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Iron deficiency anaemia - Diagnosis and treatment

Updated: Mar 27, 2023

Anaemia is a condition where you have low levels of red blood cells or haemoglobin. Haemoglobin carries oxygen to red blood cells, which distribute oxygen throughout the body. Being rich in iron, haemoglobin gives blood its red colour. Iron deficiency anaemia is one of the most common types of anaemia and is a condition and a disease in which there is an insufficient amount of red blood cells (erythrocytes) in the blood, whose main function is to carry oxygen to the tissues and organs of the body. As the name indicates, this type of anaemia is due to a lack of iron in the body, and without iron it cannot synthesize the haemoglobin molecule - the specific carrier of iron.

Symptoms

Iron deficiency anaemia can go unnoticed due to mild symptoms, which include:

  • Weakness or severe fatigue

  • Headaches, dizziness or light-headedness

  • Cold hands and feet

  • Pale skin

  • Brittle nails

  • Chest pain, rapid pulse or shortness of breath

  • Inflammation or soreness of the tongue

  • Unusual craving for non-food substances, like ice or dirt

  • Poor appetite, especially in infants and children with iron deficiency anaemia


The greater the deficiency, the more pronounced the symptoms, so if you have even a slight doubt you can test yourself with the at-home FERRI-Check® quick test.


Diagnosis

To diagnose iron deficiency anaemia, your doctor may run tests to look for:

  • Size and colour of red blood cells. In iron deficiency anaemia, the red blood cells are smaller and paler in colour than normal.

  • Haematocrit. This is the percentage of your blood volume made up of red blood cells. Normal levels are usually between 35.5 and 44.9 percent for adult women and 38.3 to 48.6 percent for adult men. These values may change depending on your age.

  • Haemoglobin. Lower than normal haemoglobin levels indicate anaemia. The normal haemoglobin range is usually defined as 13.2 to 16.6 grams (g) haemoglobin per decilitre (dL) of blood for men and 11.6 to 15 g/dL for women.

  • Ferritin. This protein helps store iron in your body, and a low level of ferritin usually indicates a low level of stored iron.

Additional diagnostic tests

If your blood tests show iron deficiency anaemia, your doctor may order additional tests to identify the underlying cause, such as:


Endoscopy. Doctors often check for bleeding from a hiatal hernia, ulcer or stomach using an endoscopy. In this procedure, a thin, lighted tube equipped with a video camera is passed through the throat to the stomach. This allows the doctor to see the tube that runs from the mouth to the stomach (oesophagus) and the stomach itself to look for sources of bleeding.


Colonoscopy. To rule out lower intestinal sources of bleeding, your doctor may recommend a procedure called a colonoscopy. A thin, flexible tube equipped with a video camera is inserted into the rectum and guided to the colon. You are usually sedated during this test. A colonoscopy allows the doctor to examine part or all of the colon and rectum to look for internal bleeding.


Ultrasound. Women may have a pelvic ultrasound to look for a cause of excessive menstrual bleeding, such as uterine fibroids.


Your doctor may order these or other tests after a trial period of treatment with iron supplements.


Treatment

To treat iron deficiency anaemia, you may be advised to take iron supplements. Your doctor will also treat the underlying cause of the iron deficiency if necessary.


Iron supplements

You may need to take iron supplements to get the right amount. Your doctor will determine the right dose for you. Iron is also available in liquid form for infants and children. To improve the chances of your body absorbing the iron in the tablets, you may be instructed to:

  • Take iron tablets on an empty stomach. If possible, take the iron tablets on an empty stomach. However, because iron tablets can upset your stomach, you may need to take iron tablets with a meal.

  • Do not take iron with antacids. Medicines that immediately relieve heartburn symptoms can interfere with iron absorption. Take iron two hours before or four hours after taking antacids.

  • Take iron with vitamin C tablets. Vitamin C improves iron absorption. Your doctor may recommend taking iron tablets with a glass of orange juice or with a vitamin C supplement.

Iron supplements can cause constipation, so your doctor may also recommend a laxative. Iron can change the colour of the stool, which is a harmless side effect.


Iron deficiency cannot be corrected overnight. But you may need to take iron supplements for several months or longer to replenish your iron stores. In general, you can expect to start feeling better after about a week of treatment. Ask your doctor when to have your blood tested again to measure your iron levels. To make sure your blood iron level is good, you may need to take iron supplements for a year or more.


Treatment of the underlying causes of iron deficiency

If iron supplements do not raise blood iron levels, the anaemia is likely due to a source of bleeding or a problem with iron absorption, which a doctor will need to investigate and treat. Depending on the cause, treatment for iron deficiency anaemia may include:

  • Medicines such as oral contraceptives to relieve heavy menstrual flow

  • Antibiotics and other drugs to treat peptic ulcers

  • Surgery to remove a bleeding polyp, tumour, or fibroid

If iron-deficiency anaemia is severe, you may need intravenous iron or need blood transfusions to quickly replenish the needed iron and haemoglobin.

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