What Happens When Iron Is Low? (Iron Deficiency Anemia)

Anemia is a condition in which blood lacks hemoglobin in your red blood cells. Red blood cells carry oxygen to the body’s tissue. Iron deficiency anemia is the most common type of anemia.  It happens when the body does not have enough iron. Iron is needed to make hemoglobin. Thus, without enough iron, our body will have low hemoglobin levels and subsequently will lead to low oxygen supply to our body tissue/cells. Iron also helps to maintain healthy cells, skin, hair and nails. 

We get iron from the food we eat. Iron will be absorbed into our body by the cells that line our gastrointestinal tract. But our body only absorbs a small amount of the iron that we eat. The iron is then released into the bloodstream and binds with transferrin and delivers to the liver. Iron will then be stored in the liver as ferritin and only will be released when needed to make new red blood cells in the bone marrow. 

What are the symptoms of iron deficiency anemia?

Initially, iron deficiency anemia could be so mild that it goes unnoticed or has no symptoms at all. Patients are only detected when doing a blood test. If no blood test is done, the signs and symptoms will start to appear when the iron deficiency anemia becomes worse.

The signs and symptoms of iron deficiency anemia:

  1. General fatigue or weakness
  2. Pale skin
  3. Dizziness
  4. Shortness of breath or palpitation
  5. Cold hands and feet
  6. Brittle nail
  7. Hair loss
  8. Inflammation or soreness of the tongue
  9. Craving food that no nutrition value

What are the causes of iron deficiency anemia?

If consuming not enough iron or losing too much iron, the body will lack iron for hemoglobin production and leading to iron deficiency anemia.

The common causes of iron deficiency anemia:

  1. Lack of iron in diet
    – Food that are rich in iron: meats, eggs, leafy green vegetables and iron-fortified food 
  1. Blood loss
    – Blood contains iron within red blood cell, so if you lose blood, you will lose iron as well
    – Women with heavy menstrual, patients with peptic ulcer/ colon polyp or colon cancer will experience bleeding/blood loss that will lead to iron deficiency as well 
  1. Unable to absorb the iron that consumes
    – Patients with certain conditions like celiac disease where the intestine absorption ability is affected. Iron is one of the nutrients that will be absorbed in the intestine, so if the ability of absorption is affected, less iron will be available.
  1. Pregnancy
    – The iron requirement will increase during pregnancy.
    – Pregnant women need more iron supply per day to serve their own increased blood volume and be a source of hemoglobin for growing fetus.

Who are at risk for iron deficiency anemia?

  • women of childbearing age
  • pregnant women
  • people with a poor diets that lack nutrition
  • people who donate blood frequently
  • infants and children
  • vegetarian

How to diagnose or screen for iron deficiency anemia?

For patients that are experiencing anemia symptoms or wish to screen for iron deficiency, the doctor will do the test as below:
– Full blood count: to look at the hemoglobin and hematocrit level
– Iron study: to look at iron level, ferritin level and transferring level

If there are signs of bleeding, additional tests will be needed to find out the underlying causes. Endoscopy, colonoscopy or ultrasound will be used to look for sources or causes of bleeding.

Treatment for iron deficiency anemia

If a patient is found to have iron deficiency anemia, treatment will be started to restore iron levels in the body.

  • The most common treatment is starting an iron tablet supplement. There are multiple brands of iron supplements available. It is best to take iron tablets with an empty stomach. Patients who are taking iron supplements are also advised to take vitamin C to help with iron absorption.
  • Another option we can consider is to administer iron intravenously. We use this most often when patients do not respond to iron tablets supplement. Some people are also less tolerant of the side effects of oral iron tablets. 
  • Importantly, we must treat the underlying causes of iron deficiency anemia. For example, if a patient is suffering from iron deficiency anemia due to colon polyp, surgery will be done to remove the polyp that is causing blood loss.

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