Iron-Deficiency Anemia (2022)

Iron is very important in maintaining many body functions, including the production of hemoglobin, the molecule in your blood that carries oxygen. Iron is also necessary to maintain healthy cells, skin, hair, and nails.

Iron from the food you eat is absorbed into the body by the cells that line the gastrointestinal tract; the body only absorbs a small fraction of the iron you ingest. The iron is then released into the blood stream, where a protein called transferrin attaches to it and delivers the iron to the liver. Iron is stored in the liver as ferritin and released as needed to make new red blood cells in the bone marrow. When red blood cells are no longer able to function (after about 120 days in circulation), they are re-absorbed by the spleen. Iron from these old cells can also be recycled by the body.

(Video) Iron deficiency anemia - an Osmosis Preview

Am I at Risk?

Iron deficiency is very common, especially among women and in people who have a diet that is low in iron. The following groups of people are at highest risk for iron-deficiency anemia:

  • Women who menstruate, particularly if menstrual periods are heavy
  • Women who arepregnant or breastfeeding or those who have recently given birth
  • People who have undergone major surgery or physical trauma
  • People with gastrointestinal diseases such as celiac disease (sprue), inflammatory bowel diseases such as ulcerative colitis, or Crohn disease
  • People with peptic ulcer disease
  • People who have undergone bariatric procedures, especially gastric bypass operations
  • Vegetarians, vegans, and other people whose diets do not include iron-rich foods (Iron from vegetables, even those that are iron-rich, is not absorbed as well as iron from meat, poultry, and fish.)
  • Children who drink more than 16 to 24 ounces a day of cow's milk (Cow's milk not only contains little iron, but it can also decrease absorption of iron and irritate the intestinal lining causing chronic blood loss.)

Other less common causes of iron deficiency include:

  • Blood loss from the gastrointestinal tract due to gastritis (inflammation of the stomach), esophagitis (inflammation of the esophagus), ulcers in the stomach or bowel, hemorrhoids, angiodysplasia (leaky blood vessels similar to varicose veins in the gastrointestinal tract), infections such as diverticulitis, or tumors in the esophagus, stomach, small bowel, or colon
  • Blood loss from chronic nosebleeds
  • Blood loss from the kidneys or bladder
  • Frequent blood donations
  • Intravascular hemolysis, a condition in which red blood cells break down in the blood stream, releasing iron that is then lost in the urine. This sometimes occurs in people who engage in vigorous exercise, particularly jogging. This can cause trauma to small blood vessels in the feet, so called "march hematuria." Intravascular hemolysis can also be seen in other conditions including damaged heart valves or rare disorders such as thrombotic thrombocytopenia purpura (TTP) or diffuse intravascular hemolysis (DIC).

What Are the Signs and Symptoms of Iron-Deficiency Anemia?

Symptoms of iron-deficiency anemia are related to decreased oxygen delivery to the entire body and may include:

  • Being pale or having yellow "sallow" skin
  • Unexplained fatigue or lack of energy
  • Shortness of breath or chest pain, especially with activity
  • Unexplained generalized weakness
  • Rapid heartbeat
  • Pounding or "whooshing" in the ears
  • Headache, especially with activity
  • Craving for ice or clay - "picophagia"
  • Sore or smooth tongue
  • Brittle nails or hair loss

How Is Iron-Deficiency Anemia Diagnosed?

Iron-deficiency anemia is diagnosed by blood tests that should include acomplete blood count (CBC). Additional tests may be ordered to evaluate the levels of serum ferritin, iron, total iron-binding capacity, and/or transferrin. In an individual who is anemic from iron deficiency, these tests usually show the following results:

The peripheral smear or blood slide may show small, oval-shaped cells with pale centers. In severe iron deficiency, thewhite blood count (WBC)may be low and theplatelet countmay be high or low.

(Video) Iron Deficiency Anemia, All you need to know!

