Iron is an important dietary mineral that is involved in various bodily functions, including the transport of oxygen in the blood. This is essential in providing energy for daily life. Iron deficiency results in depleting the iron stores within your body. This can lead to fatigue, tiredness and decreased immunity.
Keeping your iron levels within healthy limits is important. In some cases, supplements may be required. However, too much iron in the body can build up and result in toxicity and even death.
Don’t self-diagnose and don’t take iron supplements unless advised by your doctor.
Signs and Symptoms of Anemia
The most common symptom of all types of anemia is fatigue (tiredness). Fatigue occurs because your body doesn’t have enough red blood cells to carry oxygen to its many parts.
Also, the red blood cells your body makes have less hemoglobin than normal. Hemoglobin is an iron-rich protein in red blood cells. It helps red blood cells carry oxygen from the lungs to the rest of the body.
Anemia also can cause shortness of breath, dizziness, headache, coldness in your hands and feet, pale skin, chest pain, weakness, and fatigue (tiredness).
If you don’t have enough hemoglobin-carrying red blood cells, your heart has to work harder to move oxygen-rich blood through your body.
This can lead to irregular heartbeats called arrhythmias (ah-RITH-me-ahs), a heart murmur, an enlarged heart, or even heart failure.
In infants and young children, signs of anemia include poor appetite, slowed growth and development, and behavioral problems.
Signs and Symptoms of Iron Deficiency
Signs and symptoms of iron deficiency may include brittle nails, swelling or soreness of the tongue, cracks in the sides of the mouth, an enlarged spleen, and frequent infections.
People who have iron-deficiency anemia may have an unusual craving for nonfood items, such as ice, dirt, paint, or starch. This craving is called pica (PI-ka or PE-ka).
Some people who have iron-deficiency anemia develop restless legs syndrome (RLS). RLS is a disorder that causes a strong urge to move the legs. This urge to move often occurs with strange and unpleasant feelings in the legs. People who have RLS often have a hard time sleeping.
Iron-deficiency anemia can put children at greater risk for lead poisoning and infections.
Some signs and symptoms of iron-deficiency anemia are related to the condition’s causes. For example, a sign of intestinal bleeding is bright red blood in the stools or black, tarry-looking stools.
Very heavy menstrual bleeding, long periods, or other vaginal bleeding may suggest that a woman is at risk for iron-deficiency anemia.
Causes of iron deficiency
Some of the common causes of iron deficiency in adults include:
- Inadequate dietary intake – there are two types of dietary iron, haem iron (found in animal tissue) and non-haem iron. The body absorbs haem iron much more easily than non-haem iron. There are many reasons why the dietary intake of iron could be inadequate, including a poorly balanced vegetarian diet, chronic fad dieting or limited access to a wide range of fresh foods – for example, as a result of living in remote areas or having a low income.
- Blood loss – iron deficiency easily occurs in situations of chronic blood loss. Common causes include heavy menstrual periods, regular blood donation, regular nosebleeds, chronic disorders that involve bleeding (such as peptic ulcers, polyps or cancers in the large intestine) and certain medications, particularly aspirin.
- Increased need – the adolescent growth spurt, pregnancy and breastfeeding are situations when the body requires more iron. If this increased need isn’t met, a deficiency can quickly occur.
- Exercise – athletes are prone to iron deficiency because regular exercise increases the body’s need for iron in a number of ways. For example, hard training promotes red blood cell production, while iron is lost through sweating.
- Inability to absorb iron – healthy adults absorb about ten to 15 per cent of dietary iron, but some people’s bodies are unable to absorb or use iron from food.
A gradual decline in iron
Most of the body’s iron stores are within the haemoglobin of red blood cells, and carry oxygen to the body. Extra iron is stored within the liver and is used during times when dietary intake is inadequate.
If your need for dietary iron isn’t met, your body’s iron stores will decline over time. Effects include:
- Iron depletion – haemoglobin levels are normal, but the body only has a small amount of stored iron, which will soon run out. This stage usually has no obvious symptoms.
