Iron deficiency anaemia

What it is

Anaemia means you have fewer red blood cells than normal, or less haemoglobin in them, so your organs and tissues get less oxygen. WHO treats anaemia as a sign of an underlying problem rather than a diagnosis in itself. Iron deficiency anaemia is the most common type, caused by a lack of iron, often because of blood loss or pregnancy.

Not every anaemia is caused by low iron. WHO lists other causes, including low vitamin B12 or folate, infections, long-term illness and inherited red blood cell conditions such as thalassaemia and sickle cell disease. This is one reason to have a test before taking iron, and to take supplements only when a qualified health professional recommends them.

Symptoms

• Tiredness and lack of energy.
• Shortness of breath.
• Noticeable heartbeats (palpitations).
• Skin that is paler than usual.
• Headaches.

Less common signs include ringing or buzzing in the ears, food tasting strange, itching, a sore tongue, hair loss, wanting to eat things that are not food such as ice or paper, difficulty swallowing, sores in the corners of the mouth, spoon-shaped nails and restless legs. WHO adds that severe anaemia can cause paleness inside the mouth and nose and under the fingernails, fast breathing and heart rate, and dizziness on standing up.

Causes and who is more likely to get it

Heavy periods and pregnancy are very common causes. In pregnancy, it is most often due to too little iron in the diet. Bleeding in the stomach or intestines is another common cause, which can come from:

• Anti-inflammatory painkillers such as ibuprofen and aspirin.
• Stomach ulcers.
• Inflammation of the bowel or the food pipe (oesophagus).
• Piles.
• Less commonly, cancer of the bowel or stomach.

WHO says the groups most likely to be affected are young children, menstruating girls and women, and women who are pregnant or have recently given birth.

How it is diagnosed

A doctor will ask about your lifestyle and medical history, then usually arrange a full blood count (FBC), also called a complete blood count (CBC). It checks your red blood cells and other cells in your blood, and you do not need to do anything to prepare. The same test can point to other types of anaemia. See common blood tests explained.

If the cause is not clear, the doctor may arrange more tests, such as a test of a poo sample for hidden blood, or refer you to a specialist.

How it is usually treated

Treatment starts with the cause, such as treating heavy periods or an ulcer. If your red blood cell count is low, the doctor will usually recommend iron tablets, often for about 6 months, with repeat blood tests to check your levels are recovering. Follow the doctor’s advice on how to take them.

Iron tablets can cause constipation or diarrhoea, tummy pain, heartburn, feeling sick and darker poo. Taking them with or soon after food may help. Keep iron tablets out of reach of children: an overdose in a young child can be fatal.

Food helps too. The NHS suggests more dark green leafy vegetables, fortified cereals and bread, meat, dried fruit such as apricots, prunes and raisins, and pulses such as beans and lentils. WHO adds that foods rich in vitamin C help the body absorb iron.

Complications to know about

• A higher chance of illness and infection, because low iron affects the immune system.
• A higher risk of heart or lung problems, such as an abnormally fast heartbeat or heart failure.
• Complications before and after birth if you are pregnant. WHO links anaemia in pregnancy with premature birth and low birth weight.
• In children, severe anaemia can affect development.

Everyday habits that affect iron

Large amounts of tea, coffee, milk and dairy, and foods high in phytic acid such as wholegrain cereals, make it harder for your body to absorb iron. If you drink tea or coffee with meals, try having them between meals instead. WHO also advises taking calcium and iron supplements at different times of day if you take both.

When to see a doctor, and when to call 998

Call 998 or go to the nearest emergency department if you are vomiting bright red blood or vomit that looks like ground coffee, your poo is black, sticky and very smelly or has blood in it, you have severe tummy pain, or you have chest pain that started suddenly. Also call 998 for severe difficulty breathing. Do not drive yourself.

See a doctor if you think you might have iron deficiency anaemia, or if your periods are heavy. General practitioners and internal medicine doctors on medicAI work at independent facilities licensed by DHA or DoH. They can talk through your symptoms and results by video and arrange further tests if needed.