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Iron deficiency anaemia

Key points

  • You need iron for many important processes in your body, including making red blood cells.
  • If you don’t have enough iron in your body, iron supplements are the best way to make up for the shortage.
  • You can help prevent iron deficiency anaemia by eating a healthy, balanced diet that contains enough iron.

Iron deficiency anaemia is a type of anaemia that you can develop if you don't have enough iron in your body. Anaemia is a condition in which your blood can’t carry enough oxygen to meet the needs of your body.

About iron deficiency anaemia

You need iron for many important processes in your body. It’s especially important for making haemoglobin – a protein in your blood that carries oxygen.

Iron is absorbed from your food and drink by your small bowel. It’s carried in your blood to your bone marrow, where blood cells are produced. Here, the iron is combined with proteins to make haemoglobin. Any iron that doesn’t get used up is stored in your bone marrow and other organs, such as your liver.

If you don’t have enough iron, your body can’t make enough haemoglobin to meet its needs. Your red blood cells then become abnormally small and can’t carry enough oxygen to your organs and tissues. This leads to the symptoms of anaemia.

Symptoms of iron deficiency anaemia

Common symptoms of all types of anaemia include:

  • feeling tired
  • feeling short of breath
  • feeling your heart racing or thumping, which is called palpitations

If you have iron deficiency anaemia, you may also develop other symptoms, such as:

  • brittle nails
  • thinning hair
  • mouth sores or ulcers
  • itchy skin (pruritus)
  • difficulty swallowing
  • unusual cravings for things like ice or clay, for example

These symptoms may be caused by problems other than iron deficiency anaemia. If you have any of these symptoms, see your GP for advice.

Complications of iron deficiency anaemia

If you have anaemia, your heart has to work harder to deliver oxygen to your vital organs. If left untreated, this may lead to problems with your heart. In the short term, iron deficiency can affect how much work you can do and your ability to exercise.

Causes of iron deficiency anaemia

There are a number of possible causes of iron deficiency anaemia. Often it's a combination of these that can lead to anaemia. Some of the most common causes are listed below.

Blood loss

This is the most common cause of iron deficiency anaemia and includes:

  • heavy menstrual bleeding in women
  • bleeding caused by medicines, such as aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs)
  • an injury or a surgical operation in which you lose a lot of blood
  • bleeding in your stomach or bowel from an ulcer or cancerous growth, for example
  • bleeding from a hookworm infection (this usually only affects people in tropical countries)

Poor diet or digestion

You can also develop iron deficiency anaemia if you don’t get enough iron in your diet or if you don't absorb it properly. This can happen if you:

  • have a bowel disorder, such as coeliac disease or Crohn's disease
  • have had surgery on your small bowel (especially if you have had part of it removed)
  • have had surgery to remove some of your stomach (gastrectomy)
  • don’t eat enough iron-rich foods, such as meat

Other causes

If your body has a sudden demand for extra iron, you may develop iron deficiency anaemia. This can happen if you have a growth spurt, for example, which is most common during your teenage years. This is because your body makes more red blood cells to support your developing bones, muscles and tissues. It can also happen in pregnancy, because your body needs more iron to meet the needs of your developing baby.

Diagnosis of iron deficiency anaemia

Your GP will ask about your symptoms and examine you. He or she may also ask about your medical history. If your GP suspects you have anaemia, he or she will ask you to have a blood test. Your blood will be sent to a laboratory and tested for the following.

  • A full blood count. This is to check the level of haemoglobin in your blood and how many of each of the different types of blood cell you have. It will also check the size of your red cells, and the amount of haemoglobin in each red cell.
  • A blood film. This involves looking at your blood under a microscope to check the size and shape of your red blood cells. It will also assess the different white cells that are present.
  • Serum ferritin level. This is a measure of iron. A level of less than 15 microgram/L suggests you have an iron deficiency. However, this varies between laboratories and is slightly different for men and women.

You may need to have further tests to help identify the cause of your iron deficiency. Your GP may refer you to a haematologist (a doctor who specialises in identifying and treating conditions of the blood). Or your GP may refer you to see a gastroenterologist (a doctor who specialises in identifying and treating conditions that affect the digestive system). If you’re a woman and have heavy periods, your GP may refer you to a gynaecologist (a doctor who specialises in women’s reproductive health).

Treatment of iron deficiency anaemia

Your GP will try to identify why you’re deficient in iron so that he or she can treat any underlying cause.

Self-help

If you're not getting enough iron in your diet, your GP will give you advice on how to get more. He or she may refer you to a dietitian. Good sources of iron include:

  • meat, such as liver
  • beans
  • nuts
  • dried fruit – particularly dried apricots
  • brown rice
  • fortified breakfast cereals
  • dark green leafy vegetables, such as watercress and curly kale

If you eat foods that contain vitamin C at the same time as these foods, it will help your body to absorb the iron. You could have a glass of fruit juice or some fruit with your meal, for example.

Medicines

Iron supplements are the best way to make up for the shortage of iron in your body. Your GP may recommend you take iron supplements two or three times a day for around six months.

Iron supplements can cause side-effects, such as:

  • stomach pain
  • feeling sick
  • heartburn
  • constipation or diarrhoea, often with black faeces

If you get side-effects you may be able to try another type of iron supplement. However, you can reduce your risk of getting side-effects by taking the supplements after meals.

If possible, try to eat foods that contain vitamin C at the same time as you take your iron supplement. This will help your body to absorb the iron.

Always read the patient information leaflet that comes with your iron supplements and if you have any questions, ask your GP or pharmacist for advice.

If you can't take iron supplements, or they don’t work for you, you may need an iron infusion through a drip into a vein. You can have this in a hospital outpatient department. Iron infusions can cause side-effects, such as a headache or joint pains and occasionally, allergic reactions.

Hospital treatment

If you have severe anaemia, you may need to have a blood transfusion. This is when red blood cells are given straight into your bloodstream through a small tube (cannula) put into a vein, usually in your arm.

Prevention of iron deficiency anaemia

You can reduce your risk of developing iron deficiency anaemia by eating a healthy, balanced diet that contains plenty of iron-rich foods. For most people this will provide enough iron without the need to take supplements. If you're pregnant you will need more iron – this can be twice as much as you’d normally need in the second half of your pregnancy.

Produced by Rachael Mayfield-Blake, Bupa Health Information Team, November 2013.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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