What Is Iron Deficiency Anemia?
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Medically reviewed by Daniel Combs, MD
Iron deficiency anemia is when your body does not have enough iron to produce hemoglobin—the protein in red blood cells that carries oxygen throughout the body. Iron is an essential mineral needed to make red blood cells, and low amounts can lead to anemia, causing headaches, pale skin, fatigue, and other symptoms.
Insufficient dietary intake of iron, blood loss, and certain medical conditions lead to iron deficiency anemia. Treatment varies depending on the cause but often involves dietary changes or supplements to increase your iron intake.
Iron deficiency anemia is common, affecting 30% of the global population. Anyone can be affected, but it is most common in women and children.
Iron Deficiency Anemia Symptoms
Mild iron deficiency anemia may not cause symptoms. Symptoms usually develop slowly and worsen over time due to reduced oxygen supply throughout your body.
Common symptoms of iron deficiency anemia include:
Fatigue or lack of energy
Shortness of breath or chest pain, especially during physical activity
Dizziness or lightheadedness
Headaches
Pale or yellowish skin
Cold hands and feet
Rapid heartbeat
Unexplained weakness
Pica (craving non-food items such as clay or ice)
Swollen or sore tongue
Hair loss
Brittle nails
Related:15 Signs You May Have an Iron Deficiency
What Causes Iron Deficiency Anemia?
Iron deficiency anemia occurs when you do not have enough iron to produce hemoglobin. If your iron levels are low, your body will use iron reserves to produce healthy red blood cells. As your iron reserves deplete, fewer red blood cells are produced, leading to iron deficiency anemia.
Several factors can cause low iron, including inadequate iron intake through your diet, insufficient iron absorption, blood loss, and certain medical conditions.
Inadequate Iron Intake
Your body cannot produce iron, so it is important to eat iron-rich foods to maintain healthy iron levels. If your diet is lacking in iron-containing foods, you can become deficient. The amount of iron your body needs depends on age, sex, and whether you are pregnant or lactating. The recommended dietary allowance (RDA) of iron is:
Infants 0-6 months: 0.27 mg
Infants 7-12 months: 11 mg
1-3 years: 7 mg
4-8 years: 10 mg
9-13 years: 8 mg
14-18 years: 11 mg (males), 15 mg (females)
19-50 years: 8 mg (males), 18 mg (females)
51+ years: 8 mg
The RDA for iron is 27 mg during pregnancy and 9-10 mg when breastfeeding.
Problems Absorbing Iron
Certain medical conditions and medications can interfere with or impair iron absorption (malabsorption) and lead to iron deficiency anemia, including:
Gastrointestinal conditions, such as Crohn's disease, celiac disease, ulcerative colitis, or an H. Pylori infection
Surgery on your digestive system, such as bariatric (weight loss) surgery
Genetic conditions that impair iron absorption, such as cystic fibrosis
Medications used to treat heartburn, ulcers, and other acid-related conditions (e.g., proton-pump inhibitors, calcium carbonate, and histamine-2 receptor antagonists)
Blood Loss
Your body loses iron when you bleed. Normally, your body makes new red blood cells (RBCs) after blood loss, but it can take 4-6 weeks for your body to replenish its RBC supply.
Common causes of blood loss associated with iron deficiency anemia include:
Heavy menstruation
Internal bleeding in the gastrointestinal tract due to inflammatory bowel disease, colon cancer, or other GI disorders
Bleeding during childbirth
Regular use of over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) or Aleve (naproxen)
Traumatic injury or surgery
Urinary tract bleeding due to urinary tract infection (UTI)
Risk Factors
Iron deficiency anemia is common in people of all ages, but certain risk factors can increase the likelihood of developing the condition, such as:
Following a vegetarian or vegan diet
Pregnancy, recent childbirth, and breastfeeding
Children who drink more than 16-24 ounces of cow's milk daily, which can impair iron absorption
Having a chronic inflammatory disease, such as heart failure or obesity
Diagnosis
To diagnose iron deficiency anemia, healthcare providers usually begin with a physical exam and review of your symptoms, medical history, and risk factors. Blood tests confirm the diagnosis and determine the severity of anemia.
A complete blood count (CBC) is a blood test used to confirm the diagnosis and determine the severity of anemia. A CBC measures the number, size, and shape of red blood cells and the amount of hemoglobin in the blood. A low hemoglobin level and smaller or paler red blood cells can indicate iron deficiency anemia.
Other blood tests that can point to iron deficiency include:
Serum iron: Measures the amount of iron in the blood.
Serum ferritin: Measures the amount of the protein ferritin, which stores iron in your body's cells.
Serum transferrin: Measures the amount of the protein transferrin, which transports iron throughout the body. High levels can indicate iron deficiency.
Peripheral blood smear: A blood sample is examined under a microscope to check the shape and size of red blood cells. Small or pale red blood cells can indicate iron deficiency.
If your healthcare provider suspects bleeding is the cause of your anemia, they may order additional testing, such as:
Fecal occult blood test: Detects blood in the stool.
Endoscopy: A tube with a camera is inserted into the mouth to look at the esophagus and stomach and look for abnormalities in the upper gastrointestinal tract.
