Hematologist
CION Cancer Clinics
Anaemia symptoms beyond tiredness | CION Cancer Clinics
The commonest symptoms of anaemia in adults are tiredness, breathlessness on stairs, a fast or pounding heartbeat, pale inner eyelids, headaches and dizziness. Less obvious signs include brittle nails, a sore tongue, restless legs and cravings for ice or mud. A mild low haemoglobin often causes no symptoms at all, so a blood test is the only way to know. At CION Cancer Clinics, our haematologist cares for anaemia, bleeding, clotting and inherited blood disorders, with ArogyaSri, CGHS and cashless insurance accepted.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What are the symptoms of anaemia in adults?
- Which symptoms go beyond feeling tired?
- Can a symptom hint at the cause?
- What do people wrongly believe about these symptoms?
- What should you do if these symptoms sound familiar?
- Who is most likely to have these symptoms dismissed?
- Common questions about anaemia symptoms
The short answer
What are the symptoms of anaemia in adults?
The most common symptoms are tiredness, getting breathless on stairs, a pounding or fast heartbeat, pale skin or pale inner eyelids, headaches and feeling dizzy when you stand up. Many adults with a mild low haemoglobin have no symptoms at all, and find out only from a blood test.
Why the symptoms are easy to miss
When haemoglobin falls slowly over months, the body adjusts. The heart pumps a little harder and you quietly do less. People blame work, age, the heat or poor sleep. By the time someone says they feel tired all the time, the count may have been low for a long while.
Why the speed of the fall matters
A fast drop, such as from bleeding, causes strong symptoms even at a level that would feel mild if it had fallen slowly. So how you feel is not a reliable guide to the number, and the number is not a reliable guide to how you feel.
What symptoms cannot tell you
No symptom confirms anaemia, and none rules it out. Every symptom on this page has other causes, from thyroid problems to diabetes to low mood. Only a blood test, a complete blood count, can show whether your haemoglobin is low.
This page describes symptoms. It is not a diagnosis, and it cannot tell you what is causing yours.Beyond tiredness
Which symptoms go beyond feeling tired?
These are the signs people often do not connect with their blood. Some are general. A few hint at a particular cause.
Heart and breathing
With less oxygen carried per beat, the heart speeds up to keep supply going. You may feel it thumping, or get breathless doing things that were easy before.
You may notice
- Breathless on stairs or a slope
- A racing or skipping heartbeat
- Ankle swelling in older adults
Skin, nails and hair
Paleness is easiest to see inside the lower eyelid, on the gums and on the palms, especially on darker skin. Low iron can also make nails thin, brittle or spoon-shaped, and hair fall more than usual.
Mouth and tongue
A sore, smooth or red tongue, cracks at the corners of the mouth and mouth ulcers can come with low iron, vitamin B12 or folate.
A smooth, sore tongue with tingling feet points more towards low B12.Brain, mood and sleep
Poor concentration, forgetfulness, irritability and low mood are common. Restless legs at night, an urge to keep moving them, are linked with low iron.
Unusual cravings
A strong urge to chew ice, raw rice, chalk, clay or mud has a name, pica. It is a well-known clue to low iron, and people rarely mention it unless asked.
Nerves, eyes and urine
Numbness or tingling in the hands and feet, or unsteady walking, can come with low B12. Yellow eyes with dark, cola-coloured urine can mean red cells are breaking down early.
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Symptoms that need emergency care today
Go to the nearest emergency department, or call 108, if you have chest pain, are breathless while resting, have fainted, or are passing black, tarry stools or vomiting blood. The same applies to sudden yellow eyes with dark urine and fever. These can mean fast bleeding or rapid red cell breakdown. Take any recent blood report with you. Do not wait to see whether it settles.
Clues, not answers
Can a symptom hint at the cause?
If you notice this
A doctor may think of
Craving ice or mud, brittle or spoon-shaped nails
Low iron, often from blood loss or diet
Tingling feet, a sore smooth tongue, poor memory
Low vitamin B12 or folate
Yellow eyes and dark urine
Red cells breaking down early, called haemolysis
Black stools, or very heavy periods
Blood loss from the gut or the womb
Frequent infections, easy bruising or bleeding gums as well
A problem affecting more than red cells, which needs a full blood count and review
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Commonly believed
What do people wrongly believe about these symptoms?
"Feeling tired is just part of getting older."
Tiredness in an older adult is common, but low haemoglobin in older age usually has a cause worth finding, such as kidney disease, a vitamin shortage or hidden bleeding. A simple blood test is a reasonable first step.
"If I were anaemic, I would look pale."
Paleness of the face is hard to judge, especially on brown skin and in poor light. Many people with a clearly low haemoglobin look normal to their families. The inside of the lower eyelid is a better place to look, and a blood test is better still.
"Men do not get anaemia."
They do, and when they do it always needs an explanation. Without monthly blood loss, a low haemoglobin in a man makes a doctor look for slow bleeding from the stomach or bowel, even if he feels otherwise well.
"A tonic from the medical shop will fix the tiredness."
