Iron-Deficiency Anemia; Why It Happens and What to Do About It

“I was wondering why I am always so tired. My doctor did some tests and found out I have anemia.” Anemia is a common medical condition affecting the red blood cells causing fatigue and weakness. 

Iron deficiency anemia is the most common type of anemia. The most common causes in women are heavy menstrual bleeding or pregnancy. Iron deficiency affects up to 40% of pregnant women around the world.

Men and women develop Iron deficiency through a poor diet, kidney, or gastrointestinal intestinal diseases affecting iron production and absorption. 

Medical providers will search for the underlying cause while treating this common disorder with dietary changes and iron supplementation. 

What is iron-deficiency anemia?

Iron-deficiency anemia occurs when the body lacks iron. Our bodies require certain mineral levels to carry oxygen through our red blood cells to all parts of the body. Red blood cells are produced in the bone marrow and kidneys.

If our bodies do not make enough healthy red blood cells or the blood cells function correctly, then we develop anemia. Iron-deficiency anemia is the most common type of anemia.

Iron is required to produce hemoglobin, the oxygen-binding molecule inside of red blood cells.  

Who gets iron-deficiency anemia?

Although anyone can develop Iron-deficiency anemia, it much more common in women. The risk of iron-deficiency anemia is highest for women. 

Pregnancy is a major risk factor. Iron-deficiency anemia affects up to 40% of pregnant women. Pregnancy increases the risk of iron deficiency for three reasons. 

1. Dilutional effect. Pregnant women expand their total blood volume by 50%. This increase in fluid creates a dilution effect on blood cells leading to anemia
2. Reduced blood cell lifespan. Red blood cells have a lifespan of about 120 days. During pregnancy, red blood cells live only 90 days.
3. Baby’s steal it. The growing fetus needs iron too. The baby fills its nutritional needs from maternal blood through the placenta.

Heavy menstrual periods are another cause of anemia. Menstrual cycles may be a natural process, but the body is still losing blood. Up to 5% of women of childbearing age develop iron-deficiency anemia because of heavy bleeding during their periods.

Infants, small children, and teens are also at high risk for iron-deficiency anemia due to dietary habits. 

What are the symptoms of iron-deficiency anemia?

Iron-deficiency anemia often develops slowly and gradually. In the beginning, one may have mild symptoms or none at all. As anemia becomes worse, patients may notice one or more of these symptoms:

• Fatigue
• Weakness
• Dizziness
• Headaches
• Low body temperature
• Pale or yellow “sallow” skin
• Rapid or irregular heartbeat
• Shortness of breath or chest pain, especially with physical activity
• Brittle nails
• Pica (unusual cravings for ice, or non-food items like dirt or paper)

Anyone with symptomatic anemia should talk to a doctor or practitioner.

What causes iron-deficiency anemia?

Chronic blood loss causes the loss of red blood cells faster than the body can reproduce them. Most chronic bleeding occurs in the gastrointestinal, renal, and reproductive systems. 

• Digestive system problems include stomach and intestinal ulcers, colon polyps, or colon cancer.
• Regular, long-term use of aspirin and other over-the-counter pain relievers
• Frequent blood donation
• Heavy or long menstrual periods
• Uterine fibroids– Fibroids are noncancerous growths in the uterus that can cause heavy bleeding.
• Endometrial polyps
• Pregnancy
• Poor nutrition
• Iron absorption issues- Certain health conditions, such as Crohn’s disease, celiac disease, or gastric bypass surgery reduces dietary iron absorption.
• Iron production issue- Chronic kidney disease or bone marrow disorders

How is iron-deficiency anemia diagnosed?

A physician will combine a medical history, exam, and blood testing to diagnose and evaluate anemia. 

• Health history: The doctor will ask about questions about the digestive system, menstrual cycles, diet and nutrition, medications, and family history.
• Physical exam
• Blood testing: The doctor will run a complete blood count (CBC). The CBC measures and evaluated many blood components and is the starting point for anemia evaluation. If abnormal other tests such as a serum Iron level, Iron binding capacity, and ferritin may be needed.

How is iron-deficiency anemia treated?

The first step is iron deficiency treatment is to identify the underlying cause. We can supplement iron levels, but if we do not stop the iron loss, the problem will continue. 

Think of a bathtub. We can continue to fill it up, but the water will rise faster if we plug the drain first. 

• Blood loss from a digestive system problem. Gastrointestinal ulcers may need medical treatment with antibiotics or other medications. Intestinal polyps, precancerous lesions, or even cancer will require surgical removal.
• Blood loss from heavy menstrual cycles. A gynecologist can help offer many options to help with heavy periods. Hormonal birth control methods and other medications can help reduce menstrual bleeding. Endometrial polyps and fibroids can be treated with surgery. Some choose to control heavy bleeding with an endometrial ablation or in severe cases a hysterectomy.
• Iron supplementation. Over-the-counter and prescription oral Iron supplements are often prescribed to help increase Iron levels. IV Iron injections are available for severe cases.
• Dietary changes. Eating more iron-rich foods helps increase iron storage. Good sources include meat, fish, eggs, beans, peas, and iron-fortified foods.
• Vitamin C supplements. Vitamin C helps our body absorb iron from other foods. Good sources of vitamin C include oranges, broccoli, and tomatoes.

Iron deficiency is a common condition. Identifying the underlying cause is the first step to getting affecting patients feeling much better.