Iron deficiency anaemia

Iron deficiency anaemia - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Nutritional Iron deficiency anaemia Iron deficiency anaemia About iron deficiency anaemia Causes of iron deficiency anaemia Diagnosing iron deficiency anaemia Treating iron deficiency anaemia Complications of iron deficiency anaemia About iron deficiency anaemia Iron deficiency anaemia is a condition where a lack of iron in the body leads to a reduction in the number of red blood cells. Iron is used to produce red blood cells, whichhelp store and carry oxygen in the blood. If you have fewer red blood cells than is normal, your organs and tissues wont get as much oxygen as they usually would. There are several different types of anaemia, and each one has a different cause. Iron deficiency anaemia is the most common type. Other types of anaemia can be caused by a lack of vitamin B12 or folate in the body read more about vitamin B12 and folate deficiency anaemia . Symptoms of iron deficiency anaemia Many people with iron deficiency anaemia only have a few symptoms. The severity of the symptoms largely depends on how quickly anaemia develops. You may notice symptoms immediately, or they may develop gradually if your anaemia is caused by a long-term problem, such as a stomach ulcer . The most common symptomsinclude: tiredness and lack of energy (lethargy) shortness of breath noticeable heartbeats(heart palpitations) a pale complexion Less common symptomsinclude: headache hearing sounds that come from inside the body, rather than from an outside source (tinnitus) an altered sense of taste feeling itchy a sore orabnormally smooth tongue hair loss a desire to eat non-food items, such as ice, paper or clay (pica) difficulty swallowing (dysphagia) painful open sores (ulcers) on the corners of your mouth spoon-shaped nails When to see your GP See your GP if you experience symptoms of iron deficiency anaemia. They should be able to diagnose the condition using a simple blood test . Read more about diagnosing iron deficiency anaemia What causes iron deficiency anaemia? There are many things that can lead to a lack of iron in the body. In men and post-menopausal women, the most common cause is bleeding in the stomach and intestines. This can be caused by a stomach ulcer, stomach cancer , bowel cancer , or by takingnon-steroidal anti-inflammatory drugs (NSAIDs). In womenof reproductive age,heavy periods and pregnancy are the most common causes of iron deficiency anaemia as your body needs extra iron for your babyduring pregnancy. Unless youre pregnant, its rare for iron deficiency anaemia to be caused just by a lack of iron in your diet. However, if you do lack dietary iron, it may mean youre more likely to develop anaemia than if you have one of the problems mentioned above. Read more about the causes of iron deficiency anaemia How iron deficiency anaemia is treated Treatment for iron deficiency anaemia involves taking iron supplements toboost thelow levels ofiron in your body. This is usually effective, and the condition rarely causeslong-term problems. Youll need to be monitored every few months to check the treatment is working and your iron levels have returned to normal. The underlying cause will need to be treated so you dont get anaemia again. Increasing the amount of iron in your diet may also be recommended. Good sources of iron include: dark-green leafy vegetables, such as watercress and curly kale iron-fortified cereals or bread brown rice pulses and beans nuts and seeds meat, fish andtofu eggs dried fruit, such as dried apricots, prunes and raisins Read more about treating iron deficiency anaemia Further problems If iron deficiency anaemia is left untreated, it can make you more susceptible to illness and infection, as a lack of iron affectsthe bodys natural defence system(the immune system). Severe iron deficiency anaemia may increase your risk of developing complications that affect the heart or lungs, such as an abnormally fast heartbeat (tachycardia) or heart failure , where your heart is unable to pump enough blood around your body at the right pressure. Pregnant women with severe or untreated anaemia also have a higher risk of complications before and after birth. Read more about the complications of iron deficiency anaemia Causes of iron deficiency anaemia Iron deficiency anaemia occurs when the body doesnt have enough iron, leading to the decreased production of red blood cells. Red blood cells carry oxygen around the body. A lack of iron can be caused by several factors. Some of the most common causes of iron deficiency anaemia areoutlined below. Monthly periods In women of reproductive age,periods are themost common cause of iron deficiency anaemia. Usually, only women with heavy periods develop iron deficiency anaemia. If you have heavy bleeding over several consecutive menstrual cycles, its known as menorrhagia. Pregnancy Its also very common for women to develop iron deficiency during pregnancy. This is because your body needs extra ironto ensure your baby has a sufficient blood supply and receives necessary oxygen and nutrients. Some pregnant women require an iron supplement, whileothers may need to increase the amount of iron in their diet. Read more about vitamins and minerals in pregnancy Gastrointestinal blood loss The gastrointestinal tract