Kurang darah (anaemia, or anemia) means you have fewer red blood cells or less haemoglobin than normal, so your body gets less oxygen. It often causes tiredness, shortness of breath, pale skin and headaches. Anaemia is especially common in women: worldwide, the WHO estimates that 30% of women aged 15 to 49 and 37% of pregnant women are affected. The most common cause is iron deficiency, often from heavy periods, pregnancy or a diet low in iron. In Malaysia, inherited thalassaemia is another important cause, which is why a blood test should come before any "ubat tambah darah". This guide explains the signs, causes, iron-rich Malaysian foods (makanan tambah darah), how iron tablets work best, and when to see a doctor.
What is kurang darah?
Kurang darah is the Malay term for anaemia. Haemoglobin is the protein in red blood cells that carries oxygen around the body. When there is not enough of it, your organs and muscles get less oxygen, which is why you feel tired and breathless. Anaemia is not a disease on its own but a sign of an underlying problem, such as low iron.
Anaemia is diagnosed with a full blood count. Under the WHO's 2024 guideline, these haemoglobin levels count as anaemia:
In non-pregnant women, haemoglobin between 11.0 and 11.9 g/dL is classed as mild anaemia, 8.0 to 10.9 g/dL as moderate, and below 8.0 g/dL as severe. Your doctor will also look at other results, such as the size of your red blood cells and your ferritin (iron stores), to find the cause.
What are the signs of anemia?
Mild anaemia may cause no symptoms at all. When symptoms appear, the most common ones (tanda kurang darah) are:
- tiredness and lack of energy;
- shortness of breath, especially when you are active;
- noticeable heartbeats (palpitations);
- paler than usual skin;
- headaches, dizziness or feeling light-headed;
- cold hands and feet.
Iron deficiency anaemia can also cause less common signs, according to the NHS: hair loss, a sore tongue, food tasting strange, itching, ringing in the ears, spoon-shaped nails, sores in the corners of the mouth, restless legs, and cravings for non-food items such as ice or paper (pica). If you are losing more hair than usual, our guide to hair loss in women explains how iron deficiency fits in.
What causes anemia?
Anaemia has many causes. The most common ones in women are:
- Heavy periods. Regular heavy menstrual bleeding is one of the most common causes of iron deficiency anaemia, and fibroids are a common cause of heavy periods. Heavy periods can be treated, so speak to a doctor; our guide to period pain (senggugut) covers when period symptoms are not normal.
- Pregnancy and childbirth. Blood volume expands during pregnancy and the baby needs iron, and blood loss during and after birth can lead to anaemia.
- Not enough iron in your diet, or poor absorption of iron.
- Bleeding in the stomach or bowel, for example from regular use of NSAID painkillers such as ibuprofen or aspirin, stomach ulcers, piles or, less commonly, bowel or stomach cancer.
- Low vitamin B12 or folate. These vitamins are also needed to make red blood cells; see our guide to signs of folate deficiency.
- Inherited conditions, such as thalassaemia, which is common in Malaysia.
- Long-term illnesses and infections, such as kidney disease or chronic inflammation.
Iron deficiency or thalassaemia?
Thalassaemia is one of the most common genetic conditions in Malaysia. A 2022 review reported that between 4.5% and 5.0% of Malaysians are thalassaemia carriers. Carriers usually feel well, but they can have small, pale red blood cells that look similar to iron deficiency on a basic blood test.
This matters because iron tablets do not correct thalassaemia trait, and taking iron you do not need is not helpful. Before taking "ubat tambah darah" for a long time, ask your doctor to check your iron stores (ferritin) and, if needed, test for thalassaemia. This is especially important if anaemia runs in your family or does not improve with iron. Malaysia runs a national thalassaemia screening programme, so ask at your clinic.
Makanan tambah darah: iron-rich foods
Women aged 19 to 49 need about 14.8 mg of iron a day, according to the NHS, compared with 8.7 mg for men. These everyday Malaysian foods are good sources of iron, based on the Malaysian Food Composition Database (MyFCD):
Values are per 100 g of the food as listed in MyFCD, rounded to one decimal place. Cooking, portion size and the dish recipe change how much iron you actually get.
How to absorb more iron from food:
- Combine plant iron with vitamin C. The WHO notes that vitamin C-rich fruit and vegetables help the body absorb iron. For example, eat guava, orange or papaya with a meal of dhal, tempeh or kangkung. Our vitamin C guide lists the best local sources.
- Keep tea and coffee away from iron-rich meals. Tea, coffee, cocoa, calcium and bran can reduce iron absorption. Try having your teh tarik or kopi between meals rather than with them.
- Take calcium and iron supplements at different times of the day.
- Include some haem iron if you eat meat or seafood, because iron from meat, fish and shellfish is absorbed better than iron from plants.
Food is the best way to prevent iron deficiency, but once anaemia has developed, diet alone often cannot replace the missing iron quickly enough. That is when iron tablets come in.
Ubat tambah darah: how to take iron tablets
If a blood test confirms iron deficiency anaemia, your doctor will usually prescribe iron tablets and look for the cause, such as heavy periods. According to the NHS:
- you will usually need to take iron tablets for about 6 months;
- drinking orange juice after the tablet may help your body absorb the iron;
- taking tablets with or soon after food can reduce side effects;
- common side effects include constipation or diarrhoea, tummy pain, heartburn, feeling sick and darker than usual poo;
- your doctor may repeat blood tests to check that your iron level is recovering.
