A condition caused by lack of iron to produce adequate hemoglobin in your body, leading to insufficient oxygen transport in the blood.
What is iron deficiency anemia?
Iron deficiency anemia is a common type of anemia that occurs when the body doesn't have enough iron to produce sufficient hemoglobin, a protein in red blood cells that carries oxygen throughout the body. Without enough iron, the body can't make enough healthy, oxygen-carrying red blood cells, leading to fatigue, weakness, impaired cognitive function and other symptoms.
Iron deficiency anemia is common in women due to losses from menstrual bleeding as well as during pregnancy. Pregnancy increases the demand for iron, and if the intake or absorption of iron is insufficient, it can lead to anemia.
Non-Malignant Blood Disorders Program
Benign disorders of the blood are noncancerous conditions that affect the makeup of your blood, such as red blood cells, white blood cells, platelets and coagulation factors. These disorders can impact the blood's ability to function correctly, but they are not malignant (noncancerous). Our benign blood disorder specialists at our Non-Malignant Blood Disorders Program can help.
Why choose AHN for anemia treatment?
We offer several advantages for anemia treatment that will take into consideration your specific health needs and condition. AHN delivers:
- Expert hematologists: Our team of experienced hematologists specialize in blood disorders, including anemia. They can accurately diagnose the type and cause of anemia.
- Comprehensive diagnostic services: We provide a full range of diagnostic tests to identify the underlying cause of anemia.
- Personalized treatment plans: Our team creates individualized treatment plans based on the specific type and cause of anemia, as well as the patient's overall health.
- Advanced treatment options: We offer access to the latest treatment options, including iron infusions, blood transfusions, and medications to stimulate red blood cell production.
- Multidisciplinary approach: Our multidisciplinary approach, involving hematologists, primary care physicians, and other specialists as needed, ensures comprehensive care.
- Convenient locations: We have multiple locations throughout the region and telehealth options for those outside of the region, making it easy for patients to access care.
Iron deficiency anemia symptoms and signs
The symptoms and signs of anemia can differ for each person. With anemia, the symptoms and signs can range from hard-to-spot to more noticeable. It’s important to stay in tune with changes to your health and talk with your doctor about any changes or concerns.
Iron deficiency anemia symptoms
The symptoms of iron deficiency anemia will vary depending on your overall health, age, and specific condition. These include:
- Fatigue: Feeling unusually tired or exhausted, even after adequate rest. This is often the most prominent symptom.
- Weakness: A general feeling of being physically weak or lacking energy.
- Shortness of breath: Feeling breathless or winded, especially with exertion.
- Dizziness or lightheadedness: Feeling faint or unsteady, particularly when standing up.
- Headaches: Frequent or persistent headaches.
- Pica: Unusual cravings for non-food items like ice, dirt, clay, or paper.
- Restless legs syndrome: An irresistible urge to move the legs, often accompanied by uncomfortable sensations, usually worse in the evening or at night.
- Difficulty concentrating: Problems with focus, memory, and cognitive function.
- Irritability: Feeling easily frustrated or short-tempered.
- Cold Hands and Feet: Poor circulation due to reduced red blood cells.
Iron deficiency signs
Similar to the symptoms of iron deficiency anemia, the signs will vary from person to person. If you notice the following signs, talk to your health care provider:
- Pale skin: Noticeable paleness of the skin, especially in the face, nail beds, and inside the eyelids.
- Pale conjunctiva: Paleness of the inner lining of the eyelids (conjunctiva). This is a reliable sign.
- Brittle nails: Nails that are thin, fragile, and prone to breaking. They may also be spoon-shaped (koilonychia).
- Tachycardia: A rapid heart rate. The heart works harder to compensate for the reduced oxygen-carrying capacity of the blood.
- Glossitis: Inflammation or soreness of the tongue.
- Angular cheilitis: Cracks or sores at the corners of the mouth.
- Spoon-shaped nails (Koilonychia): The nails curve upward, forming a spoon-like shape. This is a less common but more specific sign.
- Hair loss: Excessive shedding or thinning of hair.
Causes and risk factors
Understanding the causes and risk factors of iron deficiency is the first step towards maintaining your health and well-being. Iron is an essential mineral that plays a vital role in carrying oxygen throughout your body. When you don't have enough iron, it can lead to a condition called iron deficiency, which can eventually develop into iron deficiency anemia. The causes and risk factors of iron deficiency anemia include:
- Inadequate iron intake: Whether it is due to low iron in diet — which is common in vegetarians and vegans — or poor eating habits like skipping meals, inadequate iron intake can cause iron deficiency anemia.
- Poor diet: Eating a limited range of foods and relying on heavily processed foods can be a cause.
- Gastrointestinal disorders: Conditions such as celiac disease, Chron’s disease, ulcerative colitis, and gastric bypass surgery can impair the absorption of iron in the small intestine.
- Medications: Certain medications like proton pump inhibitors used to treat acid reflux can reduce iron absorption.
