Iron deficiency anemia is a common type of anemia that occurs when the body does not have enough iron. Iron is an essential mineral that is needed to produce hemoglobin, a protein in red blood cells that enables them to carry oxygen to tissues throughout the body. When iron levels are low, the body is unable to produce enough hemoglobin, leading to anemia.
What causes iron deficiency anemia?
There are several potential causes of iron deficiency anemia:
- Inadequate iron intake – This is the most common cause. Iron is found in many foods, but the iron from plant sources (non-heme iron) is not absorbed as well as iron from meat and seafood (heme iron). People who do not eat enough iron-rich foods or who have diets lacking in variety are at risk of developing iron deficiency.
- Blood loss – Losing blood through heavy menstrual bleeding, frequent blood donations, ulcers, hemorrhoids, or surgery can deplete iron stores and lead to anemia.
- Pregnancy – Pregnant women need twice as much iron to support fetal development and blood volume expansion.
- Growth spurts – Infants, toddlers, and adolescents have increased iron needs to support rapid growth.
- Malabsorption – Certain conditions that affect absorption of nutrients like celiac disease, inflammatory bowel disease, and gastric bypass surgery increase the risk of impaired iron absorption.
Women who are menstruating are at particularly high risk of iron deficiency anemia due to monthly blood loss. People with poor, restricted, or vegetarian diets also frequently have trouble getting enough iron through diet alone.
How is iron deficiency anemia diagnosed?
Iron deficiency anemia is diagnosed through a combination of patient history, physical examination, and laboratory tests. A doctor will take a thorough medical history and ask about diet, symptoms, medication use, and conditions that could cause blood loss. They will also perform a full physical exam.
Lab tests are needed to confirm the diagnosis:
- Complete blood count (CBC) – This checks hemoglobin, hematocrit, and red blood cell size. Low hemoglobin and hematocrit indicate anemia. Smaller than normal red blood cells suggests iron deficiency.
- Serum iron level – This directly measures the amount of iron in the blood. A low level indicates depleted iron stores.
- Total iron binding capacity (TIBC) – This measures the blood’s capacity to bind iron. A high TIBC indicates low iron levels.
- Transferrin saturation – This shows how much of the iron binding capacity is being used. A low percentage indicates low iron.
- Ferritin – This protein helps with iron storage. A low level indicates depleted iron reserves.
In iron deficiency anemia, hemoglobin and hematocrit are decreased, while TIBC and transferrin saturation are elevated. Serum iron and ferritin are decreased. Checking levels over time can help monitor response to treatment.
What are the symptoms of iron deficiency anemia?
The most common symptoms of iron deficiency anemia include:
- Fatigue/weakness
- Pale skin
- Chest pain
- Rapid heartbeat
- Headaches
- Dizziness
- Cravings to chew ice or dirt
- Brittle nails
- Shortness of breath
- Strange food cravings
Symptoms arise gradually as the anemia worsens. Mild iron deficiency can often go unnoticed. Severe or long-standing iron deficiency anemia leads to significant symptoms that affect quality of life.
What are the complications of iron deficiency anemia?
Most complications occur when iron deficiency anemia is severe or left untreated:
- Heart problems – Anemia starves the heart muscle of oxygen, leading to fast heartbeat, chest pain, and potential heart failure.
- Pregnancy complications – Iron deficiency anemia raises the risk of preterm delivery and low birth weight.
- Delayed growth – Infants and children may exhibit slower growth and development.
- Behavioral problems – Children may develop issues with learning, memory or behavior.
- Lower immunity – The body’s ability to fight off infections is reduced.
Catching and treating iron deficiency anemia early can prevent complications and relieve symptoms before they become severe or long-lasting.
How much iron does an anemic person need?
The recommended daily allowance (RDA) for iron provides a guideline for adequate intake based on age and gender:
| Age | RDA for Iron |
|---|---|
| 0 to 6 months | 0.27 mg |
| 7 to 12 months | 11 mg |
| 1 to 3 years | 7 mg |
| 4 to 8 years | 10 mg |
| 9 to 13 years | 8 mg |
| 14 to 18 years | 11 mg (boys) 15 mg (girls) |
| 19 to 50 years | 8 mg (men) 18 mg (women) |
| Over 50 years | 8 mg |
However, people with iron deficiency anemia often need higher doses to correct the deficiency and build up bone marrow stores. The World Health Organization recommends:
- Infants under 2 years: 2-3 mg/kg of body weight per day
- Older children: 3-6 mg/kg of body weight per day
- Adults: up to 200 mg/day
Doses may be adjusted based on the severity of deficiency, cause of anemia, and whether there is continued blood loss.
