HIV/AIDS & H1N1: anemia & flu (0066)

anemia-action-councilheader_logoControlling Anemia During an Intensifying Flu Season
NAAC (National Anemia Action Council)
October 28, 2009

With growing concern about this year’s flu season due to the spread of the H1N1 virus, many patients may be curious if having anemia can put them at a higher risk for complications from the flu or if they should be receiving a vaccination. This article recommends some steps you can take to prepare for flu season if you have anemia and also describes the role chronic illnesses play in causing anemia and potentially leading to serious complications from a viral infection.

Can Anemia Put Me At Risk?

Anemia is a condition in which your blood cannot properly transport enough oxygen throughout your body and can be caused by a variety of factors, including a hereditary disease, a chronic condition, or a nutritional deficiency. If you have been diagnosed with anemia it is important for you and your doctor to determine what is causing your anemia. During flu season it can be especially important to know what is causing anemia because some factors can put you at risk for complications from an influenza or H1N1 infection.

“Patients should talk to their doctor, because certain types of anemia may increase a patient’s risk of complications from the flu. It may be beneficial to be vaccinated depending on the nature or degree of their anemia,” said Dr. Van Winkle, a Family Practice Physician and Clinical Associate Professor of Medicine at the University of Texas.

At-Risk for Flu ComplicationsAn advisory committe for the Centers for Disease Control and Prevention (CDC) has recommended that the following groups should receive the H1N1 vaccination:

  • Pregnant women
  • People who live with or care for children under 6 months
  • All individuals 6 months to 24 years of age
  • People ages 25-64 who have a chronic health disorder
  • People ages 25-64 with a compromised immune system

Having anemia – defined as a lower than normal hemoglobin level – does not directly put you at a higher risk for contracting an influenza virus or at risk for serious medical complications from the viral infection. However, the presence of anemia can be a signal of other complications which may have an effect on how your body reacts if you come down with the flu. It is important to know that, “the reduced oxygen-carrying capacity from severe anemia or a respiratory compromise can exacerbate a flu infection,” said Dr. Van Winkle.

Having anemia also does not necessarily mean that you should receive an H1N1 or seasonal influenza vaccine when they first become available. The Centers for Disease Control and Prevention (CDC) has recommended that pregnant women, people who live with or care for children under 6 months, all individuals 6 months to 24 years of age, and people ages 25-64 who have a chronic health disorder or a compromised immune system should receive the H1N1 vaccination.1

Anemia can many times reflect a nutritional deficiency which could put you at risk for an immune system deficiency and a lowered ability for your body to naturally fight off a viral infection. Additionally, some types of hereditary or acquired anemias can be related to bone marrow failure, which may impair white blood cell production and also compromise your immune system.

Chronic Conditions and Anemia

Patients who have known chronic conditions are at a higher risk for serious complications when infected with the H1N1 virus. Patients who were hospitalized for an H1N1 virus infection this year often also had known conditions like asthma, diabetes, chronic lung disease, chronic heart disease and immunosuppressive disorders, reported Anne Schuchat, MD, on a conference call from the CDC.2

Chronic Conditions Can Lead to AnemiahandoutsNAAC provides patient handouts which explain how conditions such as cancer, kidney disease, heart disease, diabetes and HIV/AIDS can cause patients to get anemia. For more, view our manyInformation Handouts.

Some of these same patients, due to the presence of their chronic conditions, may have also been at-risk for or may have had anemia before experiencing complications with their H1N1 infection. This is because anemia is often caused by chronic conditions like cancer, kidney disease, heart disease, diabetes and HIV/AIDS, to name a few.

“Anemia is an under-recognized under-diagnosed condition which can lead to several symptoms and complications on its own and that can also signal the presence of other more serious chronic conditions,” said Dr. Shander, Chief of the Department of Anesthesiology and Critical Care at Englewood Hospital and Medical Center.

For patients who have a chronic condition that has not been diagnosed yet, anemia may be an early signal. Seeing your doctor on a regular basis to monitor for symptoms of chronic conditions or for possible anemia may help diagnose these health complications early.

People At-Risk for Serious Complications

Coming down with the flu can affect each person in a different way, but some groups may have a higher chance of becoming seriously ill if they become infected with the H1N1 virus. In addition to people with chronic conditions, the CDC has declared that the following groups may be at risk for serious complications:

Pregnant Women – Due to the hormonal and physical changes that take place when carrying a child, pregnant women are at a greater risk for serious complications from an H1N1 virus infection. Specifically, a woman’s immune system may act differently than when she is not pregnant and growth of the child can restrict a woman’s breathing capacity. Pregnant women are also at risk to become anemic due to their increased need for iron. Getting enough iron during pregnancy is important to maintain day-to-day energy levels and for the long-term health of the mother following delivery. Read the article in our series on Women & Anemia to learn more about a woman’s Increased Need for Iron During Pregnancy.

