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What Is Iron Deficiency Anemia?
Iron deficiency anemia is a condition in which the body does not have enough iron to form hemoglobin, the protein in red blood cells that carries oxygen throughout the body.
The condition can be caused by acute blood loss through injury, surgery, or childbirth; chronic blood loss through an ulcer, overuse of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), or heavy menstrual periods; or impaired absorption of dietary iron due to low dietary iron intake, prior surgeries, disease, or interference from certain medications.
Symptoms of anemia may include fatigue, shortness of breath, and a rapid heartbeat. If not treated, iron deficiency anemia can lead to heart disease because the heart has to increase its pumping activity in order to compensate for the reduced oxygen-carrying capacity of the red blood cells. In children, iron deficiency is also associated with developmental problems. The diagnosis of iron deficiency anemia is made through physical examination and blood tests.
Treatment includes a diet rich in iron-containing foods, such as red meat and leafy green vegetables, along with iron supplements. In some circumstances, hospitalization, blood transfusions, and/or intravenous iron therapy may be needed.
You should visit your primary care physician, who will take a blood test to confirm diagnosis. Treatment involves iron supplementation (pills) or transfusion in really extreme cases (not likely).
Iron Deficiency Anemia Symptoms
In mild cases of anemia, you may have minimal symptoms. However, if anemia becomes severe, you may feel tired and unwell.
- Fatigue: You may feel tired all the time, even after adequate rest, and suffer from reduced endurance.
- Pale skin: Your skin may become lighter than usual, particularly in your face and palms.
- Lightheadedness or dizziness: You may feel faint or off-balance due to reduced oxygenation of your brain.
- Rapid heart rate (tachycardia)
- Shortness of breath (dyspnea)
Symptoms of anemia vary from person to person. Other symptoms that may be present in anemia include:
- Lower leg cramps
- Palpitations: This is chest discomfort from abnormal heart rhythms.
- Pica: These are unusual cravings to eat non-food substances such as ice, dirt, and paint.
- Inflammation of the tongue (glossitis): The tongue can become swollen, red, and painful and impair normal eating or speaking
- Changes in nail shape (koilonychia): Nails may take on a spoon-like shape 
Complications of anemia
In many cases, anemia is not a dangerous condition. However, severe and chronically untreated cases can lead to other significant medical problems.
- Heart problems: The heart and blood cells work together to deliver oxygen throughout the body. When the blood cells have a reduced capacity to carry oxygen, the heart must work harder to compensate. Increased demands on the heart can lead to problems over time, including abnormal heart rhythms (arrhythmia), murmurs, enlargement of the heart, and heart failure.
- Developmental delays: Children may experience a delay of motor or cognitive development.
- Restless leg syndrome (RLS): This is an unpleasant urge to move the legs.
- Pregnancy complications: Anemia can increase the risk of preterm delivery or giving birth to a baby with a low birth weight.
- Increased risk of infection 
- Exacerbation of other chronic medical conditions: This can also occur as a result of anemia .
Iron Deficiency Anemia Causes
Iron-deficiency can develop due to loss of iron, through chronic blood loss, or insufficient intake. Intake can be limited by diet or by your body’s inability to absorb dietary iron in the gut due to prior surgeries, other medical conditions, or medications.
In the United States, chronic blood loss is the most common cause of iron deficiency anemia.
- Blood loss from the stomach and intestines: This can occur due to infection or inflammation anywhere in the gut, as well as stomach ulcers, cancer, hemorrhoids, or hookworms.
- Heavy menses
- Conditions that cause the breakdown of blood cells: Such as damaged heart valves and autoimmune diseases that attack blood cells
Decreased absorption of iron
Certain medical conditions and surgical procedures can reduce the gut’s capacity to absorb iron.
- Stomach surgery (gastrectomy)
- Bariatric surgery: For weight loss
- H. Pylori infection
- Celiac disease
- Inflammatory bowel disease: Such as Crohn’s disease or ulcerative colitis
Certain medications can increase the risk of blood loss in the gut or impair absorption of iron. These include:
- Steroids: Such as prednisone
- NSAIDs: Pain medications such as ibuprofen (Advil, Motrin)
- Proton-pump inhibitors: Medications to prevent acid reflux, such as omeprazole
Increased body demand
In some cases, iron deficiency anemia occurs when the body’s demand for red blood cells increases in the context of normal growth and development.