What Other Tests Will Be Done If Iron Deficiency Is Diagnosed?

Your doctor will decide if other tests are necessary. Iron deficiency is common in menstruating and pregnant women, children, and others with a diet history of excessive cow's milk or low iron-containing foods. By talking with your doctor about your diet and medical history, your doctor may gain enough information to determine whether additional testing is needed. In patients such as men, postmenopausal women, or younger women with severe anemia, the doctor may recommend additional testing. These tests may include the following:

  • Testing for blood in the stool (fecal occult blood test)
  • Looking for abnormalities in the gastrointestinal tract - upper and lower endoscopy (looking into the stomach, esophagus, or colon with a tube), capsule enteroscopy (swallowing a tiny camera that takes images of the gastrointestinal tract), barium enema, barium swallow, or small bowel biopsy
  • Testing the urine for blood or hemoglobin
  • In women with abnormal or increased menstrual blood losses, a gynecologic evaluation that may include a pelvic ultrasound or uterine biopsy

Sometimes it is difficult to diagnose the cause of iron deficiency, or your doctor may be concerned that there is a problem other than iron deficiency causing the anemia. These may include inherited blood disorders called thalassemiasin which red blood cells also appear small and pale, hemoglobinopathies such as sickle cell disease (but not sickle cell trait alone), or other blood disorders. People with chronic infections or conditions such as kidney failure, autoimmune diseases, and inflammatory disorders may also have small red blood cells. When the cause of the anemia is not clear, your doctor may refer you to a hematologist, a medical specialist in blood disorders,for consultation and further evaluation.

How Is Iron Deficiency Treated?

Even if the cause of the iron deficiency can be identified and treated, it is still usually necessary to take medicinal iron (more iron than a multivitamin can provide) until the deficiency is corrected and the body's iron stores are replenished. In some cases, if the cause cannot be identified or corrected, the patient may have to receive supplemental iron on an ongoing basis.

There are several ways to increase iron intake:

Diet

(Video) Iron-Deficiency Anemia (Overview) | Causes, Pathophysiology, Signs & Symptoms, Diagnosis, Treatment

  • Meat: beef, pork, or lamb, especially organ meats such as liver
  • Poultry: chicken, turkey, and duck, especially liver and dark meat
  • Fish, especially shellfish, sardines, and anchovies
  • Leafy green members of the cabbage family including broccoli, kale, turnip greens, and collard greens
  • Legumes, including lima beans, peas, pinto beans, and black-eyed peas
  • Iron-enriched pastas, grains, rice, and cereals

Medicinal Iron

The amount of iron needed to treat patients with iron deficiency is higher than the amount found in most daily multivitamin supplements. The amount of iron prescribed by your doctor will be in milligrams (mg) of elemental iron. Most people with iron deficiency need 150-200 mg per day of elemental iron (2 to 5 mg of iron per kilogram of body weight per day). Ask your doctor how many milligrams of iron you should be taking per day. If you take vitamins, bring them to your doctor's visit to be sure.

There is no evidence that any one type of iron salt, liquid, or pill is better than the others, and the amount of elemental iron varies with different preparations. To be sure of the amount of iron in a product, check the packaging. In addition to elemental iron, the iron salt content (ferrous sulfate, fumarate, or gluconate) may also be listed on the package, which can make it confusing for consumers to know how many tablets or how much liquid to take to get the proper dosage of iron.

Iron is absorbed in the small intestine (duodenum and first part of the jejunum). This means that enteric-coated iron tablets may not work as well. If you take antacids, you should take iron tablets two hours before or four hours after the antacid. Vitamin C (ascorbic acid) improves iron absorption, and some doctors recommend that you take 250 mg of vitamin C with iron tablets.

Possible side effects of iron tablets include abdominal discomfort, nausea, vomiting, diarrhea, constipation, and dark stools.