is the part of the body responsible for digesting food. It contains the stomach and intestines. Bleeding in the gastrointestinal tract is the most common cause of iron deficiency anaemia in men, as well as women whove experienced the menopause (when monthly periods stop). Most people with gastrointestinal bleeding dont notice any obvious blood in their stools and dont experience any changes in their bowel habits. Somecauses of gastrointestinal bleeding are described below. Non-steroidal anti-inflammatory drugs Non-steroidal anti-inflammatory drugs (NSAIDs) can cause bleeding in the stomach. Ibuprofen and aspirin are two commonly prescribed NSAIDs. If your GP thinks your medication is causing gastrointestinal bleeding, they can prescribe a less harmful medicine. However, dont stop taking a medicine youve been prescribed unless your GP advises you to. Stomach ulcers The acid in your stomach, which helps your body digest food, can sometimes eat into your stomach lining. When this happens, the acid forms an open sore (an ulcer). This is also known as a stomach ulcer or a peptic ulcer. Stomach ulcers can cause the stomach lining to bleed, which can lead to anaemia. In some cases, the bleedingcan cause you tovomit blood or pass blood in your stools. However, if the ulcer bleeds slowly, you may nothave any symptoms. Gastrointestinal cancer Ina fewcases, gastrointestinal bleeding can be caused by cancer, usually stomach cancer or bowel cancer . When trying to establish the cause of anaemia, your GP will check for possible signs of cancer. If your GP suspects cancer, youll be referred to a gastroenterologist (a specialist in treating digestive conditions) for a more thorough examination. This means that if cancer is found, it can be treated as quickly as possible. If youre 60 years old or over and have iron deficiency anaemia, your GPshould refer youto a specialist to rule out bowel cancer. Your appointment with the specialist should be within two weeks of your GP referring you. Angiodysplasia Gastrointestinal bleeding can also be caused by a condition called angiodysplasia. This isthe resultofabnormal, fragile superficialblood vessels in the gastrointestinal tract, which can cause bleeding. Chronic kidney disease People with chronic kidney disease (CKD) often develop iron deficiency anaemia. Most people with CKD who have iron deficiency anaemia will be given iron supplement injections, although daily tabletsmay betried first. You can read more about treating anaemia in people with CKD on the National Institutefor Health and Care Excellence (NICE) website. Other causes Other conditions or actions that cause blood loss and may lead to iron deficiency anaemia include: inflammatory bowel diseasea condition that causes redness and swelling (inflammation) in the digestive system, such as Crohns disease and ulcerative colitis oesophagitis inflammation of the gullet (oesophagus)caused by stomach acid leaking through it schistosomiasis an infection caused by parasites, mainly found in sub-Saharan Africa blood donationdonating a large amount of blood may lead to anaemia trauma a serious accident, such as a car crash, may cause you to lose a large amount of blood nosebleeds having regular nosebleeds may lead to anaemia, althoughthis is rare haematuria (blood in your urine)  but this rarely causes anaemiaand may be a symptom of another condition Malabsorption Malabsorption is when your body cant absorb iron from food, and is another possible cause of iron deficiency anaemia. This may happen if you have coeliac disease , a common digestive condition where a person has an adverse reaction to gluten, or surgery to remove all or part of your stomach (gastrectomy). Lack of iron in your diet Unless youre pregnant, its rare for iron deficiency anaemia to be caused solely by a lack of iron in your diet. However, a lack of dietary iron can increase your risk of developing anaemia if you also have any of the conditions mentioned above. Some studies suggest vegetarians or vegans are more at risk of iron deficiency anaemia because of the lack of meat in their diet. If you are vegetarian or vegan,it is possible to gain enough iron by eating other types of food, such as: beans nuts dried fruit, such as dried apricots wholegrains, such as brown rice fortified breakfast cereals soybean flour most dark-green leafy vegetables, such as watercress and curly kale If youre pregnant, you may need to increase the amount of iron-rich food you consume during pregnancy to help prevent iron deficiency anaemia. Read more about vegetarian and vegan diets Diagnosing iron deficiency anaemia See your GP if you experience symptoms of iron deficiency anaemia , such as tiredness, shortness of breath and heart palpitations. A simple blood test can usually confirm the diagnosis. Your GP may also carry out a physical examination and ask you a number of questions to help determine the cause of your anaemia. Blood test To diagnose iron deficiency anaemia, a blood sampleis taken from a vein in your arm and a full blood countis made. This meansall the different types of blood cells in the sample will be measured. If you have anaemia: your levels of haemoglobin a substance that transports oxygen will be lower than normal youll have fewer red blood cells, which contain haemoglobin, than normal your red blood cells may be