Anemia - iron deficiency

Iron deficiency anemia is the most common form of anemia.

Red blood cells bring oxygen to the body's tissues. Healthy red blood cells are made in your bone marrow. Red blood cells circulate through your body for 3 to 4 months. Parts of your body, such as your spleen, remove old blood cells.

Iron is a key part of red blood cells. Without iron, the blood cannot carry oxygen effectively. Your body normally gets iron through your diet. It also reuses iron from old red blood cells.

You get iron deficiency anemia when your body's iron stores run low. This can occur because:

• You lose more blood cells and iron than your body can replace
• Your body does not do a good job of absorbing iron
• Your body is able to absorb iron, but you are not eating enough foods that contain iron
• Your body needs more iron than normal (such as if you are pregnant or breastfeeding)

Bleeding can cause iron loss. Common causes of bleeding are:

• Heavy, long, or frequent menstrual periods
• Cancer in the esophagus, stomach, small bowel, or colon
• Esophageal varices, usually from cirrhosis
• The use of aspirin, ibuprofen, or arthritis medicines for a long time, which can cause gastrointestinal bleeding
• Peptic ulcer disease

The body may not absorb enough iron in your diet due to:

• Celiac disease
• Crohn disease
• Gastric bypass surgery
• Taking too many antacids that contain calcium

You may not get enough iron in your diet if:

• You are a strict vegetarian
• You are an older adult and do not eat a full diet

You may have no symptoms if the anemia is mild.

Most of the time, symptoms are mild at first and develop slowly. Symptoms may include:

• Feeling grumpy
• Feeling weak or tired more often than usual, or with exercise
• Headaches
• Problems concentrating or thinking

As the anemia gets worse, symptoms may include:

• Blue color to the whites of the eyes
• Brittle nails
• Desire to eat ice or other non-food things (pica)
• Light-headedness when you stand up
• Pale skin color
• Shortness of breath
• Sore tongue

Symptoms of the conditions that cause iron deficiency anemia include:

• Dark, tar-colored stools or blood
• Heavy menstrual bleeding (women)
• Pain in the upper belly (from ulcers)
• Weight loss (in people with cancer)

Treatment may include taking iron supplements and eating iron-rich foods.

Iron supplements (most often ferrous sulfate) are needed to build up the iron stores in your body. Most of the time, your doctor or nurse will measure your iron levels before starting supplements.

If you cannot take iron by mouth, you may need to take it through a vein (intravenous) or by an injection into the muscle.

Pregnant and breastfeeding women will need to take extra iron because they often cannot get enough iron from their normal diets.

Your hematocrit should return to normal after 2 months of iron therapy. You will need to keep taking iron for another 6 to 12 months to replace the body's iron stores in the bone marrow.

Iron-rich foods include:

• Chicken and turkey
• Dried lentils, peas, and beans
• Fish
• Meats (liver is the highest source)
• Peanut butter
• Soybeans
• Whole-grain bread

Other sources include:

• Oatmeal
• Raisins, prunes, and apricots
• Spinach, kale, and other greens

With treatment, the outcome is likely to be good. However, it does depend on the cause.

Call your health care provider if:

• You have symptoms of iron deficiency
• You notice blood in your stool

A balanced diet should include enough iron. Red meat, liver, and egg yolks are high sources of iron. Flour, bread, and some cereals are fortified with iron. If advised by your doctor, take iron supplements if you are not getting enough iron in your diet.

Brittenham GM. Disorders of iron homeostasis: iron deficiency and overload. In: Hoffman R, Benz EJ Jr, Silberstein LE, et al., eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 34.