Dizziness with anemia: causes, symptoms, diagnosis and treatment

Dizziness associated with anemia is often felt not as a spinning sensation, but as lightheadedness, unsteadiness, a "cotton-headed" feeling, blurred vision, weakness upon standing, or a pre-fainting sensation. This is because with anemia, the blood contains less hemoglobin or red blood cells, meaning tissues receive less oxygen, especially during exertion, fast walking, climbing stairs, heat, dehydration, or blood loss. [1]

The World Health Organization defines anemia as a condition in which the red blood cell count or hemoglobin concentration is below normal, and lists dizziness, lightheadedness, fatigue, cold hands and feet, headache, and shortness of breath during exertion among common nonspecific symptoms. Therefore, a complaint of dizziness associated with anemia is not "random," but in itself does not indicate the type of anemia or explain its cause. [2]

It is important to distinguish between three conditions: true vertigo, presyncope, and general weakness. True vertigo is a sensation of rotation of oneself or the surrounding space, most often associated with the vestibular system; presyncope is a feeling that a person is about to lose consciousness; weakness associated with anemia is a feeling of lack of strength, heaviness in the body, and poor tolerance of normal activity. [3]

With anemia, dizziness often worsens while standing, after physical exertion, after blood loss, with low blood pressure, with a rapid heartbeat, and with fluid depletion. If dizziness occurs in bouts when turning the head, accompanied by pronounced spinning, nausea, tinnitus, or hearing loss, vestibular causes should be considered, rather than simply attributed to low hemoglobin. [4]

The main practical mistake is to assume that dizziness automatically indicates iron deficiency anemia and start iron supplements without testing. Anemia can be iron deficiency, associated with vitamin B12 or folate deficiency, inflammation, chronic kidney disease, blood loss, hemolysis, bone marrow disease, or hereditary hemoglobin disorders, so treatment depends on the cause. [5]

What does a person feel?	Possible clinical interpretation	Why is this important?
Darkening of vision when standing up	Presyncope, orthostatic reaction	It is necessary to measure blood pressure and pulse while lying down and standing.
The feeling of the room spinning	True vertigo	An evaluation of the vestibular and neurological cause is needed.
Weakness and shortness of breath when walking	Possible manifestation of anemia	A complete blood count and evaluation of the cause of anemia are needed.
Palpitations and lightheadedness during exertion	Compensatory response of the heart to low oxygen transport	Monitoring hemoglobin and cardiovascular risks is important.
Dizziness with speech impairment or limb weakness	Possible stroke or other acute neurological condition	Urgent medical attention is required

Code according to ICD 10 and ICD 11

In the International Classification of Diseases, 10th revision, dizziness and lightheadedness are typically coded as R42 when they are a symptom rather than an established specific cause. Anemia itself is coded separately: iron deficiency anemia is coded as D50, anemia due to vitamin B12 deficiency is coded as D51, folate deficiency anemia is coded as D52, other nutritional anemias are coded as D53, and a broad range of other anemias falls within the range D50-D64, depending on the cause and clinical documentation. [6]

In the International Classification of Diseases, 11th revision, iron deficiency anemia is coded 3A00, and the dizziness and lightheadedness block is classified under MB48, which separately identifies vertigo, dizziness on exertion, lightheadedness, and presyncope. This is clinically useful because in a patient with anemia, the symptom of dizziness and the underlying disease causing it can be simultaneously recorded. [7]

Clinical situation	International Classification of Diseases, 10th revision	International Classification of Diseases, 11th revision	Comment
Dizziness and lightheadedness as a symptom	R42	MB48, including subcategories of dizziness and lightheadedness	Used if the reason has not yet been clarified
Iron deficiency anemia	D50	3A00	The most common nutritional cause of anemia
Anemia due to vitamin B12 deficiency	D51	3A01 for megaloblastic anemia due to vitamin B12 deficiency	It is important to consider neurological symptoms
Folate deficiency anemia	D52	3A02 for megaloblastic anemia due to folate deficiency	Concomitant vitamin B12 deficiency must be excluded.
Anemia in chronic diseases	D63 in combination with the underlying disease code	It is coded taking into account the underlying cause and manifestations.	Nutrition alone is usually not enough

Why do I feel dizzy with anemia?

