Is there a link between anemia and psoriasis? Anemia is common in people with psoriasis, psoriatic arthritis (PsA), and other inflammatory and autoimmune conditions. But anemia is sometimes overlooked in people with psoriasis and PsA because fatigue — a major symptom of anemia — is a common symptom of autoimmune diseases, too.

If you’re living with psoriasis and think you may have anemia, be sure to talk to your doctor or dermatologist. Here’s more on anemia and psoriasis.

What Is Anemia?

Anemia is a condition that occurs when the blood cannot carry enough oxygen to meet the body’s needs. In people with anemia, the blood has low levels of hemoglobin, a protein found in red blood cells that carries oxygen.

Anemia can occur for several reasons. You may develop anemia if your body:

• Isn’t making enough hemoglobin
• Isn’t making enough red blood cells to carry the hemoglobin
• Is losing blood due to bleeding
• Is breaking down red blood cells faster than it should

The most common types of anemia with psoriasis — particularly among those who also have psoriatic arthritis — are iron deficiency anemia and anemia of chronic disease. In some cases, people with psoriasis may experience pernicious anemia.

Iron Deficiency Anemia

Your body needs iron to make hemoglobin for new blood cells. Iron deficiency anemia can occur if you don’t eat enough iron, have poor iron absorption in the gut, or experience blood loss.

Anemia of Chronic Disease

Anemia of chronic disease, also called anemia of inflammation, can occur in people with conditions that cause chronic (ongoing) inflammation, such as psoriasis.

Long-term inflammation in inflammatory diseases like psoriasis can affect how the body uses iron to produce red blood cells. Anemia of chronic disease is typically mild.

Pernicious Anemia

Pernicious anemia is a rare autoimmune condition that sometimes occurs in people with psoriasis. People with pernicious anemia can’t properly absorb vitamin B12, which is needed to produce healthy red blood cells. In pernicious anemia, the immune system attacks a protein produced in the stomach known as intrinsic factor. This protein is needed to absorb vitamin B12.

What Causes Anemia With Psoriasis?

There isn’t much research specifically on anemia and psoriasis. Some research has found that people with psoriasis tend to have poor iron storage — especially people with low body mass. Scientists don’t fully understand how psoriasis is linked to abnormal iron metabolism and storage, but the study indicated that the severity of psoriasis didn’t impact iron levels.

Inflammation in psoriasis can also cause anemia of chronic disease. Chronic inflammation can decrease the production of a hormone produced by the kidneys that stimulates the production of red blood cells. Additionally, chronic inflammation can decrease the lifespan of red blood cells and prevent the recycling of iron to create more hemoglobin and red blood cells.

What Autoimmune Diseases Are Linked to Anemia?

Autoimmune conditions such as rheumatoid arthritis, inflammatory bowel disease (which includes Crohn’s disease and ulcerative colitis), and systemic lupus erythematosus (or simply lupus) are more commonly linked to anemia of chronic disease than psoriasis.

Symptoms of Anemia

If you have psoriasis, it’s important to recognize the signs and symptoms of anemia. Seek medical advice if you experience symptoms such as:

• Fatigue
• Weakness
• Shortness of breath
• Dizziness or lightheadedness
• Fast or irregular heartbeat
• Headaches
• Pale or yellowish skin
• Cold hands and feet
• Chest pain

Iron deficiency anemia can cause additional symptoms, including:

• A sore or inflamed tongue
• Brittle nails
• Poor appetite (usually in infants and children)
• Pica, a craving to eat ice, clay, chalk, or other nonfood items

Pernicious anemia can also cause symptoms such as:

• Numbness or tingling in the hands and feet
• Difficulty walking or maintaining balance
• Diarrhea
• Confusion
• Loss of smell

Fatigue is typically the most common symptom of anemia. The more severe the anemia, the more symptoms a person will generally experience. People with very mild anemia may not experience any symptoms at all. People who have psoriasis may also experience fatigue.

How Is Anemia Diagnosed?

Anemia can be diagnosed with blood tests to measure blood components, including hemoglobin levels and red blood cells.

According to the American Society of Hematology, anemia is generally defined as having a hemoglobin level less than 13.5 grams per deciliter in men and 12 grams per deciliter in women. A blood test can also help your doctor diagnose the type and cause of anemia by measuring levels of iron, folate (folic acid or vitamin B9), and vitamin B12.

How Is Anemia Treated?

Treating anemia can prevent other health complications and improve your quality of life. As one MyPsoriasisTeam member said, “I’m feeling better now that I’m not anemic anymore.”

Treatment options for anemia typically depend on the cause.

Treating Underlying Inflammation

Treating the underlying cause of inflammatory disease is an important part of treating anemia of chronic disease. Some biologic drugs used to treat psoriasis and PsA can help improve anemia.

Some research has shown that tumor necrosis factor-alpha (TNF-alpha) inhibitors — a type of biologic drug used in the treatment of psoriasis and other inflammatory health conditions — can also improve anemia in some people. One study found that TNF-alpha inhibitors effectively increased hemoglobin levels while treating underlying disease activity in people with rheumatoid arthritis and psoriatic arthritis.

However, it’s also important to know that TNF inhibitors have also been associated with an increased risk of anemia in some people with psoriasis.

Increasing Iron Intake

Iron deficiency can often be treated with dietary changes or iron supplements. Foods rich in iron include:

• Meat
• Seafood
• Legumes (beans, peas, and peanuts)
• Leafy green vegetables (spinach and kale)
• Dried fruit (apricots and raisins)
• Foods fortified with iron (cereal, bread, and pasta)

Eating foods rich in vitamin C — such as citrus fruits, broccoli, peppers, strawberries, melons, and tomatoes — can help improve iron absorption.

Eating a balanced, nutritious diet can help prevent iron deficiency, and other diet strategies for psoriasis may help decrease inflammation.

Over-the-counter or prescription iron supplements may be needed to restore healthy iron levels as well. Always talk to your dermatology team or another healthcare provider before taking supplements to avoid unwanted side effects.

Taking Vitamin B12 and Folate Supplements

Supplemental vitamin B12 or folate is often used to treat anemia in people with deficiencies in these vitamins. People with pernicious anemia may need vitamin B12 injections and vitamin B12 supplementation throughout their lives in order to maintain healthy B12 levels.

MyPsoriasisTeam members report that B12 shots have been effective. “When my B12 depletes, I get shots that bring my B12 levels up for a year or two,” said one member.

Another said, “I had some general blood tests and discovered a vitamin B12 deficiency. I have a regular injection, and my psoriasis is 80 percent better.”

Taking Medications That Stimulate Red Blood Cell Production

In some cases, your doctor may recommend drugs to increase the production of red blood cells. These are usually prescribed for people with low levels of red blood cells due to chronic inflammation, cancer, or chemotherapy.

Having a Blood Transfusion

Severe anemia that is potentially life-threatening may require a red cell blood transfusion. A transfusion of red blood cells is typically only used to treat severe anemia that has not responded to other treatments and will only provide temporary relief.

Join the Conversation

On MyPsoriasisTeam, people share their experiences with psoriasis and psoriatic arthritis, get advice, and find support from others who understand.

Have you experienced anemia since being diagnosed with psoriasis? Let others know in the comments below.