- Iron deficiency – stored and blood-borne iron stores are low and haemoglobin levels have dropped below normal. You may experience some symptoms, including tiredness.
- Iron deficiency anaemia – haemoglobin levels are so low that the blood is unable to deliver enough oxygen to the cells. Symptoms include looking very pale, breathlessness, dizziness and fatigue. Reduced immune function and impaired growth and cognition can also be symptoms.
Treatment for iron deficiency
Your iron status is easily checked by a blood test.
Treatment depends on your iron status and may include:
- For an underlying problem – it is very important that the cause of the iron deficiency is investigated and, if it has a medical cause, that it be treated appropriately.
- Iron depletion – information is provided on iron-rich foods. Another blood test is taken around six months later to check that your iron level has improved.
- Iron deficiency – dietary advice is given and is closely monitored. Iron-rich foods are encouraged, while foods and drinks such as bran, tea and coffee that can interfere with iron absorption are not recommended with meals. Iron status is regularly reviewed and supplements may be prescribed.
- Iron deficiency anaemia – iron supplements are prescribed. It may take six months to one year for the body to restock its iron stores. Your iron levels are regularly reviewed with blood tests.
How Is Iron-Deficiency Anemia Diagnosed?
Your doctor will diagnose iron-deficiency anemia based on your medical history, a physical exam, and the results from tests and procedures.
Once your doctor knows the cause and severity of the condition, he or she can create a treatment plan for you.
Mild to moderate iron-deficiency anemia may have no signs or symptoms. Thus, you may not know you have it unless your doctor discovers it from a screening test or while checking for other problems.
Primary care doctors often diagnose and treat iron-deficiency anemia. These doctors include pediatricians, family doctors, gynecologists/obstetricians, and internal medicine specialists.
A hematologist (a blood disease specialist), a gastroenterologist (a digestive system specialist), and other specialists also may help treat iron-deficiency anemia.
Your doctor will ask about your signs and symptoms and any past problems you’ve had with anemia or low iron. He or she also may ask about your diet and whether you’re taking any medicines.
If you’re a woman, your doctor may ask whether you might be pregnant.
Your doctor will do a physical exam to look for signs of iron-deficiency anemia. He or she may:
- Look at your skin, gums, and nail beds to see whether they’re pale
- Listen to your heart for rapid or irregular heartbeats
- Listen to your lungs for rapid or uneven breathing
- Feel your abdomen to check the size of your liver and spleen
- Do a pelvic and rectal exam to check for internal bleeding
Diagnostic Tests and Procedures
Many tests and procedures are used to diagnose iron-deficiency anemia. They can help confirm a diagnosis, look for a cause, and find out how severe the condition is.
Complete Blood Count
Often, the first test used to diagnose anemia is a complete blood count (CBC). The CBC measures many parts of your blood.
This test checks your hemoglobin and hematocrit (hee-MAT-oh-crit) levels. Hemoglobin is an iron-rich protein in red blood cells that carries oxygen to the body.
Hematocrit is a measure of how much space red blood cells take up in your blood. A low level of hemoglobin or hematocrit is a sign of anemia.
The normal range of these levels varies in certain racial and ethnic populations. Your doctor can explain your test results to you.
The CBC also checks the number of red blood cells, white blood cells, and platelets in your blood. Abnormal results may be a sign of infection, a blood disorder, or another condition.
Finally, the CBC looks at mean corpuscular (kor-PUS-kyu-lar) volume (MCV). MCV is a measure of the average size of your red blood cells.
The results may be a clue as to the cause of your anemia. In iron-deficiency anemia, for example, red blood cells usually are smaller than normal.
Other Blood Tests
If the CBC results confirm you have anemia, you may need other blood tests to find out what’s causing the condition, how severe it is, and the best way to treat it.
Reticulocyte count. This test measures the number of reticulocytes (re-TIK-u-lo-sites) in your blood. Reticulocytes are young, immature red blood cells.
Over time, reticulocytes become mature red blood cells that carry oxygen throughout your body.