smaller and paler than usual Your GP may also test for a substance called ferritin, a protein that stores iron. If your ferritin levels are low, it means there isnt much iron stored in your body and you mayhave iron deficiency anaemia. Read more about blood tests Vitamin B12 and folate deficiency If your GP thinks your anaemia may be the result of a vitamin B12 and folate deficiency, the levels of these substances may be tested. Folate works with vitamin B12 to help your body produce red blood cells. Vitamin B12 and folate deficiencyanaemia is more common in people who are over the age of75. Finding the cause To determine the underlying cause of your anaemia, your GP may ask questions about your lifestyle and medical history. For example, they may ask you about: your diet to see what you typically eat and whether this includes any iron-rich foods any medicines you take to see if youve been regularly taking a type of medicine that can cause bleeding from the stomach and intestines (gastrointestinal bleeding), such as ibuprofen or aspirin your menstrual pattern if youre a woman, your GP may ask if youve been experiencing particularly heavy periods your family history youll be asked if your immediate family has anaemia ora history of gastrointestinal bleeding or blood disorders Irondeficiency anaemia is common during pregnancy. If youre pregnant, your GP will usually only look for an alternative cause if a blood test has identified a particularly low haemoglobin level, or if your symptoms or medical history suggest your anaemia may be caused by something else. Physical examination Aphysical examination will usually only be needed if the cause of your iron anaemia deficiency hasnt been identified by examining your medical history and asking you about your symptoms. In such cases, your GP may: examine your stomach (abdomen) to check for any physical signs of gastrointestinal bleeding look for signs of heart failure , such asswollen anklesheart failure can have some similar symptoms to iron deficiency anaemia Two other possible types of physical examination you may have are explained below. Rectal examination Arectal examination is usually only needed if youre bleeding from your bottom. Itsa common procedure that can help your GP find out if theres something in your gastrointestinal tract thats causing bleeding. Your GP will insert a lubricatedglovedfinger into your bottom to feel for any abnormalities. A rectal examination isnt something to be embarrassed about, as its a procedure your GP will be used to doing. It shouldnt cause significant pain, but it may cause some slight discomfort this will only last for a minute. Pelvic examination Women may have a pelvic examination if their GP thinks heavy menstrual bleeding (menorrhagia) may be the cause of their anaemia. During a pelvic examination, your GP will examine your vulva and labia (external sex organs) for signs of bleeding or infection. They may also examine you internally. This will involve your GP inserting lubricated gloved fingers into your vagina to feel whether yourwomb (uterus)is tender or enlarged. A pelvic examination wont be carried out without your consent(permission), and you can choose to have someone with you. Referral to a specialist In some cases, your GP may refer you to a gastroenterologist, a specialist in treating digestive conditions. Theyll carry out a more thorough examination. For example, you may be referred to a gastroenterologist if your GP cant identify a cause and you have a particularly low haemoglobin level, or if your GP thinks theres a possibility your symptoms could be caused by stomach cancer or bowel cancer , although this is unlikely. If youre a woman with heavy periods, you may be referred to a gynaecologist if you dont respond to treatment with iron supplements. Treating iron deficiency anaemia Treatment for iron deficiency anaemia usually involves taking iron supplements and changing your diet to increase your iron levels, as well as treating the underlying cause. Iron supplements Your GP will prescribe an iron supplement to restore the iron missing from your body. The most commonly prescribed supplement is ferrous sulphate,which is takenas a tablet, usually twice a day. Some people canexperience side effects when taking iron supplements, including: abdominal (tummy) pain constipation or diarrhoea heartburn feeling sick black stools (faeces) These side effects should settle down over time. However, your GP may recommend taking the tablets with food or shortly after eating if you have troublesome side effects. Your GP may also advise you to only take one or two tablets a day, instead of three, if youre finding side effects difficult to cope with. If you cant take ferrous sulphate because you get severe side effects, you may be prescribed a different iron supplement called ferrous gluconate. This supplement should cause fewer side effects because it contains a less concentrated dose of iron. However, it may take longer for the iron levels in your body to be restored. Ina fewcasesfor example, if you have chronic kidney disease (CKD)  iron injections may be recommended instead of tablets. As with all medications,its important to store iron supplements out of the reach of children. An overdose of iron supplements in a young child can be fatal. Dietary advice If a lack of iron