(Video) Living with and Managing Iron-Deficiency Anemia

Intravenous Iron

In some cases your doctor may recommend intravenous (IV) iron. IV iron may be necessary to treat iron deficiency in patients who do not absorb iron well in the gastrointestinal tract, patients with severe iron deficiency or chronic blood loss, patients who are receiving supplemental erythropoietin, a hormone that stimulates blood production, or patients who cannot tolerate oral iron. If you need IV iron, your doctor may refer you to a hematologist to supervise the iron infusions. IV iron comes in different preparations:

  • Iron dextran
  • Iron sucrose
  • Ferric gluconate

Large doses of iron can be given at one time when using iron dextran. Iron sucrose and ferric gluconate require more frequent doses spread over several weeks. Some patients may have an allergic reaction to IV iron, so a test dose may be administered before the first infusion. Allergic reactions are more common with iron dextran and may necessitate switching to a different preparation. Severe side effects other than allergic reactions are rare and include urticaria (hives), pruritus (itching), and muscle and joint pain.

Blood Transfusions

Redblood cell transfusionsmay be given to patients with severe iron-deficiency anemia who are actively bleeding or have significant symptoms such as chest pain, shortness of breath, or weakness. Transfusions are given to replace deficient red blood cells and will not completely correct the iron deficiency. Red blood cell transfusions will only provide temporary improvement. It is important to find out why you are anemic and treat the cause as well as the symptoms.

(Video) Iron Deficiency Anemia Video

Where Can I Find More Information?

If you find that you are interested in learning more about blood diseases and disorders, here are a few other resources that may be of some help:

Results of Clinical Studies Published inBlood

SearchBlood, the official journal of ASH, for the results of the latest blood research. While recent articles generally require a subscriber login, patients interested in viewing an access-controlled article inBloodmay obtain a copy by e-mailing a request to theBloodPublishing Office.

Patient Groups

A list of Web links to patient groups and other organizations that provide information.

FAQs

What does not having enough iron mean? ›

Without enough iron, your body can't produce enough of a substance in red blood cells that enables them to carry oxygen (hemoglobin). As a result, iron deficiency anemia may leave you tired and short of breath.

What are the 4 main causes of iron deficiency anemia? ›

What are the causes of iron-deficiency anemia?
  • Inadequate iron intake. Eating too little iron over an extended amount of time can cause a shortage in your body. ...
  • Pregnancy or blood loss due to menstruation. ...
  • Internal bleeding. ...
  • Inability to absorb iron. ...
  • Endometriosis. ...
  • Genetics.

What are the signs of not having enough iron in your body? ›

wanting to eat non-food items, such as paper or ice (pica) finding it hard to swallow (dysphagia) painful open sores (ulcers) in the corners of your mouth. spoon-shaped nails.
...
Symptoms can include:
  • tiredness and lack of energy.
  • shortness of breath.
  • noticeable heartbeats (heart palpitations)
  • pale skin.

What number is too low for iron level? ›

Lower than normal hemoglobin levels indicate anemia. The normal hemoglobin range is generally defined as 13.2 to 16.6 grams (g) of hemoglobin per deciliter (dL) of blood for men and 11.6 to 15 g/dL for women.

Why is my body not absorbing iron? ›

Malabsorption is when your body can't absorb iron from food, and is another possible cause of iron deficiency anaemia. This may happen if you have coeliac disease, a common digestive condition where a person has an adverse reaction to gluten, or surgery to remove all or part of your stomach (gastrectomy).

Can low iron cause anxiety? ›

Iron is essential in the production of hemoglobin, a protein that allows red blood cells to carry oxygen to your tissues and muscles. So when you have low levels of iron, less oxygen gets to your cells, keeping them from functioning properly and often leading to fatigue, weakness, and even anxiety and depression.

What do eyes look like with low iron? ›

If you pull your lower eyelid down while looking in a mirror, the inside layer should be a vibrant red color. If it's a very pale pink or yellow, you may have iron deficiency.