Hemoglobin is a protein in red blood cells that carries oxygen from the lungs to the tissues. When hemoglobin levels are low, the brain, muscles, and heart receive less oxygen for the same amount of work, so the body compensates by increasing heart rate, redistributing blood flow, and fatigues more quickly. [8]

The brain is particularly sensitive to decreased oxygen delivery and fluctuations in blood flow. Therefore, anemia can cause nausea, unsteadiness, decreased concentration, tinnitus, headaches, drowsiness, and decreased tolerance for mental stress. [9]

In iron deficiency anemia, the effects of iron deficiency itself are added to the decreased hemoglobin. The US National Institutes of Health note that iron deficiency anemia can be accompanied by weakness, fatigue, difficulty concentrating, impaired cognitive function, decreased immune function, and impaired thermoregulation. [10]

If anemia develops slowly, the body partially adapts, and a person may perceive dizziness for a long time as "fatigue," "stress," or "low blood pressure." With a rapid drop in hemoglobin, for example during bleeding, the symptoms are usually more pronounced: sudden weakness, palpitations, sweating, fainting, shortness of breath, and poor tolerance of even light exertion. [11]

Not all dizziness associated with anemia is caused by anemia alone. A single patient may simultaneously have low hemoglobin, dehydration, orthostatic hypotension, cardiac arrhythmia, benign positional vertigo, migraine, anxiety disorder, or a medication side effect, so a broad diagnostic approach is needed. [12]

Mechanism	What's happening	How does it feel?
Decreased hemoglobin	Less oxygen is delivered to the tissues	Weakness, nausea, shortness of breath during exertion
Increased heart rate	The heart tries to pump more blood	Palpitations, an anxious feeling in the chest
Orthostatic reaction	When you stand up, your brain temporarily receives less blood.	Darkening of the vision, pre-syncope
Iron deficiency without severe anemia	Iron-dependent processes are disrupted	Fatigue, poor concentration
Vitamin B12 deficiency	Anemia and damage to the nervous system are possible.	Unsteadiness, numbness, tingling

How dizziness manifests itself with different types of anemia

In iron deficiency anemia, dizziness is often accompanied by fatigue, pallor, shortness of breath with exertion, palpitations, headache, cold intolerance, brittle nails, hair loss, tongue soreness, and an unusual craving for ice, earth, paper, or other non-food substances. The American Society of Hematology lists dizziness and lightheadedness as possible symptoms of iron deficiency anemia. [13]

With vitamin B12 deficiency anemia, dizziness may be only one part of the picture. More concerning symptoms include numbness, tingling, or burning in the feet or hands, unsteadiness, memory loss, mood changes, glossitis, and signs of megaloblastic anemia, as vitamin B12 deficiency can damage the nervous system even when anemia is moderate. [14]

In folate deficiency anemia, symptoms may resemble those of vitamin B12 deficiency, but the neurological manifestations are more typical of vitamin B12. The US National Institutes of Health emphasize that megaloblastic anemia is the main clinical sign of folate or vitamin B12 deficiency, so it is important to differentiate these conditions using laboratory tests, not just clinical symptoms. [15]

In inflammatory anemia or chronic disease, dizziness often develops in the context of a long-term illness: chronic infection, autoimmune process, kidney disease, cancer, or inflammatory bowel disease. In this situation, iron supplementation or iron supplementation without assessing the inflammation may be ineffective, as the problem is related not only to iron intake but also to its redistribution and utilization by the body. [16]