Supplemental iron
Iron is available in supplements as tablets, capsules, liquids, and powders. Common forms include:
- Ferrous sulfate: 20% elemental iron
- Ferrous gluconate: 12% elemental iron
- Ferrous fumarate: 33% elemental iron
- Iron polysaccharide complex: lower doses of highly absorbable iron
Supplements are best absorbed on an empty stomach. Taking iron with vitamin C improves absorption. Calcium, tea, coffee, antacids and dairy can decrease iron absorption if taken at the same time.
Liquid iron supplements or iron polysaccharide complexes may be better tolerated, especially for children or people with digestive issues. Extended release tablets help minimize side effects.
Dietary iron
Dietary iron should be emphasized as well. Good food sources include:
- Meat – beef, lamb, chicken, pork
- Seafood – clams, oysters, shrimp, sardines
- Fortified cereals
- Beans, lentils, spinach
- Raisins, prunes
Vitamin C from fruits, vegetables and juices helps improve absorption of non-heme iron from plant sources. Cookware like cast iron pots and pans can also add iron to food.
Treating the underlying cause
It is important to treat any underlying condition contributing to iron deficiency anemia, such as:
- Heavy periods – Hormonal birth control or endometrial ablation can reduce menstrual blood loss.
- Ulcers, hemorrhoids – Proper treatment will limit bleeding.
- Celiac disease – A gluten-free diet supports healthy intestinal absorption.
For frequent blood donors, taking iron supplements between donations and allowing enough time to replenish stores can help prevent deficiency.
How long does it take to correct iron deficiency anemia?
Response to treatment varies depending on severity, underlying cause, dose of supplemental iron, and ability to absorb iron. But in general:
- Hemoglobin levels start improving within 1-2 weeks.
- Symptoms like fatigue and pallor begin to resolve around 4-6 weeks.
- It takes 2-3 months for blood counts to return fully to normal.
- Replenishing depleted iron stores may take 3-6 months.
Improvement happens gradually. Periodic lab tests help monitor iron status and guide adjustments to treatment.
Key points
- Take iron supplements consistently, even if feeling better.
- Increase intake of iron-rich foods.
- Treat any underlying cause of blood loss.
- Allow enough recovery time between blood donations.
- Follow up regularly with your healthcare provider.
With appropriate treatment guided by regular monitoring, most cases of iron deficiency anemia can be corrected within 3-6 months.
When should someone see a doctor?
It is important to see a doctor for evaluation if you have any symptoms of iron deficiency anemia. Pregnant women should be screened for anemia regularly throughout pregnancy. Consulting with a healthcare provider allows proper diagnosis and timely treatment to prevent complications.
You should seek prompt medical attention if you experience:
- Severe fatigue impacting your daily function
- Rapid, irregular heartbeat
- Chest pain or tightness
- Difficulty breathing during activity
- Dizziness or fainting
These can indicate a more advanced stage of anemia that requires urgent treatment. Anemia left untreated can worsen over time.
Can iron deficiency anemia be prevented?
There are several ways to reduce your risk of developing iron deficiency anemia:
- Eat iron-rich foods – Consume recommended amount of iron through diet. Combine plant and animal sources.
- Enhance iron absorption – Eat iron-rich foods along with vitamin C sources. Avoid coffee/tea with meals.
- Take a supplement – If diet is inadequate, an iron supplement can help fill the gaps.
- Treat heavy periods – See your doctor about controlling excessive menstrual bleeding.
- Cook in cast iron – Use cast iron pots and pans to add iron to food.
- Allow time between donations – Space out blood donations to allow iron restoration.
Women who are pregnant or menstruating should pay extra attention to iron intake. Seeking treatment for any digestive conditions that could impair absorption can also keep iron levels optimal.
Conclusion
Iron deficiency anemia is a common but treatable condition. With screening and early detection, complications can be avoided. Most cases can be reversed with 3-6 months of proper iron supplementation, diet changes, and treatment for any underlying bleeding. Working with a healthcare provider allows iron status to be monitored closely until levels normalize. Paying attention to iron intake through diet and supplementation can help prevent the development of anemia.
