Iron Deficiency Anemia

What is it?

The body typically stores iron and recycles it.  Iron is necessary for the production of red blood cells; these cells are responsible for the delivery of oxygen to the tissues of the body.  The amount of iron stored is dependent on your age, gender, and size.  Typically, women can have lower stores because of losses due to menstrual periods, lower calorie intake, and losses with pregnancy and breast feeding. Iron is absorbed by our body through the foods we eat from the GI tract, mainly in a portion of the small intestine called the duodenum. Iron is found in several forms throughout our bodies: in red blood cells, in proteins, bound in the bloodstream or in storage, mainly in the liver, spleen, and bone marrow.

Why does it happen?

  • Blood loss is the major cause.  The bleeding may be visible such as from trauma, vomiting blood, blood present in bowel movements, coughing up blood, heavy menstrual periods, or bleeding with urination. It is also possible to have “hidden” or occult bleeding in the gastrointestinal tract where no bleeding is visible but blood is being lost.
  • Decreased absorption of iron from the GI tract.  This is relatively uncommon though inflammation in the stomach, a bacterial infection (Helicobacter pylori), or celiac disease can cause iron deficiency and should be considered especially if the low iron levels persist despite taking an iron supplement.
  • There are also several other uncommon causes such as:
    •  Breakdown of red blood cells inside vessels
    •  Losses into the lungs microscopically
    • Gastric bypass. This can lead to decreased iron level because the site of iron absorption is bypassed.

 

How is it diagnosed?

Often a blood test is ordered that shows the number of your red blood cells are low.  Next, iron blood tests are ordered. If you are low in iron, it is important to look for a cause of the iron deficiency.  Your health care provider will ask many questions and potentially order a test to check your stool for hidden blood.

The next step is typically evaluating your GI tract for sources of blood loss with both a colonoscopy and upper endoscopy.  If these tests are unrevealing for a source of blood loss, possibly the next step will be capsule endoscopy.  With this test, you swallow a small capsule that looks like a pill, but is actually a camera. This tiny camera will record pictures of your GI tract, specifically the portions of the small intestine that are not evaluated with the colonoscopy or upper endoscopy.

How is it treated?

The first step is oral iron supplements.  Iron is best absorbed on an empty stomach in an acidic environment.  This can be achieved by taking the iron with a source of Vitamin C such as orange juice or a 250 mg tablet of ascorbic acid.

There are many different iron supplements available over-the-counter. For example:

  • Ferrous fumarate has 106 mg elemental iron per tablet
  • Ferrous sulfate 65 mg of elemental iron per tablet
  • Ferrous gluconate 28-36 mg or iron per tablet.

The amount of elemental iron is important and it is recommended to take 150-200 mg/day. There is no evidence that one preparation is better than another. GI side effects such as abdominal discomfort, nausea, vomiting, diarrhea, or constipation are possible with taking iron.

Sometimes, oral iron is not effective.  If this is the case, injections of iron into blood through an IV or muscle may be tried or you may receive a blood transfusion.

What can I do?

Some foods and medications make it more difficult to absorb iron. Examples of these foods include:

  • Calcium
  • Phytate (present in bran, oats, and rye fiber)
  • Polypphenols (in tea, some vegetables, and cereals)
  • Soy protein
  • Antacids, because of this, take iron 2 hours before or 4 hours after taking
  • Some antibiotics including quinolones and tetracycline
  • Coffee
  • Eggs
     

Iron Deficiency Anemia FAQs

General:

What happens if you have low levels of iron?

Without enough iron, your body can't produce enough hemoglobin, a substance in red blood cells that enables them to carry oxygen. Low hemoglobin is called anemia and can have several negative consequences, including fatigue and trouble catching your breath. 

Are there different types of anemia?

There are hundreds of types of anemia. They fall into three groups:

  • Anemia caused by blood loss
  • Anemia caused by decreased or faulty red blood cell production
  • Anemia caused by destruction of red blood cells

What is the most common form of anemia?

The most common form of anemia is iron deficiency anemia 

What are the symptoms of anemia?

Symptoms include:

  • Extreme fatigue
  • Weakness
  • Pale skin
  • Chest pain, fast heartbeat or shortness of breath
  • Headache, dizziness or lightheadedness
  • Cold hands and feet
  • Inflammation or soreness of your tongue
  • Brittle nails
  • Unusual cravings for non-nutritive substances, such as ice, dirt or starch
  • Poor appetite, especially in infants and children with iron deficiency anemia

Symptoms: 


How do you know you have low iron levels?

If you have any of the symptoms mentioned above—and especially if they seem to be getting worse—it is worthwhile checking with your doctor. Self-diagnosis is a bad idea, and consuming more iron unsupervised may result in damage to your liver and other organs. 

Causes:


What causes iron deficiency? 

Causes of iron deficiency anemia include:

  • Blood loss. Blood contains iron within red blood cells. So if you lose blood, you lose some iron.
  • A lack of iron in your diet. If you consume too little iron, over time your body can become iron deficient. 
  • An inability to absorb iron. Intestinal disorders can lead to iron deficiency anemia. 
  • Pregnancy. Iron deficiency anemia occurs in many pregnant women because their iron stores need to serve their own increased blood volume as well as be a source of hemoglobin for the growing fetus. 

Can menstruation cause iron deficiency?

Absolutely. Women with heavy periods are at risk of iron deficiency anemia because they lose blood during menstruation.

Diagnosis:


Can a doctor order blood tests to check for iron deficiency anemia?

Yes, your doctor will begin by taking blood work to determine the health of your red blood cells. 

Are there any procedures that can be done for iron deficiency anemia?

The cause of iron deficiency has to be evaluated and this often includes procedures such as endoscopy and colonoscopy.  

Is surgery ever performed for iron deficiency anemia?

If there is an area of bleeding that cannot be stopped using endoscopy or colonoscopy, sometimes surgery is needed.  Other causes of iron deficiency can be treated medically

 
Diet:

Can you make diet changes to treat iron deficiency anemia?

Diet changes can help iron deficiency anemia, but your doctor will likely also recommend iron supplements. It’s important to remember that making diet changes alone will not be completely effective. 

Are there vitamins that can help treat iron deficiency anemia? Oral or IV?

Iron supplements taken orally has been found to greatly improve effects of iron deficiency anemia. In some cases, if needed, your doctor may also recommend IV therapy. 

Treatment:


How do you treat iron deficiency anemia?

Once the cause of your anemia has been established and any blood loss treated, your doctor may recommend a change of diet, along with iron supplements. Your doctor will evaluate and determine if IV treatment is needed.  

What will happen if anemia is not treated?

Anemia is a serious but treatable health concern. Untreated, anemia can have a serious impact on a person's health, to the point where a person could actually die from the disease. Anemia can often be managed with medications and supplements, so talking to your doctor is well worth the effort. 

 

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