunchy flakes, say, and then stutter through until lunchtime on a diet of coffee and tea, both of which prevent the absorption of iron. With one eye forever on the scales, they restrict their diets, or they become vegetarian, abandoning sources of iron such as red meat and offal, and replacing them with cheese - not known for its astounding iron content.

So how to tell if you're anaemic? The reason it so often goes unnoticed is that symptoms can be very mild. Bags under your eyes and the fact that the walk to work increasingly feels as though you are wading through syrup only means you are virtually indistinguishable from the rest of the overworked population.

The first you may know about your anaemia is when you valiantly turn up to give blood, only to be told to go home and eat better, because you're blood isn't up to it.

If you've not had your blood turned down somewhere, the first significant signs of your anaemia will usually be an inescapable tiredness, palpitations and dizziness. In long-term anaemia, sufferers may find that they experience a burning sensation on the tongue, which may itself feel bizarrely smooth. They may develop sores around the edge of their mouths, and their nails may become raggedy. In some cases, people develop insatiable cravings - known as a pica - for tastes such as coal or liquorice or soil.

Diagnosis comes via a blood test which can be carried out by your GP. Treatment depends upon whether the anaemia is symptomatic of a greater underlying problem, such as an ulcer or leukaemia, or whether it indicates some kind of dietary deficiency. "A minority of patients require a blood transfusion," says Turner. "It's only in cases where, for example, the onset is sudden." In the case of a vitamin deficiency, doctors are more likely to prescribe an iron or a B12 supplement and to advise you to eat a healthy balanced diet. Yes, that old chestnut. Those foods naturally rich in "haem iron", which is easily digested, include red meat, offal such as liver, fish, chicken, and eggs. Those laden with "non-haem iron" are green leafy vegetables, dried pulses and fruits and fortified breakfast cereals. With this second category, it is important to eat them with a hefty dose of vitamin C, which aids the absorption of the non-haem iron.

So, Ma'am, you have been warned: if you want to be up and waving regally on Saturday, you'd better eat your greens - and no skimping on the offal.

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What a scorcher

Useful links
Queen Mother profile - the Royal Report
The British Monarchy - official website

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