In acute or chronic blood loss, dizziness may be the leading symptom. In women, heavy menstrual bleeding is a significant factor; in men and postmenopausal women, occult gastrointestinal blood loss is a significant factor. In all patients, blood in the stool, black stool, unexplained weight loss, abdominal pain, long-term use of certain painkillers, and other signs of a possible source of blood loss are significant. [17]

Type of anemia	Common associated symptoms	What do they check first?
Iron deficiency	Paleness, brittle nails, palpitations, shortness of breath, craving for ice	Ferritin, serum iron, transferrin saturation
Vitamin B12 deficiency	Numbness, tingling, unsteadiness, glossitis, memory impairment	Vitamin B12, methylmalonic acid as indicated
Folate deficiency	Weakness, glossitis, signs of megaloblastic anemia	Folate, vitamin B12, nutrition and absorption
Anemia of inflammation	Symptoms of an underlying chronic disease	C-reactive protein, ferritin, transferrin saturation
Blood loss	Light-headedness, weakness, black stools, or heavy menstrual bleeding	Source of blood loss, complete blood count, ferritin

When dizziness associated with anemia can be dangerous

The danger is determined not only by the hemoglobin level, but also by the rate of its decline, the patient's age, the condition of the heart, the volume of blood loss, and accompanying symptoms. For example, a young person with slowly developing mild anemia may feel only fatigue, while an elderly patient with coronary artery disease may tolerate the same decrease in hemoglobin much worse. [18]

Seek immediate medical attention if you experience dizziness, chest pain or pressure, severe shortness of breath at rest, fainting, confusion, severe weakness, black stools, vomiting blood, heavy bleeding, sudden pallor, cold sweat, or a sharp increase in heart rate. These signs may indicate significant blood loss, severe anemia, abnormal heart rhythms, or another emergency. [19]

A separate group of danger signs relates not to anemia, but to a possible stroke or central nervous system damage. Sudden dizziness with slurred speech, weakness or numbness on one side of the body, double vision, a new severe headache, loss of coordination, falls, severe unsteadiness, or changes in consciousness require immediate medical attention. [20]

Current guidelines for assessing dizziness emphasize the need to check orthostatic blood pressure, nystagmus, and positional tests, as the description "dizzy" alone is not reliable enough to make a diagnosis. This is especially important in patients with anemia: a low hemoglobin level should not automatically close the search for other causes of dizziness. [21]

If dizziness persists for hours, is sudden in onset, and is accompanied by severe vomiting, inability to walk, impaired coordination, or unusual nystagmus, the patient should be assessed as potentially neurologically dangerous. The UK's National Institute for Health and Care Excellence recommends immediate referral of adults with sudden acute vestibular syndrome unless benign positional vertigo or postural hypotension explain the symptoms. [22]

Symptom	Why is this alarming?	What to do
Fainting or almost fainting	Severe anemia, arrhythmia, and blood loss are possible.	Urgent medical assessment
Chest pain	The heart may suffer from lack of oxygen.	Seek help urgently
Black stool or blood in the stool	Gastrointestinal bleeding is possible	See a doctor immediately
Sudden weakness on one side of the body	A stroke is possible	Call emergency help immediately
Dizziness with inability to walk	There may be a central cause	Don't delay medical evaluation
Pregnancy and severe weakness	Risk to mother and fetus	Contact a doctor on the same day

Diagnostics: what tests are needed?

The first test to be performed if anemia is suspected is a complete blood count (CBC) with hemoglobin, hematocrit, red blood cell count, mean corpuscular volume, hemoglobin saturation, white blood cell count, and platelet count. Guidelines for assessing anemia emphasize that laboratory diagnostics begin with a complete blood count and evaluation of red blood cell indices. [23]

The next step is to understand the type of anemia. A low MCV is most often thought of as iron deficiency or thalassemia; a high MCV is thought of as vitamin B12 deficiency, folate deficiency, liver disease, alcohol, certain medications, or bone marrow disease; and a normal MCV is thought of as inflammation, chronic kidney disease, early iron deficiency, blood loss, or mixed causes. [24]

