Iron deficiency anemia

Overview

Iron deficiency anemia is a common type of anemia. Anemia is a condition in which the blood doesn't have enough healthy red blood cells. Red blood cells carry oxygen to the body's tissues.

Not getting enough iron can cause iron deficiency. So can losing blood from having periods or bleeding inside the body. Without iron, the body can't make enough of the part of red blood cells that lets them carry oxygen, called hemoglobin. As a result, iron deficiency anemia can cause tiredness and shortness of breath.

Taking iron supplements most often can correct iron deficiency anemia. But a healthcare professional needs to look for the cause of iron deficiency anemia.

Symptoms

At first, iron deficiency anemia can be so mild that you don't notice it. But as the amount of iron gets lower and the anemia gets worse, the symptoms get worse as well.

Iron deficiency anemia symptoms may include:

• Extreme tiredness.
• Weakness.
• Pale skin.
• Chest pain, fast heartbeat or shortness of breath.
• Headache or being dizzy or lightheaded.
• Cold hands and feet.
• Irritation or soreness of the tongue.
• Brittle nails.
• Restless legs syndrome.

Iron deficiency anemia also can cause:

• Wanting to eat things that aren't food, such as ice, dirt or clay.
• Not wanting to eat, especially in infants and children.
• Odd smell cravings, such as for rubber, detergents or cleaning agents.

When to see a doctor

If you or your child gets symptoms that might be from iron deficiency anemia, see your healthcare professional. Don't try to diagnose or treat it on your own.

And talk to a healthcare professional before taking iron supplements. Too much iron in the body can be harmful. The iron can build up and damage the liver and other organs.

Causes

Iron deficiency anemia happens when the body doesn't get enough iron or loses too much iron. As a result, the body can't make enough hemoglobin.

Hemoglobin is the part of red blood cells that gives blood its red color. Hemoglobin lets the red blood cells carry oxygen throughout the body.

Causes of iron deficiency anemia include:

• Blood loss. Blood has iron in its red blood cells. Losing blood means losing iron. People who have heavy periods are at risk of iron deficiency anemia because of the amount of blood lost during their periods.

  Slow blood loss inside the body can cause iron deficiency anemia. This can be from a peptic ulcer, a hiatal hernia, a colon polyp or colorectal cancer.

  Regular use of some pain relievers you can get without a prescription can cause bleeding inside the body. These pain relievers include aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).

• Not enough iron in the diet. The body gets iron from food. To get enough iron, eat iron-rich foods. Iron-rich foods include meat, eggs, leafy green vegetables and ready-made foods that have iron added to them. Infants and children need to get enough iron from their diets too.
• Not being able to take in iron. Iron from food goes into the bloodstream in the small intestine. Some intestinal conditions, such as celiac disease, can affect the body's ability to take in iron. Surgery to bypass or remove part of the small intestine also can affect the body's ability to take in iron.
• Pregnancy. Without iron supplements, many pregnant people get iron deficiency anemia. The body needs more iron during pregnancy because of the higher blood volume. Iron also is a source of hemoglobin for the unborn baby.

Risk factors

These groups of people may have a higher risk of iron deficiency anemia:

• People who have heavy periods. Losing blood during periods puts people at greater risk of iron deficiency anemia.
• Infants and children. Infants who don't get enough iron from breast milk or formula may be at risk of iron deficiency. This is mainly true for those whose birth weight was low or who were born too early.

  Children need extra iron during growth spurts. Children who don't eat a healthy, varied diet might be at risk of anemia.

• Vegetarians and vegans. People who don't eat meat may have a greater risk of iron deficiency anemia if they don't eat enough other iron-rich foods.
• People who had gastric bypass or other stomach surgeries. Bypassing or removing intestinal tissues that help take in iron and other nutrients raises the risk of iron deficiency anemia.
• People who have certain conditions that affect digestion. These include celiac disease, bowel diseases such as ulcerative colitis and Crohn's disease, kidney disease, and peptic ulcers.
• People who donate blood often. These blood donors may have a higher risk of iron deficiency anemia. Giving blood can lower iron in the body. Eating more iron-rich foods might help with low hemoglobin linked to giving blood.

  If you try to donate blood and can't because of low hemoglobin, talk to your healthcare professional.

Complications

People with mild iron deficiency anemia may have no complications. But iron deficiency anemia that isn't treated can get worse. It can lead to health issues, such as:

• Heart issues. This may include a fast or irregular heartbeat. The heart must pump more blood to make up for the lack of oxygen. This can lead to an enlarged heart or heart failure.
• Issues during pregnancy. In pregnant people, serious iron deficiency anemia has been linked to babies born too early and weighing too little at birth. Taking iron supplements as part of prenatal care can prevent the condition.
• Growth issues. In infants and children, serious iron deficiency can delay growth and development. Iron deficiency anemia also is linked to having more infections.

Prevention

You can lower your risk of iron deficiency anemia by choosing foods rich in iron. Also, choosing foods high in vitamin C helps your body take in iron.

Iron-rich foods

Foods rich in iron include:

• Organ meats, such as liver.
• Beef, pork, lamb and poultry.
• Seafood.
• Beans.
• Dark green leafy vegetables, such as spinach.
• Dried fruit, such as raisins and apricots.
• Foods with added iron, such as cereals, breads and pastas.
• Legumes, including lima beans, peas, pinto beans and black-eyed peas.

