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Iron-deficiency anaemia

Published by Bupa's health information team, February 2008.

This factsheet is for people who have anaemia caused by a lack of iron, or who would like information about it.

Anaemia is a condition where you have too few red blood cells or not enough haemoglobin in your blood. It can make you feel tired, breathless and faint. The most common type of anaemia is caused when there is not enough iron in the body. This is known as iron-deficiency anaemia.

About iron-deficiency anaemia
Symptoms
Causes
Diagnosis
Treatment
Prevention
Further information
Questions and answers
Related topics
Sources

About iron-deficiency anaemia

You need iron for many important processes inside your body, especially for making the oxygen-carrying pigment in your blood called haemoglobin.

Iron is absorbed from the food and drink you eat by your small intestine. The iron is carried in the blood to the bone marrow - where blood cells are produced - where it's combined with proteins to make haemoglobin. Spare iron can be stored in the liver.

Iron is lost from your body in urine, faeces, dead skin cells and when blood is lost from the body.

On average, men need 8.7mg of iron a day and women need 14.8mg a day. You can usually get all the iron you need from your diet. Certain groups of people are more likely to have iron-deficiency anaemia. These include babies, teenagers and women who have heavy periods.

Symptoms

The symptoms of iron-deficiency anaemia include:

breathlessness
feeling very tired
dizziness
feeling cold all the time, even when it's warm and most other people around you are comfortable
a rapid, weak pulse
palpitations
headaches

Less common symptoms can include tinnitus (ringing in the ears) and an altered sense of taste.

Iron-deficiency anaemia can make people irritable and have poor concentration. It can affect children's growth, causing behavioural and learning difficulties.

Some people with iron-deficiency anaemia develop thin skin and spoon-shaped or brittle nails. It can also cause painful cracks at the sides of the mouth and a sore tongue.

Occasionally, in women over 40, iron deficiency can be a symptom of a condition called Plummer-Vinson syndrome. This also causes difficulty swallowing due to small web-like growths in the oesophagus (the pipe that runs from your mouth to your stomach).

Causes

Iron is an important ingredient of haemoglobin. A shortage, or deficiency, of iron in the body causes the bone marrow to make small red blood cells that don't contain enough haemoglobin. These red blood cells can't carry enough oxygen to the organs and tissues of the body.

In developed countries such as the UK, iron deficiency usually happens when there is not enough iron in the diet, or if the iron in the diet is not absorbed properly. It can also occur if too much iron is lost through blood loss.

Diet

A typical Western diet that includes meat contains enough iron for most adults. Vegans, vegetarians and dieters may not get enough iron. Toddlers and babies who drink cow's milk and are very "picky" about solid foods can also be short of iron.

Coeliac disease (gluten intolerance) damages the lining of the intestine, preventing the normal absorption of nutrients, including iron. Surgery on the stomach or small intestine can also interfere with normal absorption of iron.

Loss of blood

Bleeding due to an injury or surgery can lead to anaemia. It is also possible to have invisible blood loss, especially from the digestive system (stomach and intestine). Causes of iron-deficiency anaemia include:

heavy periods
an inflamed or irritated oesophagus that bleeds
hiatus hernia with bleeding ulcer
stomach or duodenal ulcers
Crohn's disease or ulcerative colitis
piles
tumours of the stomach or colon, which can bleed into the gut

The most common cause of iron deficiency worldwide is hookworm infection. These parasites live in the intestines and feed on blood.

Other causes

Pregnancy can lead to iron-deficiency anaemia because the growing baby needs iron and takes its supply from its mother. Iron deficiency is more likely to develop during pregnancy in women whose diet does not contain plenty of iron.
Premature babies and adolescents need extra iron for their growth spurts and there may not be enough in their diet.

The groups of people who are more likely to have iron-deficiency anaemia are:

babies - especially babies who are fed on cows' milk, which is low in iron (breast milk and formula milk contain more iron)
children and teenagers - growth spurts take up extra iron
adults aged over 60 - people of this age group are more likely to have a poor diet
women - around one in seven pre-menopausal women have iron-deficiency anaemia.

You are also more likely to have iron-deficiency anaemia if you:

take aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) such as indometacin or naproxen - these can cause stomach bleeding
have problems with your digestive system that may lead to bleeding of your stomach or intestines
don't eat meat or dairy products

Diagnosis

If your doctor suspects you have iron-deficiency anaemia, he or she will probably ask you to have a blood test called a full blood count (FBC).

The normal amount - or concentration - of haemoglobin for adults is at least 13g/dl for men (13 grams of haemoglobin per decilitre of blood - a decilitre is 100ml) and 11.5g/dl for women. If your haemoglobin levels are lower than this, you have anaemia.

If your haemoglobin is low, and your red cells are small, you may have iron deficiency. Other tests may be needed to give an idea of your body's store of iron.

Treatment

Your doctor will first try to work out why you are deficient in iron. If you are pregnant or a growing teenager, your doctor may recommend a course of iron supplements (such as ferrous sulphate tablets). Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

The aim of a course of tablets is to make up for the shortage of iron and then build up your body's stores of iron to the normal level. This usually involves taking tablets three times a day for up to six months. If your doctor suspects another problem, such as blood loss, you may need treatment for this as well as a course of iron tablets.

Iron supplements can have side-effects. These include constipation, diarrhoea, an upset stomach or feeling sick. They can also cause faeces to turn black. These side-effects can be off-putting, but they may be reduced by taking the tablets after meals.

People who can't take iron tablets by mouth may be given an injection into a muscle instead. This is quite uncomfortable and can stain the skin.

Prevention

The best way to prevent iron-deficiency anaemia is to eat a diet that contains plenty of iron. The recommended daily amount is 8.7mg a day for men and 14.8mg a day for women.

Good sources of iron include: liver, meat, beans, nuts, dried fruit, whole grains (such as brown rice), fortified breakfast cereals, and most dark-green leafy vegetables (such as watercress and curly kale).

It's a good idea to eat foods containing vitamin C at the same time as eating sources of iron because this helps with iron absorption. Good sources of vitamin C include peppers, fruit juice, sweet potatoes, oranges and kiwi fruit.

Iron is stored in the body and too much iron can be harmful. The UK Food Standards Agency suggests you don't take more than 17mg a day of iron supplements per day unless this is recommended by your doctor or dietician.

Further information

Food Standards Agency
www.eatwell.gov.uk
British Nutrition Foundation
020 7404 6504
www.nutrition.org.uk