- Rapid growth: During periods of rapid growth, such as during infancy and the adolescent growth spurt, it’s common to develop anemia as the body’s blood cell production strives to keep pace with the growth of the rest of the body.
- Pregnancy: During the second and third trimester, more blood is needed to provide oxygen to the growing fetus.
- Donating blood: After donating blood, you may temporarily have iron-deficiency anemia, while the body works to replace the donated blood cells
Anemia due to insufficient iron intake is relatively uncommon in the United States, but more common in developing countries.
- Restricted diet: If you are vegetarian and vegan, you may be at higher risk of iron deficiency due to avoidance of meats, which are rich in iron.
Iron Deficiency Anemia Symptom Checker
Take a quiz to find out if you have Iron Deficiency Anemia
Treatment Options and Prevention for Iron Deficiency Anemia
Treatment of iron-deficiency anemia focuses on correcting the underlying cause of the deficiency and helping your body replenish its iron stores so it can restore a normal red blood cell count.
Oral iron supplementation
Iron pills can be taken to rebuild your body’s stores of iron. Since your body has to use the iron to build new red blood cells, symptoms may not improve for a couple weeks. It is recommended to continue the pills for at least three months after your red blood cell count returns to normal, to help your body store away additional iron for later needs.
Unfortunately, some people find iron pills uncomfortable to take. The pills can cause abdominal discomfort, nausea, diarrhea, and constipation. They can also cause dark stool, although this is harmless. The pills are most effective when taken on an empty stomach because they are not absorbed as effectively if taken with other food .
Intravenous iron supplementation
In some cases, iron needs to be given intravenously (IV) to ensure the restoration of normal body iron stores. The reasons for IV iron include a failure to correct anemia with oral iron pills, an inability to absorb iron in the gut (for example, after surgery to the gut), and a need for rapid recovery (e.g., for severe iron deficiency in pregnancy) .
Treatment of underlying causes
If your anemia is caused by an underlying condition, your physician may refer you to a specialist. For example, you may need to see a gynecologist for the removal of bleeding uterine fibroids or a gastroenterologist for the removal of a polyp in the colon. Your physician may also recommend specific medications depending on your underlying condition, such as antibiotics for H. pylori.
You can take a few simple actions to prevent or control iron deficiency anemia.
Maintain a nutritious diet: In addition to iron, vitamin B12, folate, and vitamin C are all important for red blood cell production. Try to get most of your calories from nutrient-dense foods such as fruits, vegetables, whole grains, low-fat dairy products, seafood, lean meats and chicken, eggs, beans and peas, and nuts and seeds . You should also follow food safety practices to avoid foodborne illness. If you are vegan or vegetarian, make sure to eat lots of iron-rich foods, such as leafy green vegetables.
Stay up-to-date with recommended screenings: Current guidelines suggest screening for iron deficiency for all infants are at 1 year of age and all pregnant women . Additionally, colon cancer screening is recommended for all adults over age 50.
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When to Seek Further Consultation for Iron Deficiency Anemia
If you have signs and symptoms of anemia
Anemia can be caused by a variety of factors. If you have signs and symptoms of anemia, you should contact your physician for a full medical evaluation. Although some cases may be managed with simple dietary changes, anemia can be a sign of more significant medical conditions.
If you have significant blood loss
If you notice that you’re bleeding frequently or more easily than before or have dark or bloody stool, contact your physician. Both acute and chronic blood loss can cause problems if not treated appropriately.
Questions Your Doctor May Ask to Determine Iron Deficiency Anemia
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Have you had any changes in your weight?
- Has any part of your body become paler than normal?
- Are you experiencing unusually quick or severe fatigue when doing physical activity or exercising?
- Do you have dry skin?
If you've answered yes to one or more of these questions
Iron Deficiency Anemia Symptom Checker
Take a quiz to find out if you have Iron Deficiency Anemia
- Braunstein EM. Iron deficiency anemia (anemia of chronic blood loss; chlorosis). Merck Manual Professional Version. Updated July 2018. Merck Manual Professional Version Link
- Camaschella C. Iron deficiency. Blood. 2019;133(1):30-39. PubMed Link
- Iron-deficiency anemia. National Heart, Lung, and Blood Institute. NHLBI Link
- Short MW, Domagalski JE. Iron deficiency anemia: Evaluation and management. Am Fam Physician. 2013;87(2):98-104. AAFP Link
- In brief: Your guide to anemia. National Heart, Lung, and Blood Institute. Published September 2011. NHLBI Link
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