Children – Unlike the seasonal flu, the H1N1 virus has proven to be serious in those under the age of 25 and especially for children 5 years and under. In fact, from late August to mid-November over 50% of the nearly 5,000 hospitalizations as a result of a confirmed H1N1 infection have been people 0-25 years old, according to the CDC.3 Children under 5 years old are also hospitalized more than twice as often as those 5-24 years old, with 4.5 hospitalizations per 100,000 people compared to 2.1 hospitalization per 100,000 people.4 Of the over 500 children hospitalized for complications from the infection this spring and summer, asthma, chronic lung disease, neurologic and neuromuscular disorders, and sickle cell anemia were among the most commonly seen preexisting conditions.2

Elderly – Although people over the age of 65 have not become infected as easily as people in younger age groups, if an elderly person does become sick they have a much greater chance of requiring medical attention. This trend is similar to what is seen in patients infected with the seasonal flu.3 Therefore it is important for older adults to maintain good health, and reducing the risk of anemia is an important step. Although considered by many as a normal part of the aging process, anemia is neither normal nor harmless. To learn more about anemia in adults 65 years and older, read the article Anemia is Not a Normal Consequence of Aging and the Information Handout Anemia & Aging.

The H1N1 Virus and Symptoms

Flu season came early this year in the United States with the emergence and spread of the new strain of influenza known as the H1N1 virus. Different than the seasonal influenza virus which usually emerges during late fall and winter months, the H1N1 virus was first seen in the United States in April 2009 and has spread readily in summer and autumn months.3 In June World Health Organization (WHO) declared that there were nearly 30,000 confirmed cases reported in 74 countries.5 Now called H1N1, the virus was initially referred to as “swine flu” because of its genetic similarity to a virus that infects pigs (swine) in North America. Further testing of the H1N1 virus determined that it is different from the virus which circulates in pig populations and is in fact a new form of influenza.3

Several symptoms which may indicate that you have an influenza or H1N1 virus infection include fever, cough, shortness of breath, fatigue or weakness, chills, myalgias (muscle pain), rhinorrhea (nasal mucous), sore throat, headache, vomiting, wheezing, diarrhea. The two most common symptoms for both infections include fever and cough. Vomiting and diarrhea have also been reported more commonly in patients with an H1N1 infection than normally seen in a normal influenza infection.4 Additionally, there are some warning signs for children and for adults which may warrant medical attention.

If you are experiencing flu-like symptoms please consult the CDC handout 2009 H1N1 and Seasonal Flu: What To Do If You Get Sick6 or learn more about vaccination for the flu on the CDC’s website.7

Warning Signs for Children

  • Fast breathing or trouble breathing
  • Bluish skin color
  • Not drinking enough fluids
  • Not waking up or not interacting
  • Being so irritable that the child does not want to be held
  • Flu-like symptoms improve, but return with fever and worse cough
  • Fever with a rash
Warning Signs for Adults

  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Severe or persistent vomiting

Anemia During Flu Season

With the growing concern for staying healthy this flu season and preventing unnecessary illness, managing your known chronic conditions and monitoring for symptoms of anemia may be just what the doctor ordered. In fact, catching symptoms of anemia early can avoid worsening of anemia and can allow your doctor to treat the underlying cause whether related to nutritional deficiencies or a chronic condition. Close communication with your doctor or healthcare providers about the symptoms you are having – related to the flu or to anemia – and any history of chronic conditions will help him or her provide you with the care you need.


  1. Center for Disease Control and Prevention. 2009 H1N1 Influenza Vaccine. Link. Accessed: October 21, 2009.
  2. MedPage Today. Infectious Disease, Flu & URI. CDC Confirms Sickest H1N1 Patients Have Comorbidities. Link. Accessed: October 16, 2009.
  3. Center for Disease Control and Prevention. 2009 H1N1 Flu & You. Link. Accessed: October 19, 2009.
  4. Center for Disease Control and Prevention. Novel H1N1 Flu: Facts and Figures. Link. Accessed: October 22, 2009.
  5. World Health Organization. Global Alert and Response (GAR). Pandemic (H1N1) 2009. Link. Accessed: October 20, 2009.
  6. Center for Disease Control and Prevention. 2009 H1N1 and Seasonal Flu: What To Do If You Get Sick. Updated: September 24, 2009. Link. Accessed: October 22, 2009.
  7. Center for Disease Control and Prevention. State/Jurisdiction Contact Information for Providers Interested in Providing H1N1 Vaccine. Link. Accessed: October 26, 2009.

Last Updated: October 28, 2009

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