Iron Deficiency Anaemia

Overview

Red blood cells carry oxygen from the lungs to every part of the body. They need iron to do this. When iron runs low, the body makes fewer and smaller red cells, and less oxygen reaches your tissues — which is why the main symptom is tiredness.

Anaemia is very common in India, particularly among women who are having periods, pregnant women, teenage girls and young children.

Iron deficiency is a sign, not a full diagnosis. Finding out why the iron is low matters just as much as correcting it — in adults, unexplained iron deficiency always needs a cause to be identified.

Symptoms of Iron Deficiency Anaemia

• Tiredness and weakness, even after adequate sleep
• Pale skin, and pale nails, inner eyelids and tongue
• Getting breathless while climbing stairs or walking quickly
• Dizziness or feeling faint
• Headache
• Cold hands and feet
• Brittle, spoon-shaped nails and increased hair fall
• Craving non-food items such as mud, chalk or ice
• Fast or pounding heartbeat
• Poor concentration, and reduced performance at school or work

What causes it

• Not enough iron in the diet, or a diet where iron is present but poorly absorbed
• Blood loss — heavy periods are the commonest cause in women
• Blood loss from the digestive tract due to piles, ulcers or, less often, a growth
• Hookworm infection, still a significant cause in parts of India
• Pregnancy, which sharply increases the body's iron requirement
• Conditions that reduce absorption, such as coeliac disease or long-term antacid use

Who is at higher risk

• Being a woman who is having periods, particularly heavy ones
• Pregnancy and breastfeeding
• Infancy, early childhood and adolescence — periods of rapid growth
• A diet low in iron-rich foods
• Frequent blood donation
• Long-term kidney disease

Tests and diagnosis

These are the tests doctors commonly use. Which ones you need depends on your symptoms.

• Complete blood count (CBC) — shows low haemoglobin and small, pale red cells
• Serum ferritin — the best single indicator of the body's iron stores
• Iron studies — serum iron, total iron binding capacity and transferrin saturation
• Peripheral smear — to look at the shape and size of the red cells
• Further tests to find the cause where needed, such as a stool test for blood or worms, or an endoscopy

Treatment

• Iron tablets or syrup, usually taken for three to six months — importantly, continued for a few months after the haemoglobin is normal, to refill the body's stores.
• Take iron with vitamin C, such as a lemon or orange, which markedly improves absorption.
• Avoid tea, coffee, milk and calcium tablets within an hour of your iron dose — they block absorption.
• Dark stools while on iron are expected and harmless. Nausea and constipation are common; taking the tablet after food or on alternate days often helps.
• Treat the underlying cause. Iron tablets alone will not fix ongoing blood loss.
• Severe anaemia may need iron given through a drip into a vein, or occasionally a blood transfusion.

Prevention

• Include iron-rich foods regularly — green leafy vegetables, ragi, bajra, jaggery, dates, rajma, chana, and eggs, fish or meat if you eat them
• Add a source of vitamin C to meals — lemon, amla, tomato, guava or orange
• Keep tea and coffee away from mealtimes
• Take iron and folic acid supplements during pregnancy as advised
• Follow national deworming programmes for children and adolescents

When should you see a doctor?

Frequently Asked Questions