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How Anemia Can Worsen Multiple Sclerosis Fatigue

Posted on April 19, 2022
Medically reviewed by
Amit M. Shelat, D.O.
Article written by
Sarah Winfrey

Everyone feels tired from time to time. But if you have multiple sclerosis (MS), you may experience severe tiredness, sleepiness, or exhaustion, no matter how much sleep you get. This is fatigue, the single most common symptom of MS, which affects between 75 percent and 95 percent of people with the condition.

One possible contributor to fatigue is a low red blood cell count (RBC) — also called anemia. Anemia is more common among people living with MS than the general population and is known to cause or worsen fatigue.

Here is what you need to know about anemia in MS, why it occurs, and how it can worsen MS-related fatigue.

The Relationship Between Anemia, MS, and Fatigue

The relationship between MS and anemia is unclear. However, anemia is approximately twice as likely in people with MS than it is in the general population. The connection seems to work both ways — people with anemia are more than twice as likely to eventually develop MS.

According to one study, the association between anemia and MS appears to be higher in men than in women. However, more studies are needed to replicate and confirm these findings.

Although anemia causes significant fatigue, there have not yet been any studies indicating whether and how anemia can contribute to MS-related fatigue. Some researchers believe that fatigue in MS is due to the condition itself and is not connected to other conditions, like anemia.

All of this research suggests a connection between MS and anemia, but further neuroscience studies and clinical trials are needed to determine the exact nature of their relationship.

What Can Cause Anemia in MS?

Disease-modifying therapies are medications proven to reduce disease activity in MS, reducing the number of relapses and slowing the development of lesions in the central nervous system (brain and spinal cord). Certain disease-modifying therapies can potentially cause anemia as a side effect. These include:

Rarely, people taking fingolimod (Gilenya) or interferon-beta-1b (sold under brand names including Betaseron and Extavia) have developed autoimmune hemolytic anemia, in which the immune system destroys RBCs.

Similarly, treating MS with alemtuzumab (Lemtrada) can result in the development of an autoimmune thyroid condition called Graves’ disease. Anemia is a common symptom of thyroid diseases.

Some side effects are common, and others are rare. Not everyone will experience every side effect associated with medication. If you have concerns about a potential side effect, consult your health care provider rather than discontinuing the medication. They may be able to recommend ways to manage side effects.

Also, some drugs must be carefully tapered off rather than stopped abruptly to avoid withdrawal effects such as flare-ups in relapsing-remitting MS.

Other Causes of Anemia

Anemia may not be a symptom of MS or a side effect of MS treatment. There are three main potential causes of anemia:

  • Insufficient RBC production
  • Blood loss
  • Excess destruction of RBCs

Many different health conditions and situations can affect the number of RBCs and cause dysfunction. These can include:

  • Not getting enough iron, vitamin B12, or folic acid in your diet
  • Having heavy menstrual bleeding (periods)
  • Pregnancy
  • Blood disorders or other inherited conditions
  • Ulcers
  • The metabolic disorder G6PD deficiency
  • A condition known as aplastic anemia (which can be inherited or developed later in life)
  • Colon cancer or colon polyps

Diagnosing Anemia

Let your doctor know if you are experiencing significant fatigue beyond what you have come to expect with MS. They may recommend a blood test to screen for anemia. A complete blood count will check the numbers of RBCs and measure:

  • Hematocrit — The proportion of RBCs in your blood
  • Hemoglobin — A protein in RBCs that transports oxygen throughout the body

If any of these measures are low, your health care provider may order further tests to determine the cause of anemia.

Managing Anemia

If you are diagnosed with anemia, talk to your neurologist about how best to manage it. Treating your anemia may help alleviate some of your fatigue, improving your overall well-being and quality of life.

There are several treatments or interventions available for anemia. Recommendations will depend on what is causing your anemia.

Anemia caused by a lack of iron can be managed by taking iron supplements or incorporating more iron-rich foods into your diet. Other vitamins, like B12, can also be taken through oral supplements, injections, or intravenous infusions. Some types of anemia require a blood transfusion or a bone marrow transplant, although these are less common. Some medications can be prescribed to help your body produce more RBCs.

As always, talk to your doctor before starting any new supplements, even if they are available over the counter. Your doctor will be able to recommend the right dosage for you and determine whether any supplements may potentially affect your MS or its treatment.

Find Your Team

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 184,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Have you experienced anemia and fatigue with MS? How have you managed it? Share your story in the comments below or by posting on MyMSTeam.

All updates must be accompanied by text or a picture.
Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Sarah Winfrey is a writer at MyHealthTeam. Learn more about her here.

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