What Is Iron-Deficiency Anemia?

Anaemia occurs when your red blood cells (RBCs) do not contain enough haemoglobin. RBCs carry oxygen from the bloodstream to tissues through haemoglobin.

Signs and Symptoms

You might not even notice the first signs of iron deficiency anaemia as it can be mild. According to the American Society of Hematology
(ASH), most people don’t realize they have mild anaemia until they have a routine blood test.

A person with moderate to severe iron deficiency anaemia may suffer from the following symptoms:

• Lack of energy or Extreme fatigue
• Generalized weakness
• pale skin
• Chest pain, fast or irregular heartbeat
• Shortness of breath
• Headache, lightheadedness or dizziness
• brittle nails
• Cravings for unnutritional foods like ice, dirt or starch
• Tingling or crawling sensation in the legs
• Tongue swelling or soreness
• Cold hands and feet
• Irritability
• Having pale or yellowish skin
• Whooshing or pounding in the ears

Causes 

Several factors can cause iron-deficiency anaemia:

Low Iron Levels in the Diet

We obtain iron from meat, chicken, and fish; however, it is only absorbed in a small amount for every ten to twenty milligrams we consume. A person who doesn’t consume enough iron-rich foods is at risk of iron deficiency anaemia.

Body Changes

During periods of change in your body’s needs, such as growth spurts for children and adolescents or pregnancy and lactation, you need more red blood cells.

Gastrointestinal Tract Abnormalities

Malabsorption of iron is common after certain forms of gastrointestinal surgery. Foods contain a large amount of iron, which is mainly absorbed in the upper small intestine. Having a gastrointestinal problem can make it difficult to absorb iron, which might lead to anaemia caused by iron deficiency. It is also possible to decrease iron absorption with medical procedures that stop stomach acid production.

Blood Loss

The loss of blood can lead to anaemia caused. Bleeding due to gastrointestinal disorders, menstrual bleeding, or injury are all possible sources of blood loss. Blood loss and iron loss from bleeding may exceed what your body can replace. The following factors can cause low iron levels in women:

• Digestive system problems like ulcers, colon cancer or colon polyps
• Over-the-counter pain relievers and aspirin are regularly used for a long time
• Having too many blood donations or not allowing your body time to recover between blood donations5
• Having longer or heavier periods than usual
• Inflammation of the uterus caused by fibroids is noncancerous and can lead to heavy bleeding

Not Eating Enough Food that Contains Iron

Foods such as meat, poultry, and fish provide much better absorption of iron than plant-based foods, such as grains and beans. Plant-based foods absorb iron better from the body when consumed along with foods rich in vitamin C, such as oranges and tomatoes, which is why vegetarians and vegans who consume little or no animal-based foods will need to find alternative sources of iron.6 They should also consume foods rich in vitamin C, such as oranges and tomatoes, along with plant-based foods. However, Americans get sufficient amounts of iron from their diets.

Pregnancy

Due to their increased blood volume and their need for haemoglobin to grow fetuses, pregnant women commonly suffer from iron deficiency anaemia without supplementation. As your baby grows, your body uses more iron than usual.

Diagnose

Other tests will be recommended by your doctor. People with an excessive diet of cow’s milk and low iron-containing foods, including menstruating and pregnant women, are at risk for iron deficiency. It may be possible for your doctor to determine whether additional testing is needed by discussing your diet and medical history with you. If the patient has severe anaemia, the doctor may recommend further testing, especially in men, women postmenopausal, or younger women. The tests may include:

The following tests may be run to diagnose iron-deficiency anaemia:

The size and colour of red blood cells. Red blood cells in iron deficiency anaemia are smaller and paler than those in normal anaemia.

Ferritin. Low ferritin levels indicate low levels of stored iron, as this protein helps store iron in your body.

Haemoglobin. The level of haemoglobin in your blood is below normal, which indicates anaemia. Haemoglobin levels in men are generally considered to be between 13.2 and 16.6 grams per deciliter of blood, and those in women are typically between 11.6 and 15 grams.

Hematocrit. Your red blood cells make up a percentage of your blood volume. The normal levels for adult women and men are 35.5 to 44.9 per cent and 38.3 to 48.6 per cent, respectively. Age may affect these levels.

You may not be able to determine the exact cause of iron deficiency, or your doctor may believe that there is something else causing your anaemia besides iron deficiency.

In some cases, the disorder is inherited and results in small red blood cells and pale skin, or it may be caused by hemoglobinopathies such as sickle cell disease (and not just the trait). A person with kidney failure, an autoimmune disease, or an inflammatory disorder may also have small red blood cells. The cause of anaemia can be unclear, so your doctor may refer you to a haematologist, a physician who specializes in treating blood disorders.

Other Diagnostic Tests

Anaemia caused by the iron deficiency may be detected through additional tests, including:

Colonoscopy. Your doctor may recommend a colonoscopy to rule out bleeding sources in the lower intestine.

Video cameras are inserted through a thin, flexible tube into your rectum before being guided to your colon. Most people are sedated during this procedure. To identify internal bleeding, your doctor uses a colonoscopy to look inside your colon or rectum.

Endoscopy. Through endoscopy, a doctor can examine the stomach or hiatal hernia for bleeding. Through a thin, lighted tube placed in your throat, a video camera is passed down to your stomach. A doctor will be able to see both the tube that runs from your mouth to your stomach (oesophagus) and the area around your stomach to determine where bleeding is taking place.

Ultrasound. Women with excessive menstrual bleeding, such as those with uterine fibroids, can also have a pelvic ultrasound performed.

These tests or others may be ordered by your doctor after you’ve taken iron supplements for a few weeks.

