According to experts, your eyes can reveal a lot about your overall health. Regular eye exams are not just about checking your vision; they can also help detect other health issues early. So, what does it mean when the eye's mucous membranes look unusually pale? Is it a sign of anemia?
1. Is Pale Eye Mucosa a Sign of Anemia?
If you gently pull down your lower eyelid and notice that the inner surface looks pale instead of its usual pinkish color, it might be a sign of anemia. This happens because, with anemia, the level of hemoglobin decreases. Hemoglobin is the component that gives red blood cells their color. As a result, capillaries, small veins, and even the eye's mucous membrane will appear lighter than usual. In addition to observing pale eye mucosa, there are many other symptoms that can signal anemia early. So, what exactly is anemia? What are its symptoms, and how can it be treated? The following sections will help readers gain a better understanding of this condition.
2. What is Anemia?
According to the World Health Organization (WHO), anemia is a condition characterized by a reduction in the number and size of red blood cells or hemoglobin (Hb) levels below the threshold, leading to decreased oxygen-carrying capacity in the body. Anemia is diagnosed when Hb levels are <13g/dl for adult men and <12g/dl for non-pregnant adult women. More broadly, anemia refers to the reduction of one or more red blood cell parameters, including hemoglobin concentration, hematocrit (Hct), or red blood cell count (RBC). Based on the morphology, size, and color of red blood cells, anemia can be divided into three main types:
- Macrocytic, Hyperchromic Anemia: this type is commonly caused by a deficiency of vitamin B12 or folic acid due to conditions such as stomach removal, liver cirrhosis, inadequate vitamin B12 or folic acid intake.
- Microcytic, Hypochromic Anemia: this is often seen in conditions like hemorrhoids, peptic ulcers, uterine fibroids, stomach cancer, bronchial cancer, bronchiectasis, hookworm infections, poor nutrition in children, and during pregnancy.
- Normocytic Anemia: this type is common in cases of acute blood loss, such as hemorrhage, accidents causing vascular injury, organ rupture, ectopic pregnancy rupture, or uterine rupture.
3. Causes of Anemia
Identifying the cause of anemia plays an important role in establishing an appropriate treatment plan for patients. In general, the causes of anemia can be divided into 3 categories as follows:
3.1 Due to decreased red blood cell production
- Poor appetite, picky eating, and an unbalanced diet that do not provide enough essential components for blood production such as iron, folic acid, and vitamin B12.
- Some conditions that suppress bone marrow or treatments like chemotherapy and radiation therapy can reduce the production of blood cells, causing anemia.
- Kidney failure reduces the production of erythropoietin, a hormone that stimulates blood cell production in the bone marrow.
3.2 Due to increased red blood cell destruction
- Some drugs cause red blood cell breakdown, such as quinine, quinidine, methyldopa, penicillin, ticlopidine, clopidogrel.
- Copper and lead poisoning.
- Malaria, Toxoplasma infection, severe infections…
- Blood group incompatibility between mother and infant, leading to red blood cell destruction, anemia, and jaundice (due to increased indirect bilirubin when red blood cells break down).
- Splenomegaly.
- Immune hemolysis.
- G6PD enzyme deficiency on the red blood cell membrane.
3.3 Due to blood loss or hemorrhage
- Caused by trauma or accidents.
- Conditions that cause hemorrhage include gastrointestinal bleeding due to infections such as dysentery, necrotizing enterocolitis, and Dengue fever…
- Vitamin K deficiency in newborns, which can easily lead to brain hemorrhage and gastrointestinal bleeding.
- Parasitic infections…
4. What are the Symptoms of Anemia?
The symptoms of anemia include:
- Pale skin, pale palms and soles, pale eye mucous membranes.
- Poor concentration in studying and working, reduced physical activity, less flexibility.
- Fatigue, dizziness, lightheadedness.
- Rapid, shallow breathing; palpitations, chest tightness, rapid heartbeat.
- Poor appetite, weight loss. In children, it may cause slow weight and height growth.
- People with iron-deficiency anemia may have symptoms like tongue pain, a smooth or swollen tongue, spoon-shaped nails, and brittle hair.
- In some cases, anemia caused by stomach bleeding presents symptoms such as black stools, epigastric pain, belching, and acid reflux.
- Patients with vitamin B12 deficiency anemia may develop neurological symptoms like numbness, tingling sensations, vision changes, restlessness, irritability, memory decline, and depression.
- If anemia persists for a long time, patients may also experience swelling in both legs. Women may have amenorrhea, while men may suffer from impotence.
5. How is Anemia Treated?
5.1 Iron-Deficiency Anemia
- It is necessary to identify and treat the cause of iron-deficiency anemia.
- Oral iron supplements are the first-line and effective treatment for iron-deficiency anemia. The usual treatment dose for adults is 150-200 mg of elemental iron/day, divided into 2-3 doses for better tolerance.
- Iron is best absorbed on an empty stomach. Therefore, iron supplements should be taken between meals (1 hour before or 2 hours after eating).
- Eat more iron-rich foods like meat, liver, fish, beans, and dark leafy greens such as spinach or water spinach.
- Vitamin C enhances iron absorption. Foods rich in vitamin C include oranges, lemons, guava, and kiwi. Therefore, consuming vitamin C or drinking orange or lemon juice during meals or with iron supplements helps improve absorption.
- In contrast, certain substances like phytates, phosphates, calcium (found in cereals, milk), and polyphenols (found in tea and some vegetables) can reduce iron absorption. These should be consumed in moderation and away from iron intake.
5.2 Folic Acid (Vitamin B9) Deficiency Anemia
- Folic acid deficiency anemia often accompanies iron deficiency. If folic acid supplementation alone does not show significant improvement, combined treatment with iron should be considered.
- Women of childbearing age should take folic acid daily to prevent neural tube defects in babies and reduce the risk of folic acid deficiency anemia in children.
- Folic acid is abundant in dark green vegetables like spinach, citrus fruits, and protein-rich foods such as meat, liver, fish roe, and beans. It is important to note that folic acid is easily lost during cooking—50-90% can be destroyed, especially when food is cooked at high temperatures or for long durations in water.
5.3 Vitamin B12 Deficiency Anemia
- Patients require early treatment because neurological complications caused by vitamin B12 deficiency can be difficult to detect and irreversible if not diagnosed and treated promptly. Vitamin B12 can be administered orally or via injection for vitamin B12 deficiency anemia. The daily oral dose is 1000-2000 mcg, which is as effective as intramuscular injections. In severe cases, intramuscular vitamin B12 injections are required, with a typical dose of 1000 mcg/day for 1 week to saturate body stores and treat complications. This is followed by weekly injections for 1 month and monthly injections for maintenance.
- Include vitamin B12-rich foods such as fish, eggs, milk, beef, chicken, pork, cheese, clams, and oysters.
In summary, anemia is a common clinical condition that can signal organ damage or be the consequence of an underlying disease. Mild anemia often has no symptoms and is detected incidentally. Severe anemia has clear symptoms that affect daily activities, reduce quality of life, and increase the risk of illness and mortality. Therefore, when experiencing symptoms of anemia such as pale skin, rapid breathing, dizziness, lightheadedness, and pale eye mucous membranes, patients should promptly visit medical facilities for diagnosis and timely treatment.
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