Iron deficiency anaemia
What is iron deficiency anaemia?
Iron deficiency anaemia is when lack of iron means that the blood does not contain enough haemoglobin — the iron-based pigment in red blood cells that gives them their colour and carries oxygen. Severe and prolonged iron deficiency is needed to cause anaemia.
Iron deficiency anaemia is one of several types of anaemia. This type of anaemia is common, particularly in women near menopause, teenage girls, premature or very small babies, people on restricted diets and the elderly, and is usually easy to treat.
Why did I get iron deficiency anaemia?
The reasons for getting iron deficiency anaemia include:
- losing a lot of blood from heavy periods or stomach and bowel problems, including ulcers or cancer;
- lack of iron in the diet over a long period of time;
- fast growth in children;
- being born early (premature);
- being pregnant — the mother’s iron stores go to her baby;
- excessive exercise — the body needs more iron than usual and iron is lost in sweat;
- being unable to absorb iron in the bowel, for example in Crohn’s disease or coeliac disease;
- regular use of medicines that can cause stomach bleeding (for example, aspirin and anti-inflammatories); and
- damaged veins or bleeding piles (haemorrhoids).
What happens in iron deficiency anaemia?
Iron is one of 20 minerals found in food. It is stored in your liver, spleen and bone marrow and is vital for mental and physical well-being. While most of the body’s iron is recycled from dead red blood cells, a small but essential amount comes from food. If your body does not have enough iron, it can’t make enough haemoglobin.
What does iron deficiency anaemia feel like?
The symptoms of iron deficiency anaemia are caused by the lack of oxygen being supplied to the tissues. You may feel tired, short of breath when exercising, unable to concentrate, have headaches or get irritable. Your skin and the inside of your mouth may be pale. You may also be likely to pick up infections. Eventually, your nails can become spoon-shaped and brittle, the corners of your mouth may crack, and you may have difficulty swallowing. Some people also get cravings for unusual substances, such as ice or earth.
Older people with iron deficiency anaemia may get angina (pain in the chest) because the heart has to work harder to supply enough oxygen to the body.
Children with low iron levels may be slow to learn or develop.
While symptoms can be severe, in the early stages of iron deficiency you may have no symptoms or just mild fatigue.
How is iron deficiency anaemia diagnosed?
Anaemia may be diagnosed if you have some of the symptoms listed above, but if the anaemia is not severe you may not feel anything and will be diagnosed only if you have a routine blood test. Blood tests will show how much iron is in your blood and what type of anaemia you have. Other tests may be needed to see if there is any bleeding in your stomach or bowel.
What makes iron deficiency anaemia better?
What will help the condition depends on the cause of your anaemia. However, iron deficiency anaemia is usually easily treated with iron supplements and a good diet. Your blood count will be checked regularly to make sure anaemia has not returned.
- Iron supplements are usually given as tablets, but if you need a high dose of iron, you may have an injection or intravenous infusion (via a drip into a vein). Iron tablets can turn your bowel motions black — this is harmless. They may also cause indigestion, nausea, diarrhoea or constipation. If so, your doctor may change the tablets or suggest other ways of reducing the indigestion. Take your tablets as prescribed.
- Take iron tablets on an empty stomach unless you get bad indigestion, in which case you should take them with food.
- Don’t take iron supplements with milk, tea or coffee — these can reduce the amount of iron your body absorbs.
- Wait 2 hours after taking iron tablets before taking other medicines.
- Keep taking the tablets for at least 3 months or until your doctor tells you to stop. You must take them until well after your haemoglobin is normal.
- If you are pregnant you may be given iron tablets. A healthy diet is also recommended.
- Children should be given their iron medicine (usually in liquid form) before meals with orange juice (not milk), as vitamin C increases iron absorption. They should use a straw because liquid iron can discolour the mouth.
- Your body absorbs only a small amount of iron, so it is important to eat a lot of iron-rich foods (meat, fish or poultry, whole or enriched grains) every day.
- Eating a lot of foods rich in vitamin C (e.g. citrus fruits, kiwi fruit, red capsicum, leafy green vegetables) will help iron absorption.
- Limit your milk intake to 500 mL daily. Talk with your doctor, dietitian or community health nurse about other ways to get enough calcium.
- Don’t drink tea with meals — it prevents iron absorption.
Your doctor or community health nurse can tell you how much iron you need daily. A dietitian can plan a diet for you.
What happens if anaemia is not treated?
The anaemia can get worse and you can feel more and more unwell, particularly if the underlying cause, such as stomach bleeding, is not treated.
For severe iron deficiency anaemia, you may need a blood transfusion.
Iron deficiency due to pregnancy may improve on its own if your diet is good; however, iron supplements may be needed.
If you have heavy periods your doctor may be able to suggest medicines to reduce blood loss.
- 1. Iron deficiency [revised September 2006]. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited; 2009 Nov (Accessed 2009 Dec 18.) http://www.tg.org.au/
2. Gastroenterological Society of Australia and Digestive Health Foundation [website]. Clinical update Iron deficiency (First edition 2008). Available at: http://www.gesa.org.au/pdf/booklets/IronDeficiancyClinical.pdf (Accessed 2009, December 18)
3. Royal Australian and New Zealand College of Obstetricians and Gynaecologists [website]. New College Statement Vitamin and mineral supplementation in pregnancy (published July 2008). Available at: http://www.ranzcog.edu.au/publications/statements/C-obs25.pdf (Accessed 2009, Dec 18)