Overview

Iron-deficiency anemia is a condition in which the body does not have enough iron to make hemoglobin, the part of red blood cells that carries oxygen. Less oxygen then reaches the tissues, causing tiredness, weakness, and pale skin. It is the most common type of anemia worldwide and is especially common in women with heavy periods, pregnant women, and young children.

Low iron is a sign that has a cause, not a final diagnosis. Treatment works best when the doctor also finds and treats the reason iron is low.

Symptoms

• Tiredness, weakness, and low energy
• Pale skin or pale inner eyelids
• Shortness of breath or a fast heartbeat with activity
• Dizziness, headaches, and poor concentration
• Hair shedding, brittle nails, and cold hands and feet
• Cravings for ice or non-food items, and restless legs at night
• Seek prompt care for chest pain, fainting, black or bloody stools, or very heavy bleeding

Causes & Risk Factors

• Heavy menstrual periods
• Pregnancy, when the body needs much more iron
• A diet low in iron, including some vegetarian diets
• Drinking tea or coffee with meals, which reduces iron absorption
• Poor absorption from celiac disease, H. pylori infection, or stomach surgery
• Slow bleeding in the stomach or bowel from ulcers, anti-inflammatory pain relievers (NSAIDs), polyps, or cancer
• Frequent blood donation, and rapid growth in infants and children

Complications

• Ongoing tiredness that affects work, study, and daily life
• Extra strain on the heart, especially in severe anemia
• Preterm birth and low birth weight when anemia is not treated in pregnancy
• Delayed growth and development in children
• Lower resistance to infections

Diagnosis

A complete blood count (CBC) shows low hemoglobin and small, pale red blood cells. A low ferritin level confirms that the body's iron stores are low, although ferritin can look normal during infection or inflammation, so other iron tests may be added. Thalassemia trait is common in the Gulf and also causes small red blood cells, so the doctor may test for it before starting iron. Men and women after menopause usually need tests of the stomach and bowel, such as endoscopy and colonoscopy, to look for hidden blood loss.

Treatment

• Iron tablets, often taken once a day or every other day, which may improve absorption and reduce stomach upset
• Taking iron with water or orange juice, away from tea, coffee, milk, and antacids
• Continuing iron for about 3 months after hemoglobin returns to normal, to refill iron stores
• Iron through a vein (IV iron) when tablets are not tolerated, do not work, or iron is needed quickly, such as later in pregnancy
• Treating the cause, such as heavy periods, H. pylori, or a bleeding ulcer
• Blood transfusion only in severe cases

Prevention

• Eating iron-rich foods such as red meat, chicken, fish, lentils, beans, and leafy greens
• Adding vitamin C foods such as citrus fruits, tomatoes, or peppers to meals
• Drinking tea and coffee between meals rather than with them
• Taking iron in pregnancy when the doctor recommends it
• Seeking care for heavy periods instead of accepting them as normal
• Checking a blood count when symptoms of anemia appear

Iron-deficiency anemia is diagnosed and treated by the Internal Medicine department at AlHayat Medical Center, with tests in the Laboratory and care from Obstetrics & Gynecology for heavy periods or pregnancy.

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