Treatment

If you have iron-deficiency anaemia, your doctor will determine the most appropriate treatment based on:

• How old you are, How you feel, and what your medical history is
• And how much anaemia you have
• And the reason why
• You have it and how much tolerance you have for particular treatments, procedures, or medications
• Anaemia Treatment Expectations
• Your preference or opinion

Treatment may include:

Iron Supplements

Taking iron supplements over some time can raise the levels of iron in the blood. There is a possibility that iron supplements can cause stomach irritation and discoloured stools. To increase absorption, you should take them with orange juice or without food. Taking them alone is not as effective as taking them with food. It may be necessary to give IV iron to patients suffering from malabsorption or intolerance.

Identify the source of blood loss.

Upper endoscopies and colonoscopies may be necessary.

Medicinal Iron

Iron deficiency is treated differently than most daily multivitamin supplements because the amount of iron needed is higher. Your doctor will prescribe an amount of elemental iron measured in milligrams (mg).

The daily iron requirement for people suffering from iron deficiency is 150 to 200 mg per kilogram of body weight (up to 2 mg/kg). Make sure you are getting enough iron per day by asking your doctor. Ensure your doctor knows you’re taking vitamins by bringing them with you.

Iron salts, liquids, or pills are all safe, but different types contain different amounts of elemental iron. To be sure that a product contains iron, check its package. A package may also list the number of iron salts (ferrous sulfate, fumarate, or gluconate), which can complicate determining how many tablets to take or how much liquid to take to get the correct dose of iron.

As iron enters the small intestine (duodenum and jejunum), it is absorbed. There is therefore a possibility that enteric-coated iron tablets do not work as well as they should. If you take antacids, you should take iron tablets before or after them. When you take iron tablets, you can increase iron absorption by taking 250 mg of vitamin C (ascorbic acid). This may be recommended by your doctor.

Iron tablets may also cause diarrhoea, constipation, nausea, vomiting, and abdominal discomfort, in addition to nausea and vomiting.

Intravenous Iron

It is possible to receive intravenous iron (IV) under certain circumstances. The use of iron infusions may be necessary when patients have poor gastrointestinal absorption, severe iron deficiency or chronic blood loss, or when erythropoietin supplements are taken, which increase the production of blood, or any time oral iron cannot be taken. You may need to receive IV iron under the supervision of a haematologist if you need this treatment. You can receive IV iron in the following forms:

1. Iron dextran
2. Iron sucrose
3. Ferric gluconate

It is possible to give large amounts of iron at once when using iron dextran. Sucrose and ferric gluconate must be given more often and over a longer period. A test dose may be administered before the first IV iron infusion to determine if the patient has an allergic reaction. Iron dextran is more likely to cause allergic reactions and may need to be switched to a different preparation. Allergic reactions are the most common side effect of this drug, followed by pruritus (itching) and muscle and joint pain.

Blood Transfusions

A red blood cell transfusion may be given to a patient with severe iron deficiency anaemia whose blood is actively clotting or whose symptoms include chest pain, shortness of breath, or weakness. Iron deficiency can only be partially corrected by transfusion as it replaces deficient red blood cells. An RBC transfusion will only temporarily improve your condition. You should determine the cause of your anaemia and treat the underlying causes as well as your symptoms.

Am I at Risk?

Women and those with low iron diets are more likely to suffer from iron deficiency, especially if they are pregnant.

The following causes are less common:

• Anaemia results from blood loss from the gastrointestinal tract due to gastritis (a condition which causes inflammation of the stomach), esophagitis (an illness that causes inflammation in the oesophagus), ulcers in the stomach or bowel, haemorrhoids, angiodysplasia (a condition in which blood vessels leak and appear similar to varicose veins in the gastrointestinal tract), or tumours (in the stomach, small bowel, colon, or
• Chronic nosebleeds can cause blood loss
• due to kidney stones or bladder stones
• Donating blood frequently can cause blood loss
• During intravascular hemolysis, red blood cells are broken down and iron is released into the bloodstream, which is subsequently excreted in the urine.
• March hematuria sometimes occurs following vigorous exercise, such as running, which damages the small blood vessels in the feet.
• Hemolysis in the blood is not the only cause of intravascular hemolysis, since other factors can cause it, such as damaged heart valves or rare disorders like thrombotic thrombocytopenic purpura (TTP) and diffuse intravascular hemolysis (DIC).

Iron-deficiency anaemia is most prevalent among the following groups of people:

• Menstruating women, especially those with heavy periods; pregnant women, nursing mothers, and new mothers
• People who have undergone major surgery or physical trauma
• Inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease are common among people with gastrointestinal disorders
• People who suffer from peptic ulcer disease
• Bariatric surgery patients, especially those who have undergone gastric bypass procedures
• Vegans, vegetarians, and those with diets lacking iron-rich foods will not absorb iron as well as those who consume meat, poultry, and fish.
• A child who consumes more than 16 to 24 ounces of cow’s milk a day will suffer chronic anaemia (as cow’s milk does not only contain little iron, it can also cause intestinal irritation while decreasing iron absorption.)

How to Do Things Yourself?

The GP will tell you how to eat more iron-rich foods if your diet is partly responsible for your iron deficiency anaemia.

Increase your intake of fruits and vegetables:

• Vegetables with dark green leaves, such as watercress and curly kale, and fortified cereals and bread
• Pulses (beans, peas, and lentils)
• Meat
• Dried fruit like apricots, prunes, and raisins

Drinking less and eating less:

• Tea
• Milk and dairy
• Coffee
• Some foods, such as wholegrain cereals, have high levels of phytic acids, which inhibit your body’s ability to absorb iron from other foods or pills.

Your body has a harder time absorbing iron if you consume large amounts of these foods and drinks.

If you are having trouble including iron in your diet, a specialist dietitian might refer you to one.