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Iron-Deficiency Anemia

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(Reduced Iron in Blood)

Definition

Anemia is a low level of healthy red blood cells (RBC). RBCs carry oxygen from the lungs to the rest of the body. When red blood cells are low the body does not get enough oxygen. This can cause symptoms such as fatigue, pale skin, or irregular heartbeat.
Iron is needed to build healthy RBCs. Iron-deficiency anemia is caused by low levels of iron in the body.
Red Blood Cells
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Iron makes a critical component of red blood cells.
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Causes

Factors that play a role include:
  • Iron that is poorly absorbed in the digestive tract (may occur due to intestinal diseases or surgery)
  • Chronic bleeding (eg, heavy menstrual bleeding, bleeding in the gastrointestinal [GI] tract)
  • Not enough iron in the diet (common cause in infants, children, and pregnant women)

Risk Factors

These factors increase your chance of developing this condition. Tell your doctor if you have any of these risk factors:
  • Rapid growth cycles (infancy, adolescence)
  • Heavy menstrual bleeding or chronic blood loss from the GI tract
  • Pregnancy
  • Diets that contain insufficient iron (rare in the United States)
  • Breastfed infants who have not started on solid food after six months of age
  • Babies who are given cow’s milk prior to age 12 months
  • Alcoholism

Symptoms

While most people with mild anemia have no symptoms, when present, symptoms may include:
  • Fatigue
  • Pale skin
  • Fingernail changes
  • Weakness
  • Headache
  • Decreased work capacity
  • Heart palpitations
  • Infection
  • Craving to eat things that are not food (called a pica), such as ice or clay
  • Hair loss
  • Shortness of breath during or after physical activity

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include:
  • Serum iron
  • Transferrin iron binding capacity
  • Serum ferritin level
  • Microscope examination of a blood smear
  • Fecal occult blood test—to look for hidden blood in the stool

Treatment

Treatments may include:

Iron Supplements

Iron can be taken as a supplement or as part of a multivitamin. Iron comes in many "salt" forms. Ferrous salts are better absorbed than ferric salts. Ferrous sulfate is the cheapest and most commonly used iron salt. Slow-release or coated products may cause less stomach problems. However, they may not be absorbed as well. Some products contain vitamin C to improve absorption. Talk to your doctor, though, because your iron level could get too high.

Iron-Fortified Cereal

Your doctor may recommend that you feed your baby iron-fortified cereal.

Prevention

To help reduce you or your child's chances of getting this condition, take the following steps:
  • Eat a diet rich in iron (eg, oysters, meat, poultry, fish)
  • Avoid foods that interfere with iron absorption, like black tea
  • Ask your doctor if your infant is getting enough iron—The general guidelines are:
    • Starting at four months, breastfed infants need an iron supplement until they get enough iron from other sources, like infant cereal or iron-fortified formula.
    • Bottle-fed infants should get a formula that is fortified with iron.
    • Many premature infants need extra iron starting at one month of age.

RESOURCES

American Academy of Pediatrics http://www.aap.org/

American College Obstetrics and Gynecology http://www.acog.org/

CANADIAN RESOURCES

Dietitians of Canada http://www.dietitians.ca/

Health Canada http://www.hc-sc.gc.ca/

References

American Academy of Pediatrics. Committee on Nutrition. Iron fortification of infant formulas. Pediatrics . 1999;104:119-123. Pediatrics website. Available at: http://pediatrics.aappublications.org/cgi/content/full/104/1/119 . Accessed July 15, 2007.

Beers MH, Berkow R. The Merck Manual of Diagnosis and Therapy . 17th ed. Hoboken, NJ: John Wiley & Sons; 1999.

Beers MH, Berkow R. The Merck Manual of Diagnosis and Therapy . 18th ed. Hoboken, NJ: John Wiley & Sons; 2006.

Iron. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 2007. Accessed July 15, 2008.

Schroeder K. Good food sources of iron. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 2006. Accessed July 15, 2008.

US Preventive Services Task Force. The Guide to Clinical Preventive Services: Report of the United States Preventive Services Task Force . 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002.

US Preventive Services Task Force. The Guide to Clinical Preventive Services: Report of the United States Preventive Services Task Force . AHRQ Publication No. 06-0588; Rockville, MD: 2006.

10/12/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Baker R, Greer F, the Committee on Nutrition. Clinical report—diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). American Academy of Pediatrics website. Available at: http://pediatrics.aappublications.org/cgi/reprint/peds.2010-2576v1 . Published October 5, 2010. Accessed October 12, 2010.

Revision Information

  • Reviewer: Kari Kassir, MD
  • Review Date: 09/2012 -
  • Update Date: 03/28/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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