What foods to avoid if you are anemic? ›

Foods to avoid
  • tea and coffee.
  • milk and some dairy products.
  • foods that contain tannins, such as grapes, corn, and sorghum.
  • foods that contain phytates or phytic acid, such as brown rice and whole-grain wheat products.
  • foods that contain oxalic acid, such as peanuts, parsley, and chocolate.
14 Dec 2018

What are the 3 stages of iron deficiency symptoms? ›

This occurs in three stages:
  • First stage: Iron stores are depleted. ...
  • Second stage: When iron stores are low, the normal process of making red blood cells is altered. ...
  • Third stage: Iron-deficiency anemia develops because there isn't enough iron to make hemoglobin for red blood cells.
21 Apr 2022

Can you be hospitalized for low iron? ›

Severe iron-deficiency anemia may require a blood transfusion, iron injections, or intravenous (IV) iron therapy. Treatment may need to be done in a hospital.

What are the 3 main causes of anemia? ›

Anemia has three main causes: blood loss, lack of red blood cell production, and high rates of red blood cell destruction.

What level requires iron infusion? ›

The European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel disease (ECCO Guidelines), recommend iron supplementation, preferably intravenous (IV), for patients with ferritin levels <30 ng/mL or <100 ng/mL and TSAT <20%15.

What is the fastest way to cure anemia? ›

Iron-deficiency anemia is treated with:
  1. Iron supplements taken by mouth.
  2. Foods high in iron and foods that help your body absorb iron (like foods with Vitamin C).
  3. Iron given through an intravenous (IV) infusion. (This is often a choice if you have chronic kidney disease, or CKD.)
  4. Transfusions of red blood cells.
6 Apr 2020

What causes iron levels to drop? ›

Common causes of iron deficiency include not getting enough iron in your diet, chronic blood loss, pregnancy and vigorous exercise. Some people become iron deficient if they are unable to absorb iron. Iron deficiency can be treated by adding iron-rich foods to the diet.

Does stress cause anemia? ›

Sustained stress is another cause of anaemia. Excessive stress hinders the manufacture of hydrochloric acid in your body, which is very important for the integration of iron and proteins. The deficiency of iron is equal to lack of haemoglobin and thus, anaemia.

Why do I have anemia all the time? ›

A diet consistently low in iron, vitamin B-12, folate and copper increases your risk of anemia. Intestinal disorders. Having an intestinal disorder that affects the absorption of nutrients in your small intestine — such as Crohn's disease and celiac disease — puts you at risk of anemia.

Does B12 affect iron absorption? ›

The relationship among vitamin B-12, folate and iron is a good example of the complex way in which some essential nutrients help keep your body healthy. Vitamin B-12 is indirectly responsible for raising your blood iron level to keep it in a healthy range.

Do you need B12 to absorb iron? ›

Well, it's because blood loss is one of the primary causes of Iron deficiency. And given B12 is required for the production of red blood cells, a deficiency in Vitamin B12 can lead to a deficiency in Iron. This is why the onset of anemia is often the result of a B12 deficiency rather than an Iron deficiency on its own.

Can anemia make you pee a lot? ›

A frequent urge to urinate is less common with anemia or mononucleosis. It is important to discuss your symptoms with your doctor before stopping any prescription medications. Talk to your doctor about any other concerning symptoms.

Can low iron lead to hair loss? ›

Yes. Most hair loss due to an iron deficiency can be reversed. If you've been experiencing hair loss and think it may be due to an iron deficiency, Dr. Piliang recommends talking to your doctor.

Does iron deficiency cause weight gain? ›

Iron-deficient people experience low energy levels and sudden weight gain because of an underactive thyroid gland.

How do you fix low iron? ›

Eating a diet with iron-rich foods can help treat iron-deficiency anemia. Good sources of iron include the following: Meats, such as beef, pork, lamb, liver, and other organ meats. Poultry, such as chicken, duck, turkey, (especially dark meat), liver.