Ferritin, serum iron, total iron-binding capacity (TIBC) or transferrin, and transferrin saturation are used to assess iron status. The American Gastroenterological Association recommends a ferritin cutoff of 45 nanograms per milliliter (ng/mL) for anemia, rather than 15 ng/mL, to better detect iron deficiency anemia.[25]

Ferritin should be interpreted with caution in patients with inflammation, infections, liver disease, obesity, and chronic kidney disease, as it can be elevated as an acute phase protein and mask iron deficiency. In such situations, the physician may need transferrin saturation, C-reactive protein, reticulocytes, and other indicators to distinguish absolute iron deficiency from functional deficiency or inflammatory anemia. [26]

In cases of dizziness, diagnostic testing is not limited to blood tests. Blood pressure and pulse measurements (lying and standing), heart rate assessment, a neurological examination, nystagmus testing, the Dix-Hallpike test for positional vertigo, and, if indicated, an electrocardiogram, vitamin B12 and folate tests, kidney and thyroid function tests, and an examination for the source of blood loss are required. [27]

Examination	What does it show?	When it's especially important
Complete blood count	Is there anemia and what is the size of the red blood cells?	All patients with suspected anemia
Ferritin	Iron reserves	In case of weakness, dizziness, heavy menstruation, suspected iron deficiency
Transferrin saturation	Iron availability for hematopoiesis	For inflammation, chronic kidney disease, controversial ferritin
Vitamin B12	Risk of megaloblastic anemia and neurological impairment	For numbness, unsteadiness, vegan diet, old age
Folate	Risk of folate deficiency anemia	In case of poor nutrition, alcohol, pregnancy, intestinal diseases
Orthostatic parameters	Drop in blood pressure when standing up	For pre-fainting and darkening of the eyes
Electrocardiography	Heart rhythm disturbances or signs of stress on the heart	For palpitations, chest pain, fainting

Treatment

Treatment for dizziness associated with anemia begins with treating the underlying cause of the anemia, not with "anti-dizziness" medications. If dizziness is caused by low oxygen delivery due to anemia, antiemetic, vascular, or vestibular medications will not address the underlying cause until hemoglobin, iron stores, or deficient vitamins are restored. [28]

Iron deficiency anemia is typically treated with iron supplements while the cause of the deficiency is investigated. The American Gastroenterological Association, in its clinical practice update, recommends that oral iron is often prescribed once daily, but if poorly tolerated, alternate-day dosing may be reasonable; supplementation with vitamin C may improve iron absorption. [29]

Intravenous iron is considered if a person cannot tolerate oral medications, ferritin does not improve after a trial of treatment, or there is a condition in which oral iron is poorly absorbed. This approach is especially important in inflammatory bowel disease, after certain gastric and intestinal surgeries, chronic kidney disease, and ongoing blood loss. [30]

For vitamin B12 deficiency, treatment may involve high oral doses or injectable forms, and the choice depends on the severity of the deficiency, neurological symptoms, and the cause of the malabsorption. The Merck Manual indicates that 1000-2000 micrograms of vitamin B12 orally daily may be used in patients without severe deficiency and without neurological signs, but if neurological symptoms are present, medical supervision is required. [31]

Red blood cell transfusion is not a routine treatment for mild to moderate chronic anemia, but may be necessary for severe anemia, active bleeding, instability, or organ compromise. The 2023 AABB International Panel recommended a restrictive transfusion strategy for many hospitalized stable adults, typically considering transfusion for hemoglobin levels below 7 grams per deciliter, but the decision always depends on the clinical situation. [32]

