Iron-deficiency anemia

Overview

Red blood cells carry oxygen through your body. They need iron to do this. When your iron runs low, your body makes fewer red blood cells, and you may feel tired, weak, or short of breath.

Mild iron-deficiency anemia may cause no symptoms. It usually develops slowly. Finding out why your iron is low is important, because the cause, like hidden bleeding, may need treatment too.

Symptoms

Symptoms start slowly and may be mild at first.

• Fatigue or weakness
• Pale skin
• Dizziness or lightheadedness
• Cold hands and feet
• Craving ice, dirt, clay, or starch (pica)

Less common

• Shortness of breath
• Headaches
• Fast or uneven heartbeat
• Brittle or spoon-shaped nails
• Sore or swollen tongue
• Restless legs at night
• Hair loss

How it usually goes

• Months: Iron slowly runs low, often without symptoms.
• Weeks 1 to 6 of treatment: Energy often improves; blood counts rise.
• 3 to 6 months: Iron stores are refilled.

Look up a symptom: Cold hands or feet · Craving ice, dirt, clay, or starch · Dizziness · Eating a very limited diet, or had weight-loss surgery · Fatigue · Feeling weak all over · Hair loss · Heavy periods · Low vitamins or minerals on a blood test, or worried about a deficiency · Muscle weakness in arms or legs · Pale skin · Smooth, red, sore, or swollen tongue · Urge to move the legs at night · Vegan or vegetarian diet

When to get medical care

Causes

Iron runs low when you lose blood, don't get enough iron in your diet, or can't absorb it.

Common causes include heavy periods, pregnancy, bleeding in the stomach or gut (sometimes from aspirin or ibuprofen), celiac disease, and weight-loss surgery.

Does it spread or run in families?

• It isn't contagious. You can't catch it from someone else.

Who is more likely to get it

• Heavy periods or pregnancy
• Babies and toddlers, especially if they drink a lot of cow's milk
• Vegan or vegetarian diets
• Stomach or gut problems, like celiac disease or ulcers
• Weight-loss surgery

Possible complications

• Restless legs syndrome: An urge to move the legs at night
• Pica: Craving ice or non-food items
• Stomach ulcer: A possible hidden cause of bleeding

Diagnosis

Simple blood tests can show low iron and anemia.

Questions you may be asked

• How tired you've been and for how long
• Heavy or long periods
• Black or bloody stools, or stomach pain
• Your diet, including if you're vegan or vegetarian
• Medicines like aspirin or ibuprofen
• Past stomach or weight-loss surgery

The exam

They'll check your skin, nails, tongue, heart, and belly.

Tests

Tests often include:

• Complete blood count (CBC): Checks your red blood cells and hemoglobin.
• Iron tests: Including ferritin, which shows how much iron your body has stored.
• Tests for bleeding: Such as a stool test, or a scope of the stomach or colon, to find a cause.

Treatment

Treatment builds your iron back up and fixes the cause.

Self-care

• Take iron as directed, often for several months
• Take iron with vitamin C, like orange juice, to help your body absorb it
• Eat iron-rich foods, like meat, fish, beans, lentils, spinach, and iron-fortified cereal
• Avoid taking iron with milk, tea, coffee, or antacids, which can block it
• Drink water and eat fiber if iron makes you constipated

Medicines

Ask your healthcare professional before starting iron. Too much iron can harm your organs.

Iron pills are not for people who don't have low iron.

If iron pills don't work or upset your stomach too much, iron can be given through a vein (IV). Severe anemia may need a blood transfusion. Bleeding in the gut may need a procedure or surgery.

How it compares

Prevention

You can lower the risk:

• Eat iron-rich foods, with vitamin C
• Ask about iron if you're pregnant or have heavy periods
• Give babies iron-fortified formula or cereal; no cow's milk before age 1
• Limit toddlers' cow's milk so it doesn't replace iron-rich foods

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to a hematologist (blood doctor).
• A registered dietitian can help plan meals.

Children, pregnancy, and older adults

• Babies and children: Low iron can affect growth and learning. Don't give iron supplements without asking the child's healthcare professional.
• Pregnancy: Your body needs more iron. You may be asked to take iron pills.
• Older adults: Low iron may be a sign of bleeding in the gut. Get checked.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

Outlook

Most people feel better within weeks of starting iron. Iron stores take several months to refill. It can come back if the cause isn't treated.

Myths and facts

Getting ready for your visit

Bring notes about bleeding and diet.

What to bring

• How heavy and long your periods are
• Any changes in your stool
• All medicines and supplements
• What you usually eat

Questions to ask

• Why is my iron low?
• Do I need tests for bleeding?
• How long should I take iron?
• When should my blood be checked again?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Iron-deficiency anemia