Anemia is one of the most common blood disorders. It affects more than three million Americans.¹
People with anemia may experience significant skin itching and rashes. This is particularly true if they are allergic to treatment.²
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Anemia is typically characterized by having low levels of healthy red blood cells. Your doctor will test for anemia by looking at your blood hemoglobin levels. Hemoglobin is an iron-containing protein found inside red blood cells.
Generally, anemia is defined as hemoglobin levels of less than 13.5g/dL in men and less than 12g/dL in women.³
Having low hemoglobin levels means your body’s tissues don’t receive enough oxygen. This might leave you feeling tired, dizzy, and weak. You might also be short of breath and have an increased heart rate.
Iron deficiency anemia is the most common type of anemia. It is caused by low iron levels in the body.
Aplastic anemia is another type. It occurs when the bone marrow does not produce enough red blood cells.
Other anemias include the following:
Anemia secondary to hemorrhage or blood loss: Reasons for blood loss may include gastrointestinal bleeding, menstrual bleeding, and injury.
Pernicious anemia: An autoimmune condition where the immune system attacks healthy stomach cells. This stops vitamin B12 from being naturally absorbed, which affects red blood cell production.
Hemolytic anemia: Red blood cells are destroyed too early in this type of anemia, meaning the supply can’t keep up with your body’s demand. This can occur in certain autoimmune conditions, such as lupus, or with certain infections or drugs.
Macrocytic anemia: The red blood cells are larger than normal in this type of anemia, meaning they cannot do their job effectively. Macrocytic anemia can occur in people who are very low in vitamin B12 or folate.
Skin problems related to anemia or anemia treatment may be referred to as “anemia rash.” However, this is not a medical term and is not commonly used by medical professionals.
Some people with anemia may experience skin changes such as pallor (pale skin), which can make blood vessels more visible and give the skin a reddish or purplish appearance. Some people mistake this for a rash.
People with iron deficiency anemia may develop an itchy skin condition known as pruritus, but this is rare. Research suggests that iron deficiency anemia and associated low hemoglobin production can reduce the body’s ability to correctly assemble the elastic fibers in the skin, which could lead to itching.⁴
In some cases, treatment for iron deficiency anemia causes skin problems. For instance, your doctor may prescribe an iron supplement called ferrous sulfate to raise your iron levels and relieve your symptoms. Some people are allergic to this therapy and may experience itchy rashes, hives, and swelling of the lips, tongue, or throat.⁵
Aplastic anemia can also cause petechiae — small, round, red dots that appear on the skin. Petechiae can look like a skin rash. It occurs because aplastic anemia prevents blood clotting, which can cause more bleeding in the small blood vessels.⁶
Your doctor will perform a physical exam to evaluate your skin concerns and ask if you are experiencing any other anemia symptoms.
Tests are carried out to diagnose anemia, typically starting with a complete blood count (CBC). Your blood sample will be studied in a lab to understand your hemoglobin levels and red blood cell count. Your doctor may also recommend a peripheral blood smear to examine your blood cells through a microscope. This technique can help them understand the cells’ shape and size.
If these tests indicate you have anemia or there are abnormalities in your red blood cells, your doctor may request a bone marrow examination. A sample of bone marrow will be taken and examined to see if it’s making healthy red blood cells. This test is only required in rare cases.
The best way to treat anemia rash is to address the underlying cause. There are several treatment plans depending on the type of anemia you have.
Your doctor may recommend increasing your iron levels if you have iron deficiency anemia. You can do this through dietary changes, iron supplementation, iron infusions, or blood transfusions.
As mentioned above, iron supplements are thought to cause allergic reactions in some people. Other possible side effects include the following:⁷
Tarry black stools
Your doctor will advise you on how to take iron supplements safely. Do not start taking over-the-counter iron supplements without first speaking to your doctor.
If you think you are having an allergic reaction to the supplements you are taking, seek immediate medical attention.
People with aplastic anemia may need a bone marrow transplant to replace damaged cells with healthy ones. They may also receive medications to try to stimulate the bone marrow to make more red blood cells.
Additional treatments include the following:
Iron transfusions: If dietary changes or oral supplements don’t raise your iron levels effectively, your doctor may recommend having an intravenous iron transfusion to quickly restore your iron levels. An iron transfusion is often recommended if you have an upcoming surgery or you are due to give birth.
Blood transfusions: Your doctor may recommend a transfusion of red blood cells, especially if you have anemia secondary to significant bleeding. Note that this will only reduce your symptoms; it won’t cure your anemia. Blood transfusion could also become less effective long-term as your body develops antibodies.
Immunosuppressants: In the case of autoimmune-related anemia, immunosuppressants stop your immune system from damaging healthy cells and tissues.
You may want to relieve your irritated skin as you wait to improve your anemia symptoms.
For pruritus related to iron deficiency anemia, you may wish to use topical corticosteroids or antihistamines to help with itching. Keep the affected area moisturized, as dry skin can worsen your discomfort.
The only way to prevent anemia rash is to treat your anemia or take steps to prevent it from occurring in the first place.
You can prevent iron deficiency anemia in some cases by eating an iron-rich diet. Aplastic anemia is not preventable.
This rash won’t go away on its own. The good news is that both aplastic and iron deficiency anemia are treatable. Once you treat your anemia, your rash will improve.
It would be best to see your doctor if you’re experiencing any skin changes, especially if:
You have rashes covering a large part of your body.
The rash comes on suddenly with no clear cause or spreads very quickly.
The rash doesn’t improve with home treatment or lasts longer than two weeks.
The rash is severe.
The rash is painful.
The rash is blistering, swelling, or bruising.
You experience other symptoms, like feeling tired or difficulty breathing.
Skin rashes have many possible causes. Most won’t be related to anemia. If you are feeling unwell or have a fever, please seek medical attention immediately.
Developing skin problems from anemia can occur, but this is typically rare.
Tell your doctor if you develop a rash and other anemia symptoms. Treating the underlying cause of anemia is the best way to clear anemia rash and other side effects.
Anemia | American Society of Hematology
Aplastic anemia (2023)
Iron supplementation (2023)