Cause of anemia	Basic treatment	When dizziness usually subsides
Iron deficiency anemia	Iron supplements, correction of blood loss or poor absorption	As hemoglobin increases and iron stores are restored
Vitamin B12 deficiency	Vitamin B12 orally or by injection as indicated	Hematological symptoms usually improve before neurological symptoms.
Folate deficiency	Folic acid after ruling out vitamin B12 deficiency	After restoration of normal hematopoiesis
Anemia of inflammation	Treatment of the underlying disease, sometimes iron or hematopoiesis stimulants	Depends on inflammation control
Chronic kidney disease	Iron, correction of deficiencies, sometimes drugs that stimulate erythropoiesis	Gradually, under the control of hemoglobin and safety
Acute blood loss	Stopping bleeding, infusions, sometimes transfusions	After stabilization of blood circulation and hemoglobin

Diet and lifestyle for dizziness associated with anemia

Diet is helpful if it corrects the deficiency or supports treatment, but it does not replace testing. For iron deficiency anemia, meat, poultry, fish, seafood, legumes, fortified cereals, green vegetables, and foods with vitamin C are beneficial because heme iron from animal products is better absorbed, and vitamin C improves the absorption of non-heme iron from plant foods. [33]

Tea, coffee, cocoa, large amounts of bran, and calcium can interfere with iron absorption if consumed with iron-containing foods or iron supplements. Therefore, for anemia, it's often sufficient to avoid these foods entirely, but to delay their consumption by 1-2 hours after the main iron-containing meal or iron tablet. [34]

For vitamin B12 deficiency, fish, meat, poultry, eggs, dairy products, and fortified foods are important, but if absorption is impaired, the diet may be inadequate. The US National Institutes of Health emphasizes that vitamin B12 deficiency can occur even with adequate dietary intake if there are problems with the release of the vitamin from food, intrinsic factor, or long-term use of certain medications. [35]

For folate deficiency, green leafy vegetables, legumes, asparagus, Brussels sprouts, liver, and fortified grains are beneficial. However, large doses of folic acid without assessing vitamin B12 levels are dangerous because they can correct blood clots without preventing the neurological damage associated with vitamin B12 deficiency. [36]

If you're prone to fainting due to anemia, practical precautions are important: rise slowly, avoid overheating, drink plenty of fluids, don't skip meals, avoid sudden exertion until your condition stabilizes, and sit or lie down at the first sign of blurred vision. If dizziness worsens, fainting occurs, or symptoms persist despite treatment, a follow-up medical evaluation is necessary. [37]

Target	What to do	What to avoid
Improve iron intake	Meat, fish, poultry, legumes, fortified cereals	The only hope is pomegranate, beetroot or apples
Improve iron absorption	Add vitamin C to plant sources of iron	Tea and coffee immediately after meals
Support vitamin B12	Fish, eggs, dairy products, fortified foods	A vegan diet without a reliable source of vitamin B12
Support folate	Green vegetables, legumes, asparagus	High doses of folic acid without assessment of vitamin B12
Reduce the risk of falls	Get up and sit down slowly if you feel sick	Stand up abruptly or drive a car if you feel severely dizzy.

Special patient groups

In pregnant women, dizziness can be associated not only with anemia, but also with changes in circulation, blood pressure, toxicosis, dehydration, hypoglycemia, and other conditions. The World Health Organization indicates that anemia affects approximately 37% of pregnant women worldwide, and severe anemia can be associated with problems for both mother and child. [38]

In children, anemia can manifest not only as dizziness, but also as fatigue, pallor, poor activity tolerance, decreased attention, irritability, and developmental delays with prolonged deficiency. The World Health Organization emphasizes that anemia in children can impair cognitive and motor development, so a child's complaints of weakness and lightheadedness should not be attributed solely to "overwork." [39]

In older adults, dizziness associated with anemia is particularly dangerous due to the risk of falls, fractures, heart rhythm disturbances, worsening of coronary artery disease, and masking a serious underlying cause of blood loss. Even moderate iron deficiency anemia in older adults requires careful investigation of the underlying cause, including gastrointestinal causes. [40]