If you don't eat meat, you may need to eat more plant-based foods that are rich in iron to get enough iron.

Foods high in vitamin C

When you eat foods high in iron, you can help your body take in more iron by eating foods or drinking juices high in vitamin C at the same time.

Good sources of vitamin C include:

• Broccoli.
• Grapefruit.
• Kiwi.
• Leafy greens.
• Melons.
• Oranges and orange juice.
• Peppers.
• Strawberries.
• Tangerines.
• Tomatoes.

Preventing iron deficiency anemia in infants

To keep infants from having iron deficiency anemia, feed your baby breast milk or iron-fortified formula for the first year. Breastfed children need iron supplements starting at 4 months.

Cow's milk is not a good source of iron for infants. It isn't suggested for children younger than 1 year old.

After 6 months, babies can eat cereals with added iron or pureed meats at least twice a day to boost iron intake. Children older than 1 year shouldn't drink more than 24 fluid ounces (720 milliliters) of milk a day. Too much milk often takes the place of other foods, including those that are rich in iron.

Diagnosis

To diagnose iron deficiency anemia, your healthcare professional may run tests to look for:

• Red blood cell size and color. With iron deficiency anemia, red blood cells are smaller and paler than usual.
• Hematocrit. This is the percentage of blood volume made up by red blood cells. Standard levels mainly are between 35.5% and 44.9% for adults assigned female at birth and 38.3% to 48.6% for adults assigned male at birth. These values may change depending on age.
• Hemoglobin. Lower than standard hemoglobin levels mean anemia. Experts define the hemoglobin range as 13.2 to 16.6 grams (g) of hemoglobin per deciliter (dL) of blood for adults assigned male at birth and 11.6 to 15.0 g/dL for adults assigned female at birth. The ranges for children vary depending on their age and sex.
• Ferritin. This protein helps store iron in the body. A low level of ferritin most often means a low level of stored iron.

Other diagnostic tests

If bloodwork shows iron deficiency anemia, more tests can help find the cause. These tests might include:

• Endoscopy. This procedure can help check for bleeding from a hiatal hernia, an ulcer or the stomach itself. A healthcare professional passes a thin, lighted tube with a camera from the throat to the stomach. Endoscopy also can show bleeding inside the tube that runs from the mouth to the stomach, called the esophagus.
• Colonoscopy. This procedure can help rule out bleeding in the lower intestinal tract. A healthcare professional puts a thin, flexible tube with a camera into the rectum and guides it to the colon.

  A colonoscopy lets the healthcare professional look for bleeding inside the colon and rectum.

• Ultrasound. People who have periods might have a pelvic ultrasound to look for the cause of too much bleeding during periods, such as uterine fibroids.

You might have these or other tests after trying iron supplements to see if the supplements help.

Treatment

Iron supplements most often treat iron deficiency anemia. There also might be treatment for the cause of anemia.

Iron supplements

Your healthcare professional might suggest you take iron tablets you can get without a prescription and how much to take. Iron also comes in liquid form for infants and children.

To help your body take in iron, your healthcare professional may tell you to:

• Take iron tablets on an empty stomach. If possible, take your iron tablets before you eat. But because iron tablets can upset your stomach, you may need to take your iron tablets with meals.
• Don't take iron with antacids. Medicines that quickly relieve heartburn can keep the body from taking in iron. Take iron two hours before or four hours after you take antacids.
• Take iron tablets with vitamin C. Vitamin C might help the body take in iron. Try taking iron tablets with a glass of orange juice or with a vitamin C supplement.
• Don't drink coffee or tea within an hour of taking iron. Coffee and tea can keep your body from taking in iron.

Iron supplements can cause trouble with passing stool, called constipation. So you might need a stool softener. Iron also can turn stools black. This is harmless.

If iron deficiency anemia is bad, you may need to get iron through a tube in a vein. Rarely, getting donated blood, called a transfusion, can help replace iron and hemoglobin quickly.

You can't fix iron deficiency overnight. You may need to take iron supplements for several months or longer to build up your iron. Ask your healthcare professional when to have your blood rechecked to measure your iron levels. Most people start to feel better after a week or so of treatment.

Treating causes of iron deficiency

If iron supplements don't raise blood-iron levels, the anemia likely is due to bleeding or an issue taking in iron. Your healthcare professional will need to try to find the cause to treat it.

Preparing for your appointment

Make an appointment with your healthcare professional if you have symptoms that worry you. Your healthcare professional might send you to a specialist in blood conditions, called a hematologist.

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

• Your symptoms, even ones you don't think are important, and when they began.
• Key personal information, including any major stresses or recent life changes.
• All medicines, vitamins and supplements you take, including doses.
• Questions to ask your healthcare professional.

For iron deficiency anemia, basic questions to ask include:

• What's the most likely cause of my symptoms?
• Are there other possible causes of my symptoms?
• Is my condition likely to go away?
• What treatment do you suggest?
• I have another health condition. How can I manage these conditions together?
• Do I need to change my diet?
• Are there brochures or other printed information I can have? What websites do you suggest?

Be sure to ask all the questions you have.

What to expect from your doctor

Be ready to answer questions such as:

• How bad are your symptoms?
• Does anything seem to make your symptoms better?
• Does anything seem to make your symptoms worse?
• Have you noticed bleeding that isn't usual, such as heavy periods, bleeding from hemorrhoids or nosebleeds?
• Are you a vegetarian?
• Have you recently donated blood more than once?