If iron tablets make you constipated, our guide to sembelit (constipation) covers foods and habits that help. Do not stop the tablets without speaking to your doctor.
Alternate-day dosing. Iron supplements trigger a hormone called hepcidin that temporarily reduces iron absorption. In a 2017 study of iron-depleted women, taking 60 mg of iron on alternate days led to higher fractional absorption (21.8%) than taking it every day (16.3%). A 2023 randomised trial in 150 iron-depleted women found that, at the same total dose, alternate-day iron caused fewer stomach side effects, and fewer women were iron deficient at 6 months (3.0% vs 11.4%). Ask your doctor whether an alternate-day schedule suits you; do not change a prescribed dose on your own.
Safety. The NHS advises that taking 17 mg or less of iron a day from supplements is unlikely to cause harm, and that higher doses should be taken only on medical advice. Keep iron tablets out of reach of children, because an iron overdose can be fatal for a young child.
Anemia in pregnancy
Iron needs rise during pregnancy, and anaemia in pregnancy has been linked to premature birth, low birth weight and maternal complications. Your antenatal clinic will check your haemoglobin, and your doctor may prescribe iron and folic acid (see our guide to folate and folic acid). Take only what your doctor or clinic recommends. The NHS advises avoiding liver and liver products during pregnancy, because their high vitamin A content can harm the baby, so choose other iron sources such as well-cooked meat, fish, eggs, dhal and green vegetables.
When to see a doctor
See a doctor if you:
- think you may have anaemia, or feel tired and breathless for no clear reason;
- have heavy periods;
- notice black or bloody poo, or other unexplained bleeding;
- are pregnant or planning a pregnancy;
- have anaemia that is not improving with treatment;
- have a family history of thalassaemia or anaemia.
Seek medical help promptly if you have signs of severe anaemia, which the WHO lists as a fast heartbeat and breathing, dizziness when you stand up, and pale skin, nail beds or inside of the mouth. Untreated iron deficiency anaemia can increase the risk of heart and lung complications.
Frequently asked questions (FAQ)
What is kurang darah in English?
Kurang darah is the Malay term for anaemia (anemia): having fewer red blood cells or less haemoglobin than normal, so your body gets less oxygen. It is diagnosed with a blood test, not by symptoms alone.
What are the signs of kurang darah?
Common signs include tiredness and lack of energy, shortness of breath, noticeable heartbeats, paler than usual skin, headaches, dizziness, and cold hands and feet. Some people with iron deficiency also notice hair loss, a sore tongue, spoon-shaped nails or cravings for ice.
Which foods help with anemia (makanan tambah darah)?
Iron-rich foods include liver, cockles (kerang), red meat, fish, eggs, dhal and other pulses, and dark green vegetables such as kangkung and bayam. Iron from meat and seafood is absorbed better than iron from plants, and eating vitamin C-rich fruit or vegetables with your meal helps you absorb plant iron. Food alone may not be enough to correct anaemia that has already developed.
What is the best ubat tambah darah?
For iron deficiency anaemia, doctors usually prescribe iron tablets, often for about 6 months. The right treatment depends on the cause, so get a blood test first: anaemia can also be caused by low vitamin B12 or folate, thalassaemia or blood loss, which iron tablets alone will not fix.
How should I take iron tablets?
Follow your doctor's advice. Taking iron with or soon after food can reduce side effects, and orange juice may help absorption. Avoid tea, coffee and milk around the dose. Research in iron-deficient women found that taking iron on alternate days led to better absorption and fewer stomach side effects than daily dosing, so ask your doctor whether this suits you.
Should I take iron if I have thalassaemia trait?
Only if a blood test shows you are also iron deficient. About 4.5 to 5% of Malaysians carry a thalassaemia gene, and carriers can have small, pale red blood cells that look like iron deficiency on a basic blood test. Iron tablets do not correct thalassaemia trait, so check with your doctor before taking them.
Is anemia in pregnancy dangerous?
Anaemia in pregnancy has been linked to premature birth, low birth weight and other complications, so it should be treated. Your antenatal clinic checks your haemoglobin and may prescribe iron and folic acid. Do not take extra supplements without advice, and avoid liver during pregnancy because of its high vitamin A content.
Disclaimer
This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor or pharmacist. Health supplements are not intended to diagnose, treat, cure or prevent any disease.
References
- Anaemia — World Health Organization fact sheet
- Guideline on haemoglobin cutoffs to define anaemia in individuals and populations — World Health Organization, 2024
- Iron deficiency anaemia — NHS
- Iron — NHS
- Foods to avoid in pregnancy — NHS
- Malaysian Food Composition Database (MyFCD) — Ministry of Health Malaysia
- Alwi ZB, Syed-Hassan SR. Thalassemia in Malaysia. Hemoglobin. 2022;46(1):45-52.
- Stoffel NU, et al. Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials. Lancet Haematol. 2017;4(11):e524-e533.
- von Siebenthal HK, et al. Alternate day versus consecutive day oral iron supplementation in iron-depleted women: a randomized double-blind placebo-controlled study. EClinicalMedicine. 2023;65:102286.