What are the 3 stages of iron deficiency symptoms? ›

This occurs in three stages:
  • First stage: Iron stores are depleted. ...
  • Second stage: When iron stores are low, the normal process of making red blood cells is altered. ...
  • Third stage: Iron-deficiency anemia develops because there isn't enough iron to make hemoglobin for red blood cells.
21 Apr 2022

Does iron deficiency cause weight gain? ›

Iron-deficient people experience low energy levels and sudden weight gain because of an underactive thyroid gland.

What drink has a lot of iron in it? ›

A. Juices like prune juice, beetroot juice, pumpkin juice and spinach juice are rich plant-based iron sources. They are also a powerhouse of various vitamins and minerals, which increase your body's healthy iron levels.

What foods to avoid if you are anemic? ›

Foods to avoid
  • tea and coffee.
  • milk and some dairy products.
  • foods that contain tannins, such as grapes, corn, and sorghum.
  • foods that contain phytates or phytic acid, such as brown rice and whole-grain wheat products.
  • foods that contain oxalic acid, such as peanuts, parsley, and chocolate.
14 Dec 2018

What are the 3 main causes of anemia? ›

Anemia has three main causes: blood loss, lack of red blood cell production, and high rates of red blood cell destruction.

What is the fastest way to cure anemia? ›

Iron-deficiency anemia is treated with:
  1. Iron supplements taken by mouth.
  2. Foods high in iron and foods that help your body absorb iron (like foods with Vitamin C).
  3. Iron given through an intravenous (IV) infusion. (This is often a choice if you have chronic kidney disease, or CKD.)
  4. Transfusions of red blood cells.
6 Apr 2020

How long does it take to recover from iron deficiency? ›

Iron supplements, also called iron pills or oral iron, help increase the iron in your body. This is the most common treatment for iron-deficiency anemia. It often takes three to six months to restore your iron levels.

What cancers cause iron deficiency anemia? ›

Iron deficiency anemia “may be the red flag that leads a health care provider to search for cancer,” says Francis, since it's typically caused by blood loss, which often occurs in colon cancer and uterine cancer but is less commonly in bladder cancer.

Does low iron affect your teeth? ›

Iron and other vitamins are essential for good oral health. The iron helps keep the teeth strong and the vitamins help keep the teeth and gums healthy. If the teeth and do not get the nutrients they need because of anemia, they can suffer. They become more prone to tooth decay and gum disease.

Does low iron cause joint pain? ›

Fatigue and neurocognitive symptoms often raise a suspicion of depression. Furthermore, headache and muscle and joint pain associated with iron deficiency are repeatedly considered migraine and fibromyalgia syndrome, respectively 3, 19.

What causes iron levels to drop? ›

Common causes of iron deficiency include not getting enough iron in your diet, chronic blood loss, pregnancy and vigorous exercise. Some people become iron deficient if they are unable to absorb iron. Iron deficiency can be treated by adding iron-rich foods to the diet.

What does anemia fatigue feel like? ›

If you're feeling tired or weak, having trouble sleeping and are unable to tolerate even moderate exercise, anemia could be the culprit. Anemia develops when there aren't enough healthy red blood cells to carry oxygen through your body.

Videos

1. Iron Deficiency Anemia Treatment, Nursing, Pathophysiology, Symptoms w/ Nursing Interventions
(RegisteredNurseRN)
2. Iron-Deficiency Anemia Signs & Symptoms (ex. Fatigue, “Spoon Nails”, Cracked Lips)
(JJ Medicine)
3. 7 Takeaways From the AGA's New Iron-Deficiency Anemia Guidelines
(Medscape)
4. Iron Deficiency Anemia (Causes)
(Medicosis Perfectionalis)
5. Understanding Iron Deficiency Anemia in Gastroenterology: Who and Why?
(HMP Education)
6. What is iron deficiency? | Hematologic System Diseases | NCLEX-RN | Khan Academy
(khanacademymedicine)

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