In people with chronic kidney disease, anemia is often associated with insufficient erythropoietin production, inflammation, iron deficiency, and blood loss during medical procedures. In this situation, dizziness may only improve with comprehensive correction of iron, inflammation, kidney function, and, when indicated, therapy with erythropoiesis-stimulating drugs. [41]

For people on a vegan diet, the risk of vitamin B12 deficiency requires special attention. Even if the diet is rich in legumes, greens, and grains, vitamin B12 should be obtained from fortified foods or supplements, as regular plant foods are not a reliable source of this vitamin. [42]

Group	Why is the risk higher?	What is especially important
Pregnant women	Increased need for iron and folate	Monitoring tests and safe drug doses
Children	Impact on development and learning	Early diagnosis and treatment of the cause
Elderly people	Risk of falls and hidden blood loss	Search for a gastrointestinal source of deficiency
People with chronic kidney disease	Disorders of hematopoiesis and iron metabolism	Comprehensive treatment under the supervision of a physician
Vegans	Risk of vitamin B12 deficiency	A reliable source of vitamin B12

Preventing recurrence of dizziness after treatment for anemia

Prevention begins not with periodic iron supplementation "as a safety net," but with understanding the cause of anemia. If heavy menstrual bleeding is the cause, the underlying gynecological issue should be addressed; if gastrointestinal bleeding is the cause, its source should be identified; if malabsorption is the cause, a regular diet may not be sufficient. [43]

After starting treatment, it is important to monitor not only your well-being but also your laboratory parameters. Dizziness may subside before iron stores are fully restored, so premature discontinuation of therapy may lead to a recurrence of ferritin levels and a return of symptoms. [44]

If iron supplements cause nausea, abdominal pain, constipation, or poor tolerability, this is not a reason to simply discontinue treatment. Current recommendations allow for the selection of a different iron salt, a change in dosage regimen, alternate-day dosing in certain cases, or switching to intravenous iron if indicated. [45]

To prevent falls during recovery, it's worth temporarily limiting situations where sudden nausea is particularly dangerous: climbing to high altitudes, hot baths, intense exercise, standing for long periods in hot weather, driving with severe symptoms, and operating machinery. These measures don't cure anemia, but they do reduce the risk of injury until hemoglobin levels and stability are restored. [46]

If dizziness persists after hemoglobin levels have returned to normal, the diagnosis should be reconsidered. Vestibular migraine, benign positional vertigo, Meniere's disease, orthostatic hypotension, cardiac arrhythmia, anxiety disorder, medication side effects, or neurological causes are possible. [47]

The purpose of prevention	Practical step	Why is this important?
Don't miss the reason	Find the source of deficiency or blood loss	Without this, anemia may return.
Restore iron reserves	Monitor ferritin levels as directed by your doctor.	Hemoglobin may normalize before iron stores
Prevent falls	Get up slowly, avoid dangerous situations	Dizziness increases the risk of injury
Improve tolerability of treatment	Report side effects to your doctor	It is possible to change the form or regimen of treatment
Don't blame everything on anemia	Check for other causes if symptoms persist	Possible vestibular, cardiac or neurological cause

Frequently asked questions

Can anemia cause severe dizziness? Yes, especially if hemoglobin levels drop rapidly, there is blood loss, dehydration, low blood pressure, heart disease, or physical exertion. However, severe dizziness, unsteadiness, slurred speech, limb weakness, or a new severe headache require evaluation of other causes, including neurological ones. [48]

At what hemoglobin level does dizziness begin? There is no universal threshold: symptoms depend on the rate of anemia development, age, physical fitness, cardiovascular status, and the cause of the anemia. Some people experience severe nausea with a moderate decrease in hemoglobin, while others adapt to chronic anemia and notice only fatigue for a long time. [49]

If you're dizzy, is a hemoglobin test sufficient? No, hemoglobin indicates the presence or absence of anemia, but it doesn't explain its cause. Typically, red blood cell indices, ferritin, iron metabolism indicators, vitamin B12, folate, and an assessment of possible blood loss or chronic inflammation are needed. [50]