- Gastrointestinal bleeding: Bleeding in the gastrointestinal track can be a cause of iron deficiency anemia. The bleeding can be a result of ulcers, taking anti-inflammatory drugs, colon polyps, and hemorrhoids.
- Pregnancy and breastfeeding: Being pregnant means you have a significantly higher iron requirement to support the growth of the fetus and the placenta. Breastfeeding mothers also have increased iron needs to replenish iron stores depleted during pregnancy and to provide iron for the infant.
- Infancy and childhood: Infants and young children, especially those born prematurely or with low birth weight, need adequate iron for growth and development.
- Being assigned female at birth: At a reproductive age, those assigned female at birth are at higher chance of iron deficiency anemia due to menstrual blood loss, especially those with heavy menstrual periods.
- Blood loss: Whether from chronic gastrointestinal issues, chronic nosebleeds, or frequent blood donations can increase the risk of developing iron deficiency anemia.
- Malabsorption: Certain conditions (like celiac disease, Crohn's disease, or gastric bypass surgery) can interfere with the body's ability to absorb iron from food.
- Other medical conditions: Kidney disease and other chronic illnesses can affect iron absorption or red blood cell production.
Iron deficiency anemia screening and diagnosis
Low iron levels can cause fatigue, weakness, shortness of breath, and other symptoms that significantly impact your quality of life. Early screening and diagnosis can help prevent these symptoms and ensure you receive timely treatment. The first step is usually to discuss your symptoms and concerns with your primary care physician. If your primary care physician suspects iron deficiency anemia, they may refer you to a hematologist (a doctor specializing in blood disorders) for further evaluation and management.
Screening
Getting checked during routine blood tests can help to uncover anemia sooner. Early detection followed by treatment can prevent the condition from worsening and causing more significant health problems. You may be screened for anemia more often if you are pregnant, diagnosed with gastrointestinal disorders that affect iron absorption, or have a family history of anemia. After a sample of your blood is taken, specialists look at:
- Routine blood tests: During routine checkups, particularly for women of childbearing age, pregnant women, and individuals with risk factors, a Complete Blood Count (CBC) is often performed. The CBC measures:
- Hemoglobin (Hgb): The protein in red blood cells that carries oxygen. Low levels indicate anemia.
- Hematocrit (Hct): The percentage of red blood cells in your blood. Low levels also suggest anemia.
- Mean corpuscular volume (MCV): The average size of red blood cells. In iron deficiency anemia, red blood cells are typically smaller than normal (microcytic).
Diagnosis
If the initial screening suggests iron deficiency anemia, further diagnostic tests are performed to confirm the diagnosis and determine the severity. These tests may include:
- Serum iron: Measures the amount of iron in the blood.
- Serum ferritin: Measures the amount of iron stored in the body. This is often the most reliable indicator of iron deficiency.
- Total iron binding capacity (TIBC): Measures the blood's capacity to bind iron. In iron deficiency, TIBC is usually elevated.
- Transferrin saturation: This is calculated by dividing serum iron by TIBC. Low transferrin saturation indicates iron deficiency.
- Peripheral blood smear: A blood sample is examined under a microscope to assess the size and shape of red blood cells. In iron deficiency anemia, cells are often small (microcytic) and pale (hypochromic).
- Additional testing: In some cases, further tests may be needed to identify the underlying cause of iron deficiency. These may include:
- Stool occult blood test: To check for blood loss in the stool.
- Endoscopy or colonoscopy: To examine the gastrointestinal tract for sources of bleeding or malabsorption.
- Bone marrow biopsy: Rarely needed, but may be performed to evaluate iron stores in the bone marrow.
Types and stages of iron deficiency anemia
While the term "iron deficiency anemia" usually refers to anemia caused by insufficient iron, it can be further categorized by the cause of the deficiency:
- Dietary iron deficiency: This is caused by inadequate intake of iron-rich foods. It's more common in vegetarians, vegans, and individuals with limited access to nutritious foods.
- Iron loss anemia: This occurs when the body loses more iron than it can absorb. Common causes include:
- Heavy menstrual bleeding (menorrhagia): A very common cause in women.
- Gastrointestinal bleeding: From ulcers, polyps, tumors, or conditions like inflammatory bowel disease. This can be chronic and slow, making it difficult to detect without testing.
- Blood donation: Frequent blood donation can deplete iron stores.
- Iron malabsorption anemia: This happens when the body has trouble absorbing iron from food, even if the diet is adequate. This can be caused by:
- Celiac disease: Damages the small intestine, impairing nutrient absorption.
- Gastric bypass surgery: Can alter the digestive process and reduce iron absorption.
- Certain medications: Some medications can interfere with iron absorption.
- Atrophic gastritis: A condition where the stomach lining thins, reducing stomach acid needed for iron absorption.
- Increased iron demand:
- Pregnancy: The growing fetus requires a significant amount of iron.
- Infancy and childhood: Rapid growth spurts increase iron needs.
