Iron deficiency anemia is a condition in which the body lacks enough iron to make healthy red blood cells.
Iron is necessary to make hemoglobin, a protein that gives red blood cells their bright red color. And hemoglobin is what enables red blood cells to carry oxygen to the cells, tissues, and throughout your body.
So in iron deficiency anemia, your body is not getting enough oxygen for its metabolic needs and that is what causes the signs and symptoms of iron deficiency.
And signs of iron deficiency can develop slowly and get worse over time so you may not have symptoms for a long time, but you will start to notice as the condition worsens.
What causes low iron?
There are several reasons why one can develop iron deficiency anemia. The most common cause is bleeding. And bleeding can occur in certain conditions such as :
- gastrointestinal bleeding. Causes of Gi bleeding are also many and be due to ulcers, polyps, cancer, and the use of certain medications.
- heavy periods
- Blood loss due to injury
- Inflammatory bowel diseases
- Lack of adequate iron intake in food.
- pregnancy and increased iron need to serve the baby and mom.
- Urinary tract bleeding
Other causes of anemia
Anemia, however, can be caused by many things and iron deficiency anemia is just one type of anemia. Other types of anemia include:
- Thalassemia anemia
- Aplastic anemia- when the bone marrow cannot make enough new blood cells.
- Sickle cell anemia
- Vitamin Deficiency anemia- such as folate and or B12 deficiency anemia
Iron deficiency is just one type of anemia caused by a lack of adequate iron to make hemoglobin leading inability of red blood cells to carry oxygen to the cells. There are other causes of anemia too. These include:
- A deficiency in vitamin B12.
- Chronic kidneys disease
- Autoimmune diseases like thalassemia
- alcohol abuse
- liver disease
- lead poisoning
- Use of certain medications such as chemo, diabetes drugs,
- Genetic diseases like sickle cell disease conditions in which red blood cells hemolyze as soon as they are made.
- Certain enzymes deficiency
Signs and symptoms of iron deficiency anemia
One of the most common signs of iron deficiency is fatigue. If you find that you lack energy and are easily fatigued even after a small exertion, you may be iron deficient.
Since hemoglobin is required to help transport oxygen to the cells, without enough oxygen cells have no fuel to metabolize nutrients and so that means you don’t have the energy to function normally.
Unfortunately, many people miss the connection between fatigue and iron deficiency, especially those with busy lives thinking it’s due to having too much to do, or other lifestyle factors.
However, feeling tired all the time is just not normal and if you are experiencing it, see your, doctor, to get to the root cause. If it is iron deficiency in many cases diet or supplements can remedy the problem.
When your body has enough iron, you have more hemoglobin and that is what gives the blood that red color. And that in turn gives your skin a nice rosy healthy color ( in pale skin individual), or healthy glow in darker skin populations. However, without adequate iron, your red blood cells are small and pale making the skin look pale and sometimes yellow, – or grey and ashy in dark skin populations.
The yellowing skin is due to damaged unhealthy red blood cells causing a jaundiced appearance.
Cold intolerance is often a symptom of iron deficiency. According to research iron deficiency alters thermoregulation in the brain causing thyroid hormone metabolism. Iron deficiency also affects epinephrine metabolism affecting the ability to generate heat. So lack of sufficient oxygen can lead to central thermoregulation ( in the hypothalamus) changes.
Remember that your thyroid gland controls energy metabolism and if it’s not getting enough oxygen it slows the body down. And that affects metabolic processes that produce heat in the body.
Also, without adequate hemoglobin, red blood cells are unhealthy, which can affect circulation as well making it hard to get adequate circulation, especially in the extremities. And that makes you have cold hands and feet and general cold intolerance.
This study found that iron deficiency was associated with higher levels of reported depression in adults, and depression risk was more likely in pregnant women with iron deficiency, other studies found.
While these studies don’t address why this happens, it is likely due to insufficient oxygen reaching the brain and likely affecting neurotransmitter function, at least that’s what I would think. But studies to examine the association are needed. But if you are feeling depressed have your doctor also check your iron levels.
A common sign of iron deficiency anemia is feeling dizzy. You may feel dizzy because you are not getting enough oxygen in the brain and the brain requires a lot of oxygen to function better, so you are likely to feel foggy as well.
Having dizzy spells is a serious symptom and one you should never ever ignore as it may also be a symptom of other serious health problems including, heart attack and stroke, serious internal bleeding, or dehydration. So always have dizzy spells addressed by a doctor.