A reticulocyte count shows whether your bone marrow is making red blood cells at the correct rate.
Peripheral smear. For this test, a sample of your blood is examined under a microscope. If you have iron-deficiency anemia, your red blood cells will look smaller and paler than normal.
Tests to measure iron levels. These tests can show how much iron has been used from your body’s stored iron. Tests to measure iron levels include:
- Serum iron. This test measures the amount of iron in your blood. The level of iron in your blood may be normal even if the total amount of iron in your body is low. For this reason, other iron tests also are done.
- Serum ferritin. Ferritin is a protein that helps store iron in your body. A measure of this protein helps your doctor find out how much of your body’s stored iron has been used.
- Transferrin level, or total iron-binding capacity. Transferrin is a protein that carries iron in your blood. Total iron-binding capacity measures how much of the transferrin in your blood isn’t carrying iron. If you have iron-deficiency anemia, you’ll have a high level of transferrin that has no iron.
- Other tests. Your doctor also may recommend tests to check your hormone levels, especially your thyroid hormone.
You also may have a blood test for a chemical called erythrocyte protoporphyrin. This chemical is a building block for hemoglobin.
Children also may be tested for the level of lead in their blood. Lead can make it hard for the body to produce hemoglobin.
Tests and Procedures for Gastrointestinal Blood Loss
To check whether internal bleeding is causing your iron-deficiency anemia, your doctor may suggest a fecal occult blood test. This test looks for blood in the stools and can detect bleeding in the intestines.
If the test finds blood, you may have other tests and procedures to find the exact spot of the bleeding. These tests and procedures may look for bleeding in the stomach, upper intestines, colon, or pelvic organs.
Iron can be toxic
Iron overdose occurs when you take an excessive amount of supplements that contain iron. Iron is toxic in large amounts and can be fatal at high doses. Children are especially at risk as they commonly mistake the red tablets for lollies.
Iron supplements must be kept tightly capped and away from children’s reach. If you suspect iron overdose, call your doctor or the Victorian Poisons Information Centre on 13 11 26 immediately or visit your local hospital emergency department.
Iron absorption by the body can be affected by the amount and type of iron consumed (haem and non haem iron).
Dietary factors can enhance or inhibit iron absorption, for example, vitamin C can enhance absorption of iron while tea can interfere with absorption.
A person’s need for iron also affects the body’s absorption ability. When the body is low in iron, it absorbs a higher percentage of iron from food.
Absorption of iron from food is about 18 per cent from a typical western diet (including animal foods) and about ten per cent from a vegetarian diet.
Consult with your doctor for more information about building iron into a healthy diet. Some suggestions include:
Wholegrain cereals, meat, poultry and fish are good sources of dietary iron.
Liver is an especially rich source of iron, but pregnant women should avoid this source because of its high content of vitamin A.
Choose iron-fortified breakfast cereals and breads.
Vegetarians who exclude all animal tissue from their diet may need almost twice as much dietary iron each day as non-vegetarians.
ources include dark green leafy vegetables, such as broccoli, prunes, dried apricots, raisins, nuts, seeds, dried beans and peas, and iron-fortified cereals, breads and pastas.
Vitamin C increases iron absorption, so eat more brightly coloured fruits and vegetables.
Cut back on the amount of tea and coffee you drink, especially around mealtimes, since the tannins in tea and coffee bind to the iron and interfere with absorption.
Living With Iron-Deficiency Anemia
If you have iron-deficiency anemia, get ongoing care to make sure your iron levels are improving. At your checkups, your doctor may change your medicines or supplements. He or she also may suggest ways to improve your diet.
Take iron supplements only with your doctor’s approval, and only as he or she prescribes. It’s possible to have too much iron in your body (a condition called iron overload). Too much iron in your body can damage your organs.
You may have fatigue (tiredness) and other symptoms of iron-deficiency anemia until your iron levels return to normal, which can take months. Tell your doctor if you have any new symptoms or if your symptoms get worse.