Iron deficiency progresses through stages. These stages don't always have clear-cut boundaries, but they represent a continuum. In the early stages of iron deficiency, symptoms may be mild or absent. This is why screening is important, especially for those at risk. Diagnosis relies heavily on blood tests. A complete iron panel is usually needed to assess iron status accurately.
Iron depletion (decreased iron stores)
In the first stage, iron stores in the body (ferritin) start to decrease, but there's usually no noticeable change in red blood cell production or hemoglobin levels. You will usually be asymptomatic (no noticeable symptoms). Lab work will show your serum ferritin levels as low. Other iron tests (serum iron, TIBC) are typically normal.
Iron-deficient erythropoiesis (iron deficiency without anemia)
Your iron stores are now depleted, and the body starts to have difficulty producing red blood cells normally. Hemoglobin levels are still within the normal range, but other indicators may show a problem. Symptoms of mild fatigue or weakness may be present. Bloodwork will indicate your serum ferritin is low. Transferrin saturation (iron) may be decreased, and your red blood cells may start to become smaller (microcytic).
Iron deficiency anemia
At a later stage, your iron stores are severely depleted, and your body can no longer produce enough normal red blood cells. Hemoglobin levels fall below the normal range, leading to anemia. Symptoms may include fatigue, weakness, pale skin, shortness of breath, dizziness, headache, brittle nails, pica (craving non-food substances like ice or dirt), restless legs syndrome.
Lab findings will include:
- Low hemoglobin (Hgb)
- Low hematocrit (Hct)
- Low serum ferritin
- Low serum iron
- High total iron-binding capacity (TIBC)
- Low transferrin saturation
- Red blood cells are microcytic (small) and hypochromic (pale)
Iron deficiency anemia treatment
The most common treatment for iron deficiency anemia involves replenishing iron levels in the body. Addressing the underlying cause of iron deficiency anemia will help determine the treatment. Treatment can often be a combination of:
- Iron supplements: Both oral and liquid iron supplements are common and convenient way to treat iron deficiency anemia. Ferrous sulfate is a commonly prescribed form of oral iron supplements and is usually taken daily or every other day.
- Dietary changes: Increasing iron-rich foods in the diet is important. Good sources of iron include red meat, poultry, fish, dark leafy green vegetables, dried fruits, and iron-fortified cereals and breads.
- Intravenous (IV) iron: Iron is administered directly into a vein. This method is faster and more effective for raising iron levels quickly, and it avoids the gastrointestinal side effects of oral iron.
- Blood transfusion: In severe cases of anemia, a blood transfusion may be necessary to quickly increase the number of red blood cells.
Iron deficiency anemia FAQs
AHN is here to help you navigate an iron deficiency. To help you feel empowered and informed, we’ve provided answers to some frequently asked questions our patients usually have. This way, you can work with your AHN care team to find the right treatments for you.
What happens when your iron is low?
When your iron is low, your body can't produce enough hemoglobin, a protein in red blood cells that carries oxygen to your tissues. This can lead to iron deficiency anemia. As a result, your body's tissues and organs don't get enough oxygen, which can cause a range of symptoms like fatigue, weakness, shortness of breath, and pale skin.
How can I raise my iron levels quickly?
The quickest way to raise iron levels is usually through intravenous (IV) iron infusions. This bypasses the digestive system and delivers iron directly into the bloodstream. Oral iron supplements are also effective, but they take longer to work. To maximize absorption of oral supplements, take them on an empty stomach (if tolerated) and with a source of Vitamin C. Dietary changes alone are less likely to raise iron levels quickly but are important for long-term maintenance.
What are four symptoms of iron deficiency anemia?
Four common symptoms of iron deficiency anemia are:
- Fatigue: Feeling unusually tired or weak.
- Pale skin: A noticeable paleness, especially in the face, nail beds, and inner eyelids.
- Shortness of breath: Feeling breathless during normal activities.
- Dizziness/lightheadedness: Feeling faint or unsteady.
What are the 3 stages of iron deficiency anemia?
The three stages of iron deficiency anemia are:
- Iron depletion: Iron stores in the body are decreasing, but hemoglobin levels are still normal. There are usually no symptoms at this stage, but ferritin levels (which measure iron stores) will be low.
- Iron deficiency: Iron stores are depleted, and hemoglobin production is starting to be affected. Red blood cells may appear normal, but the body is struggling to make enough. Symptoms such as fatigue, restless legs, impaired concentration, or brain fog can occur at this stage.
- Iron deficiency anemia: Iron stores are exhausted, and hemoglobin levels fall below normal. Red blood cells become smaller and paler than usual (microcytic and hypochromic), and symptoms of anemia become apparent.
Contact us
Call the Division of Hematology and Cellular Therapy at 412-578-4484. We have anemia specialists available at AHN West Penn Hospital, Mellon Pavilion and AHN Allegheny General Hospital. Once scheduled, our staff will instruct you on what is needed so that our doctors get access to your medical records.
We also provide telehealth services if you live far from our offices and would like to work with one of our hematologists.