A 2020 study in PLOS ONE found that iron deficiency sufferers tended to have decreased appetite and this was associated with a decrease in ghrelin the hunger hormone.
While the connection between decreased iron and ghrelin isn’t explained, a connection does exist because with iron replacement ghrelin decreases and appetite improves.
Clearly decreased oxygen affects the activity of the hormone that controls hunger and tells you to eat. So in iron deficiency, malnutrition can occur because you don’t feel as hungry and may eat less than you should.
Weak spoon-like nails-koilonychia
Sometimes in a severe case of iron deficiency, spoon-like shaped nails happen. This may start off with nails with lines or ridges, nails that are weak, brittle, and easily break, but as iron deficiency increases nails develop a dip in the middle looking like a spoon.
This is all due to cells not receiving enough oxygen for proper nourishment and growth.
Dry hair and Skin
Another sign of iron deficiency is thin dry hair. Lack of adequate oxygen stops hair from growing and may become thin dry and damaged. Due to the hair being so dry and weak, it easily falls out. So if you are losing lots of hair, have your doctor check your iron levels.
Iron deficiency may also cause very dry skin. When hemoglobin is low, the cells don’t receive enough oxygen for metabolism and so skin cells don’t regenerate as they should and the outer layers of the skin become dry even cracked especially on the heels.
Shortness of breath
When you have an iron deficiency you tend to get short of breath when doing just regular activities like chores around the house, and even every little movement.
Since hemoglobin carries oxygen to organs and tissues when there is a short supply of oxygen the lungs try to work harder to get more oxygen throughout the body. And it is that effort that makes you breathe faster and feels short of breath.
Chest pain and heart palpitations
Chest pain and heart palpitations can occur when you have iron deficiency. First of all, muscles need oxygen and the heart is a muscle. And due to decreased circulating oxygen caused by decreased hemoglobin, the heart tries to compensate by beating faster and may even beat irregularly making you feel like you are missing beats in which case you are experiencing heart palpitations.
If you have other conditions that affect your heart, having iron deficiency anemia can make them even worse.
For example, if you have CHF, the heart muscle tends to enlarge and becomes ineffective in pumping blood.
And so adding decreased oxygen to that makes the work of the heart even harder and of course, you would feel sicker. See your doctor immediately if you are having shortness of breath, or chest pain because that needs immediate diagnosis and treatment.
If you are having frequent headaches, it would be advisable to have your iron levels checked. Although the link isn’t clear why this is, research shows there may be a connection but more research is needed.
But also keep in mind there are many causes of headaches and that is why testing is important.
Swollen and sore tongue
Inflammation and having a smooth swollen tongue may be a sign of iron deficiency anemia. However, be sure to see your doctor as there can be other serious conditions that can cause swelling inside the mouth and some may require emergency care.
Other signs of iron deficiency may include cracks in the corners of the mouth, dry mouth, and mouth ulcers.
Brain fog or problems with focus
Iron deficiency may also cause trouble with concentration and focus. The brain requires a substantial oxygen supply to function well. So when you don’t have enough hemoglobin to carry oxygen to the brain, you find it hard to think clearly and concentrate on tasks.
Pika or eating strange things
Pika is a condition where you crave strange and non-food items. People with iron deficiency will eat such things as dirt ( earth, soil). These strange cravings sometimes occur in pregnancy as well but seeing a doctor is recommended to get iron levels checked.
Iron deficiency treatment
Usually, a physical exam and history taking for symptoms and to determine risk factors for iron deficiency anemia are done first. Then depending on the severity, the doctor may order a stool sample, a colonoscopy, or an endoscopy.
Treating iron deficiency depends on how bad it is. If the hemoglobin level is below 7 in most cases you will need a packed red blood cells infusion. This is usually followed with iron infusion and iron tablets are prescribed.
If iron deficiency is due to malabsorption, iron shorts are needed. And if you have internal bleeding such as gastric bleeding, such as a gastric ulcer surgery may be needed. And including foods rich in iron is usually advised.
When to see a doctor
If you are having any of the symptoms listed above, you should see your primary care doctor for a diagnosis. Some symptoms may have more than one cause so you want to be sure. Never try to personally treat yourself with iron supplementation at home as higher than normal iron levels can be toxic.
Iron deficiency is quite common, and if you have symptoms it is a good idea to see a doctor and get a diagnosis and a treatment plan. additionally eating healthy foods rich in iron will help as well. Do not ignore the symptoms of iron deficiency as they can lead to major health complications.