A tonic cannot fix a cause it does not treat. If the problem is low B12, kidney disease or bleeding, iron or a multivitamin may change nothing, or make you feel slightly better while the real cause continues. Get the blood test first and talk to your doctor before starting anything.
Next steps
What should you do if these symptoms sound familiar?
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Write down what you notice
Note which symptoms you have, when they started, how your periods are, any change in stool colour, weight loss and any medicines or painkillers you take regularly.
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Ask for a complete blood count
Your family doctor or a physician can order it. It shows your haemoglobin, the size of your red cells, and your white cells and platelets in one report.
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Take your old reports along
A trend tells your doctor much more than a single result. Earlier reports from any lab help, even if they look unrelated.
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Expect tests for the cause
If haemoglobin is low, iron studies, vitamin B12, folate and kidney function are usually next. The results decide whether you need gut tests, a gynaecology review or a haematologist.
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Follow up the result
Go back for the repeat blood count your doctor asks for. It shows whether treatment of the cause is working.
Often overlooked
Who is most likely to have these symptoms dismissed?
Some groups are more likely to have symptoms put down to something else. If you are in one of them, it is fair to ask for a blood test.
Women with heavy periods
Heavy bleeding is often treated as normal within families. Soaking through pads quickly, passing large clots or bleeding for longer than usual can steadily drain iron.
Older parents
Breathlessness, confusion or falls in an older parent are easily blamed on age. Low haemoglobin is a common and checkable reason.
People with long-term illness
Kidney disease, diabetes, rheumatoid arthritis and long-standing infections can all lower haemoglobin gradually.
When a haematologist is needed
A haematologist, a blood specialist, is the right person when other counts are also abnormal, when red cells are breaking down, or when the cause stays unclear. At CION, Dr. Basudev Pokhrel reviews such cases and discusses them with a wider team where needed.
Questions we are asked
Common questions about anaemia symptoms
What is usually the first sign of low haemoglobin?
For most adults it is tiredness that sleep does not fix, often with breathlessness on stairs. Because these creep up slowly, many people do not notice the change until someone else points it out or a routine blood test shows a low result.
Can low haemoglobin cause headaches and dizziness?
Yes. With less oxygen reaching the brain, headaches, light-headedness and dizziness on standing are common. They have many other causes too, including dehydration and blood pressure changes. If you faint, or dizziness comes with chest pain or breathlessness at rest, seek emergency care.
Why do my legs feel restless at night?
Restless legs, an uncomfortable urge to move them when you lie down, are linked with low iron stores. This can happen even when haemoglobin is only slightly low or still normal. A ferritin test, which measures stored iron, is often part of checking this.
Can low haemoglobin cause hair fall?
Low iron can contribute to hair thinning and hair fall, along with brittle nails. Hair fall has many other causes, including thyroid problems, stress and recent illness. A blood test that includes haemoglobin and ferritin helps sort out whether iron plays a part.
How do I check for paleness at home?
Gently pull down the lower eyelid in good daylight. The inside is normally pink to red. A very pale inner lid, pale gums or pale palm creases can suggest a low haemoglobin. This is a rough check only. A normal look does not rule anything out, and a blood test is needed.
Are the symptoms different in older adults?
Often, yes. Older adults may show confusion, falls, worsening breathlessness, ankle swelling or chest discomfort rather than simple tiredness. Heart and lung conditions can make symptoms stronger at the same level. Families should not accept these as just ageing without a blood test.
Could my symptoms mean blood cancer?
Usually not. Most people with these symptoms have low iron, a vitamin shortage or blood loss. Blood cancer is less common, and it tends to show other changes, such as repeated infections, easy bruising, fevers or night sweats, and abnormal white cells or platelets. A blood count is the way to check.
Which test should I ask for?
Start with a complete blood count, sometimes called a CBC or haemogram. It shows haemoglobin and the size of your red cells. If haemoglobin is low, your doctor will usually add iron studies, vitamin B12 and folate. Take the report back to your doctor rather than reading it alone.
Your Haematologist
Meet CION's haematologist. One specialist for your blood report and your plan.
Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Where to find us
Our centres in and around Hyderabad
Addressed by landmark, because that is how this city navigates. A haematology consultation can be booked at any of these centres through one helpline, and your team will tell you where each test or treatment takes place.
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Sources
- NHS — Iron deficiency anaemia
- NHS — Vitamin B12 or folate deficiency anaemia
- World Health Organization — Anaemia fact sheet
- NICE Clinical Knowledge Summaries — Anaemia - iron deficiency
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
What low haemoglobin actually meansThe starting point if your report says lowHaemoglobin levels: what is normal by age and sexCheck your number against the usual rangesWhich tests find the causeWhat happens after the first blood countLow haemoglobin in men: why it needs an explanationWhy doctors look for hidden bleedingWhen low haemoglobin needs a haematologistThe signs that call for a blood specialist
Talk to us
Worried your symptoms and your report do not add up?
Share your blood report or call the helpline. A CION haematology team member will go through it with you and explain the sensible next step. One helpline serves every CION centre.