in your diet is thought to be contributing to your iron deficiency anaemia, your GP will tell you how to up your intake. Iron-rich foods include: dark-green leafy vegetables, such aswatercress and curly kale iron-fortified cereals or bread brown rice pulses and beans nuts and seeds white and red meat fish tofu eggs dried fruit,such asdried apricots, prunes and raisins Your diet should include foods from all the major food groups to ensure itshealthy and balanced. In particular,food and drink containing vitamin Care importantas vitamin C helps your body absorb iron. However, consuming large amounts of some foods and drinks, as well as certainmedicines,may make it harder for your body to absorb iron. These include: tea and coffee calciumfound indairy products, such as milk antacidsandproton pump inhibitors (PPIs)medications usedto relieve indigestion wholegrain cerealsalthough wholegrains are a good source of iron themselves, they contain phytic acid, which can stop your body absorbing iron from other foods and pills You may be referred to a nutrition specialist called a dietitian if youre finding it difficult to include iron in your diet. Theyll be able to give you detailed, personalised advice about how you canimprove your diet. Treating the underlying cause Your GP will also need to ensurethe underlying cause of your anaemia is treated soit doesnt happen again. For example, ifnon-steroidal anti-inflammatory drugs (NSAIDs) are causing bleeding in your stomach, your GP may prescribe a different medicine to help minimise the risk of stomach bleeding. Heavy periods canbe treated withmedication or in particularly severe cases surgery. Monitoring Your GP will ask you to return two to four weeks after youve started takingiron supplements to check how well youve responded to the treatment. Youll have a blood test to check your haemoglobin levels. If yourblood test results show an improvement, youll be asked to continue taking iron supplements and return in two to fourmonths for another blood test. Once your haemoglobin levels and red blood cells are normal, your GP will usually recommend continuing totake iron supplements for three months to help build up the iron levels in your body. After this, you should be able to stop taking the supplements, depending on the cause of your iron deficiency anaemia. Your condition will be monitored every three months over the course of a year, and again a year later. Continuing treatment Sometimes after a persons iron levels have been replenished, they start to fall again. This could happen if you dont get enough iron in your diet, youre pregnant, or you have consistently heavy periods. In such cases, you may be prescribed an ongoing iron supplement to help stop your anaemia returning. This will usually be a tablet, which youll have to take once a day. If treatment is ineffective If your iron levels dont improve, your GP will ask how regularly youve been taking your iron supplements. Some people are put off taking the medication because of the side effects. However, your condition wont improve if you dont take the supplements. If youve been taking the supplements as prescribed and your iron levels still havent improved, your GP may refer you to a specialist for an assessment. Complications of iron deficiency anaemia Iron deficiency anaemia rarely causes serious or long-term complications, although some people with the condition find it affects their daily life. Somecommon complications are outlined below. Tiredness Iron deficiency anaemia can make you feel tired and lacking in energy (lethargic). This may result in you being less productive at work, andyou may find it difficult to stay awakeornot feel able to exercise regularly. Increased risk of infections Research has showniron deficiency anaemia can affect your immune system the bodys natural defence system. This increases your vulnerability to infection. Heart and lung problems Adults with severe anaemia may be at risk of developing complications that affect their heart or lungs. For example, you may develop tachycardia , which isan abnormally fast heartbeat,or heart failure , where the heart fails to pump enough blood around your body at the right pressure. Pregnancy complications Pregnant women with severe anaemia have an increased risk of developing complications, particularly during and after birth. They may also develop postnatal depression , which some women experience after having a baby. Research suggests babies born to mothers who have untreated anaemia are more likely to: be born prematurelybefore the 37th week of pregnancy have a low birth weight have problems withiron levels themselves do less well in mental ability tests Restless legs syndrome Some cases of restless legs syndrome are thought to be caused by iron deficiency anaemia. Doctors often refer to this as secondary restless legs syndrome. Restless legs syndromeis a common condition that affects the nervous system, andcauses an overwhelming, irresistible urge to move the legs. It also causes an unpleasant feeling in the feet, calves and thighs. Restless legs syndrome caused by iron deficiency anaemiacan usually be treated with iron supplements. Source: NHS 24 - Opens in new browser window Last updated: 21 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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