Conditions
Anemia: symptoms, blood tests and video visits
Anemia means having fewer healthy red blood cells than normal, and the most common cause is low iron. It causes tiredness, weakness, dizziness and pale skin. A blood test confirms it: by video, the doctor evaluates you and gives you a lab order for a complete blood count (CBC) and ferritin at a lab near you. Then she reviews the results with you and looks for the cause.
Is it an emergency? Call 911.
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Is this an emergency?
This is not an emergency service. Call 911 or go to the nearest emergency room if you have:
- Chest pain
- Fainting
- Shortness of breath at rest or getting worse quickly
- Black, tarry or bloody stools, or vomiting blood
- Very heavy vaginal bleeding with dizziness or weakness
Help lines
At a glance
Anemia
Common symptoms
- Unusual tiredness or weakness
- Dizziness or lightheadedness
- Pale skin
- Cold hands and feet
- Shortness of breath or headaches
- Brittle nails
- Craving ice
- Other names
- Iron-deficiency anemia · Low iron
- Usual test
- Complete blood count (CBC) and ferritin, by lab order
- Treatment
- Iron supplements and treating the cause, when the medical evaluation calls for it
On this page(8)
What is anemia?
Anemia happens when your blood has fewer healthy red blood cells than normal, so less oxygen reaches your body. According to the NHLBI, the most common type is iron-deficiency anemia. There are other types, such as anemia from vitamin B12 deficiency.
Low iron usually comes from blood loss (heavy periods, or bleeding in the stomach or intestines), from not absorbing iron well (for example with celiac disease or after stomach surgery) or from not getting enough iron in your diet. Women with heavy periods, pregnant women and young children are at higher risk. Sometimes anemia is a sign of another illness, which is why finding the cause matters. Low iron is also a known cause of hair loss.
How we care for anemia by video
You see Dr. Diana Nieves Castro, MD, a Puerto Rico–licensed general practice physician with several years of emergency-department experience, in English or Spanish. She asks about your symptoms, your periods, your diet, your medicines and whether you have seen blood or black stools.
Anemia can’t be diagnosed by looking. The doctor gives you a lab order for a complete blood count (CBC) and, depending on your case, ferritin and other tests, at a lab near you. Once your results are in, the doctor reviews them with you in a follow-up visit and explains the plan. If appropriate, the doctor prescribes and we send your prescription to your pharmacy.
We see adults and children of all ages. If the patient is under 21, a parent or legal guardian must sign the consent, stay on camera for the whole visit and show photo ID. If you want someone to follow your health over time, see online primary care.
Your doctor
Dr. Diana Nieves Castro, MD
General practice physician
Several years of emergency-department experience.
Founding Executive Director of The Health Initiative.
Your visit in 3 steps
Video doctor visits 24/7 — book online and choose your time right away.
Request your visit.
Book a visit and choose "Doctor visit". You pay by card when you request it.
See the doctor by video.
We send you a secure video link. It works on your phone, tablet or computer.
Get tested and get a plan.
Take the order to the lab; the doctor reviews your results with you and tells you the next step.
Price
The first visit is a doctor visit, with no membership, and includes the lab order. You pay the lab for the tests. Reviewing the results of tests our doctor ordered is a follow-up visit. You pay by card when you request the visit, and you get a full refund if the clinic can’t see you. See all prices.
Video visit
Doctor visit
$79
For a new problem, urgent care (non-emergencies), primary care, children, birth control, STIs, skin and acne, and visitors. Includes a doctor's note if you need one.
- You’re charged when you request the visit.
- Full refund if the clinic can’t see you
Anemia symptoms
Mild anemia may cause no symptoms. When there are symptoms, the most common are:
- Unusual tiredness or weakness
- Dizziness or lightheadedness
- Pale skin
- Cold hands and feet
- Shortness of breath or headaches
- Brittle nails
- Craving ice
Anemia treatment, and when more tests are needed
Treatment depends on the type and the cause. For iron-deficiency anemia, MedlinePlus and the NHLBI describe:
- Iron supplements by mouth. According to MedlinePlus, improvement is usually seen in about 6 weeks, and according to the NHLBI, rebuilding iron stores takes 3 to 6 months.
- Eating iron-rich foods such as beans, red meat and leafy greens, along with vitamin C, which helps absorption.
- Treating the cause, such as heavy periods. See period cramps.
If the anemia is severe or does not improve with iron by mouth, the doctor refers you to a specialist; treatments such as IV iron are given in person.
When there is no obvious cause, as in men or in women after menopause, the source of blood loss needs to be found. According to MedlinePlus, that can include a stool test for hidden blood, a colonoscopy or an upper endoscopy: the doctor gives you the right lab order and we refer you for the procedures.
If anemia does not explain your tiredness, the doctor looks for other causes with you. See also hypothyroidism.
When to go to the ER
For your safety, go to the emergency room or call 911 if you have:
- Chest pain
- Fainting
- Shortness of breath at rest or getting worse quickly
- Black, tarry or bloody stools, or vomiting blood
- Very heavy vaginal bleeding with dizziness or weakness
Why a video visit
| Comparison | By video | Emergency room |
|---|---|---|
| Getting there | From home: join from your phone, tablet or computer. | Drive and find parking. |
| Hours and time | Every day, any time (Puerto Rico time). Video doctor visits 24/7 — book online and choose your time right away. | In Puerto Rico, a median of 4 h 52 min from arrival to departure for patients sent home (US: 2 h 42 min; Oct 2024–Sep 2025).1,2 |
| Price | $79 visit · $49 follow-up · $35 forms. You see it before you pay; no insurance needed. | Depends on your insurance and on what is done. |
For problems that are not emergencies. In an emergency, call 911.
Table sources
- 1. CMS Care Compare, “Timely and Effective Care – State”, measure OP-18b: median time in the emergency department, arrival to departure, for patients sent home (opens in a new tab), data for Oct 2024–Sep 2025 (accessed 2026-10-02)
- 2. CMS Care Compare, “Timely and Effective Care – National”, measure OP-18b (US figure) (opens in a new tab), data for Oct 2024–Sep 2025 (accessed 2026-10-02)
How we care for you
We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you.
We see adults and children of all ages. Patients under 21: a parent with patria potestad (parental authority) or a legal guardian is on camera for the whole visit and shows photo ID.
Real-time video visit. We send you a secure video link. It works on your phone, tablet or computer.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy.
You must be physically in Puerto Rico during the visit (visitors, tourists and cruise passengers are welcome).
In an emergency, call 911.
Frequently asked questions
How do I know if I have anemia?
What blood tests check for anemia?
How long does it take to raise iron levels?
Do you see children with anemia?
Related topics
About this page
Author: The Health Initiative
Medical care provided by Dr. Diana Nieves Castro, MD (PR license 24027)
Disclosure: Founding Executive Director of The Health Initiative
Published: 2026-10-02 · Updated: 2026-10-11
Sources (3)
- Iron-Deficiency Anemia (NHLBI, NIH) (opens in a new tab) (accessed 2026-10-02)
- Anemia (NHLBI, NIH) (opens in a new tab) (accessed 2026-10-02)
- Iron-deficiency anemia (MedlinePlus, NIH) (opens in a new tab) (accessed 2026-10-02)