Can dizziness occur with low ferritin without anemia? Iron deficiency can cause symptoms even before a significant drop in hemoglobin, but dizziness is nonspecific and requires ruling out other causes. Therefore, low ferritin should be treated while simultaneously assessing the overall clinical picture. [51]

Will iron supplements immediately relieve dizziness? Usually not, because it takes time to restore hemoglobin and iron stores. If dizziness is severe, worsens, or is accompanied by fainting, chest pain, shortness of breath, or signs of bleeding, you shouldn't expect the pills to be effective. [52]

Why does anemia cause palpitations along with dizziness? When hemoglobin levels are low, the heart tries to compensate for the decreased oxygen supply by increasing heart rate and blood flow. Therefore, anemia can cause palpitations, shortness of breath during exertion, weakness, and lightheadedness. [53]

Can dizziness associated with anemia be treated with anti-vertigo medications? If anemia is the cause, the primary treatment is aimed at restoring blood flow and eliminating the underlying cause of the deficiency or blood loss. Anti-vertigo medications may only be necessary if a vestibular cause is confirmed, and not as a substitute for treatment of anemia. [54]

When should you call an ambulance? Urgent care is needed for fainting, chest pain, severe shortness of breath, black stools, vomiting blood, active bleeding, sudden weakness on one side of the body, slurred speech, double vision, sudden unsteadiness, or changes in consciousness. These signs may be associated not only with anemia but also with bleeding, stroke, or cardiac arrest. [55]

Can vitamin B12 cause dizziness? Yes, vitamin B12 deficiency can cause anemia, weakness, palpitations, and neurological symptoms, including unsteadiness, numbness, and tingling. It is important not to mask a possible vitamin B12 deficiency with high doses of folic acid without diagnosis. [56]

Why does dizziness persist after hemoglobin levels have returned to normal? This suggests that anemia may not be the sole cause of the symptom. Blood pressure, heart rate, vestibular system, medications, anxiety disorders, neurological signs, and other possible factors should be assessed. [57]

Key points from experts

Thomas G. DeLoughery, MD, MACP, FAWM, is a professor of medicine, pathology, and pediatrics at Oregon Health & Science University, a hematologist-oncologist, and the author of papers on iron deficiency anemia. His approach is important for the topic of dizziness in anemia because the symptom cannot be treated separately from the cause: it is necessary to confirm the type of anemia, assess iron stores, and search for the source of the deficiency. [58]

Cynthia W. Ko, MD, MS, is a board-certified gastroenterologist, professor of medicine and gastroenterology at the University of Washington, and chair of the American Gastroenterological Association Guidelines Panel on Gastrointestinal Evaluation of Iron Deficiency Anemia. Her guidance is particularly important in adult patients with dizziness and iron deficiency anemia because occult gastrointestinal blood loss can be a cause of iron deficiency. [59]

Professor Sant-Rayn Pasricha, MBBS, MPH, Ph.D., FRACP, FRCPA, is a hematologist, epidemiologist, and molecular biologist who directs a laboratory at the Walter and Eliza Hall Institute. His research on erythropoiesis and global anemia control highlights that anemia is not simply “low hemoglobin” but a complex issue involving nutrition, inflammation, iron metabolism, and bone marrow function. [60]

David E. Newman-Toker, MD, Ph.D., is a professor of neurology at Johns Hopkins University and an expert in the diagnosis of acute dizziness and vertigo, known for his research on oculomotor methods for recognizing stroke in patients with acute dizziness. His work is important to this topic because, even when anemia is detected, sudden dizziness with neurological signs cannot automatically be considered "anemic." [61]

The main clinical conclusion: dizziness associated with anemia is a common and understandable symptom, but it is not a diagnosis in itself. Safe management includes confirming anemia with tests, determining its cause, assessing danger signs, ruling out vestibular, cardiac, and neurological causes of dizziness, and treating the specific mechanism that has impaired oxygen transport or balance. [62]