Colonoscopy: A tube with a camera is inserted into the rectum to look at the colon to check for abnormalities (e.g., polyps) that can cause bleeding.
Pelvic examination: If you menstruate, a pelvic exam can help search for a source of bleeding. A pelvic ultrasound may be a part of this exam to visualize the uterus and bladder and determine the cause of heavy or abnormal menstrual bleeding.
Urine testing: To look for blood or hemoglobin in the urine.
Treatments for Iron Deficiency Anemia
Treatment for iron deficiency anemia focuses on increasing your iron intake to replenish your body's iron stores. If an underlying condition, such as an ulcer or excessive menstrual bleeding, causes iron deficiency, treatment will involve managing the condition and stopping the bleeding.
Treatment options for iron deficiency anemia may include making necessary dietary changes, taking iron supplements, getting iron intravenously, a blood transfusion, or a combination of these things.
Dietary Changes
Eating iron-rich foods can help restore iron levels in your body. Foods that contain iron include red meat, poultry, seafood, beans, leafy green vegetables, and fortified pasta and grains. Vitamin C can also help with iron absorption, so including foods such as citrus fruits, tomatoes, and bell peppers can be helpful.
Iron Supplements
Iron supplementation is a mainstay treatment for anemia. Your healthcare provider may recommend over-the-counter iron or prescribe iron supplements in liquid, tablet, or capsule form. They may recommend you take a vitamin C supplement with your iron to help improve iron absorption.
Intravenous (IV) Iron
If you have severe iron deficiency anemia, do not absorb iron well, or tolerate oral supplements, you may need intravenous (IV) iron. IV iron is administered in a healthcare setting (e.g., doctor's office) in one large dose or smaller doses given over several weeks.
Blood Transfusion
In severe cases of iron deficiency anemia, blood transfusions may be necessary to restore red blood cells quickly. Blood transfusions are usually reserved for people actively bleeding or with severe symptoms such as shortness of breath and chest pain. A blood transfusion doesn't fully correct the iron deficiency, so you will require other treatments to restore your iron levels.
Prevention
Preventing iron deficiency anemia involves making lifestyle choices that can help maintain healthy iron levels, including:
Take iron supplements: If you have risk factors for iron deficiency anemia, your healthcare provider may recommend taking iron supplements. For some people, a multivitamin that includes iron is adequate.
Treat the underlying cause: If you have an underlying condition associated with an increased risk of iron deficiency or experience heavy bleeding, work with your healthcare provider to properly manage the condition and prevent heavy bleeding.
Limit caffeine consumption: Coffee, tea, and other caffeinated beverages can inhibit iron absorption.
Complications
Untreated iron deficiency anemia can lead to health problems, such as:
Heart problems: Your heart has to work harder than normal when anemic, which can lead to a rapid or irregular heartbeat. Over time, this can lead to heart failure.
Increased risk of infections: Iron deficiency anemia can weaken the immune system and increase the risk of infections.
Pregnancy complications: Iron deficiency anemia during pregnancy can increase the risk of preterm delivery, low birth weight, and postpartum depression.
Growth and developmental delays: Children with severe or long-lasting iron deficiency anemia may experience stunted growth, developmental delays, and short attention spans.
Cognitive impairment: Severe iron deficiency anemia may lead to cognitive impairment, including problems with memory, attention, and concentration.
Restless legs syndrome: This is characterized by a strong urge to move your legs due to uncomfortable sensations in them.
Living With Iron Deficiency Anemia
If you have iron deficiency anemia, you may feel weak and lack the energy to carry out your daily tasks. Managing iron deficiency anemia and your symptoms can be frustrating, so taking care of yourself physically and emotionally is important.
Treatment for iron deficiency anemia can help replenish your iron stores; you should feel better within a few weeks, and your iron stores should be fully replenished within a few months. In the meantime, focus on eating a healthy, balanced diet, taking your supplements as prescribed, and resting when you can. Seek support from family and friends, and contact your healthcare provider if your symptoms are not improving with treatment.
Frequently Asked Questions
Can I drink coffee if I have anemia?
Drinking coffee in moderation is generally considered safe for people with anemia as long as it is not consumed with iron-rich foods or supplements. Research suggests that drinking coffee with a meal can inhibit iron absorption, so it is best to drink coffee in between meals.
Does drinking water help iron deficiency?
While drinking water is essential for overall health, it does not directly affect iron deficiency. Adequate hydration is important for the optimal absorption of nutrients, including iron, but it is not a substitute for consuming iron-rich foods or taking iron supplements. Drinking beverages rich in vitamin C (e.g., orange juice) can help your body absorb iron.
How much sleep does an anemic person need?
The amount of sleep an anemic person needs is the same as the recommended amount for adults, which is 7-9 hours per night. Anemia can cause fatigue and weakness, so people with anemia may need to rest or nap more frequently during the day to manage their symptoms.
What foods should you avoid if you have anemia?
People with anemia should avoid consuming foods that can make it harder for the body to absorb iron, such as milk, egg whites, coffee, tea, and soy protein. Instead, eat foods rich in vitamin C that help the body absorb iron, such as citrus fruits, broccoli, and peppers.
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