This paper presents three distinct models for the development of acquired
anemia: iron-deficiency anemia produced by the inadequate intake and/or absorption of
iron, the
anemia of
chronic disease (ACD) caused by the body's natural
iron-withholding defense against microbial invaders, and
megaloblastic anemia caused by insufficient intake and/or absorption of
vitamin B(12) or
folic acid. These etiological models are used to interpret the distribution and etiology of
anemia among adult individuals interred at the Medieval Gilbertine Priory of St. Andrew, Fishergate, York (n = 147). This bioarchaeological analysis uncovered not only a strong relationship between decreasing status and increasing prevalence of
anemia for both men and women, but also identified clear sex-based differences at this site. Within the high-status
group, blood and
iron loss as a result of rampant parasitism likely produced an environment ripe for the development of
iron-deficiency anemia, while the parasitic consumption of
vitamin B(12) may have caused occasional cases of
megaloblastic anemia. As status decreases, the interpretation of
anemia becomes more complex, with
megaloblastic anemia and ACD emerging as viable, potentially heavy contributors to the
anemia experiences of low-status people at St. Andrew's. Apart from status effects, women (especially young women) are disproportionately affected by
anemia when compared to men within their own status group and, on average, are also more likely to have experienced
anemia than their male peers from other status groups. This suggests that high
iron-demand reproductive functions helped to make
iron-deficiency anemia a
chronic condition in many women's lives irrespective of their status affiliation.