Overview
Iron deficiency anemia is a condition in which the body lacks enough iron to produce sufficient healthy red blood cells. It is very common, especially among women, children, and pregnant women.
Iron is a critical mineral that carries oxygen as part of hemoglobin. Its deficiency causes fatigue, weakness, and paleness, and in serious cases, strains the heart.
Symptoms
May not cause symptoms at first. As it progresses:
- Extreme fatigue, weakness
- Paleness (especially face, nail beds, lower eyelid)
- Shortness of breath, easy fatigue
- Palpitations
- Headache, dizziness
- Cold hands and feet
- Brittle nails, spoon-shaped nails (koilonychia)
- Hair loss
- Burning, sore tongue
- Difficulty concentrating
- Weakened immune system
- Restless leg syndrome
- Pica (cravings for soil, ice, chalk)
- Growth delay and attention problems in children
Causes
Blood loss:
- Heavy menstrual bleeding (most common cause in women)
- Gastrointestinal bleeding (ulcers, hemorrhoids, colon cancer, polyps)
- Frequent blood donation
- Trauma, surgery
Insufficient iron intake:
- Iron-poor diet
- Vegetarian/vegan diet
- Inadequate nutrition in infants and children
Problems with iron absorption:
- Celiac disease
- Inflammatory bowel disease (Crohn's, ulcerative colitis)
- Bariatric surgery
- Helicobacter pylori infection
- Some medications (acid blockers)
Increased iron need:
- Pregnancy
- Breastfeeding
- Growth spurts (childhood, adolescence)
Risk Factors
- Being female (especially of reproductive age)
- Pregnancy
- Being an infant or child
- Vegetarian diet
- Frequent blood donation
- Gastrointestinal disease
- Being over 65
Complications
- Heart problems: Palpitations, heart enlargement, heart failure
- Pregnancy complications: Preterm birth, low birth weight
- Growth and developmental delay in babies and children
- Weakened immunity, frequent infections
- Difficulty concentrating and learning
When to See a Doctor
- If you have one or more symptoms
- If you notice extreme fatigue and paleness
- If you have heavy menstrual bleeding
- If there are unexplained digestive issues
- Do not skip your routine check-ups during pregnancy
- Children must be screened, especially after age 1
Diagnosis and Treatment
Diagnosis:
- Complete blood count (low hemoglobin, low hematocrit; low MCV — microcytic anemia)
- Serum iron, ferritin (iron stores), iron-binding capacity
- Vitamin B12, folic acid (for differential diagnosis)
- Tests to find the underlying cause: stool occult blood, endoscopy, colonoscopy, gynecological evaluation
Treatment:
1. Treating the underlying cause (most important step)
2. Iron supplementation:
- Oral iron tablets: Ferrous sulfate, ferrous gluconate
- Absorption increases when taken with vitamin C
- Effective on an empty stomach; may cause stomach upset
- Should not be taken with milk, tea, coffee
- Treatment lasts at least 3-6 months (to replenish stores)
3. Intravenous iron therapy:
- For those who cannot tolerate oral iron
- Severe deficiency
- Patients with ongoing blood loss
4. Blood transfusion: Only in very severe anemia and emergencies
Prevention
Iron-rich foods:
- Red meat, chicken, fish, turkey
- Liver, egg yolk
- Dried legumes (lentils, chickpeas, beans)
- Dark leafy vegetables (spinach, lettuce)
- Molasses, dried fruits
- Iron-fortified cereals
Tips to improve iron absorption:
- Consume with vitamin C (orange, pepper, tomato)
- Drink tea and coffee 1-2 hours after meals
- Separate iron sources from dairy if possible
Special recommendations:
- Take iron supplements during pregnancy
- Start iron-rich complementary foods in infants after 6 months
- Women of reproductive age should check hemoglobin at least once a year