Iron deficiency (ID) is more frequent than ID anemia [1] and between 2 -5% of postmenopausal women and adult men suffer from ID anemia [2] [3]. ID develops when the iron intake falls short of the iron requirements of the body (pregnancy, adolescence) or when the output of iron exceeds the intake (gastrointestinal bleeding).

ID often presents insidiously with non-specific symptoms like tiredness, poor immunity to infections and low exercise tolerance. The incidence of ID is more common in premenopausal women due to menstrual blood loss while in pregnancy, adolescence and during breastfeeding, ID is due to increased requirements of iron. ID can lead to increased fatigability, especially in women [4] [5] [6]. Athletes are also at risk of iron deficiency as studies have shown urinary loss of iron following repeated minor intravascular hemolysis [7] [8]. ID can lead to anemia which can present with koilonychia, atrophic glossitis, fissured tongue, angular cheilitis, pica, pallor, decreased intellectual abilities, dyspnea, hepatosplenomegaly (in hemolytic anemias), high output cardiac failure, and recurrent upper respiratory tract as well as other infections. Chronic diseases like celiac disease, chronic renal failure, cirrhosis and even cancers can be associated with ID with patients manifesting symptoms and signs of these conditions. Gastrointestinal tract bleeding is another potential presenting feature in individuals taking non-steroidal anti-inflammatory drugs (NSAIDs) over long periods of time or in those with malignancies of the gastrointestinal tract.

• Fatigue

  Iron-Rich Foods to Fight Fatigue To fight fatigue that's caused by an iron deficiency, turn to iron-rich foods. By changing your diet, you could see significant changes in your energy level within as little as one week. [doctoroz.com]

  Mental fatigue can manifest as somnolence, lethargy, or directed attention fatigue.[4] Fatigue and 'feelings of fatigue' are sometimes confused.[5] Unlike weakness, fatigue usually can be alleviated by periods of rest. [en.wikipedia.org]

  Iron loss can contribute to a multitude of health problems – not just fatigue. [glutenfreesociety.org]

  Extreme fatigue and exhaustion “Fatigue is one of the most common signs of iron deficiency because it means your body is having trouble carrying the oxygen to your cells so it’s affecting your energy levels,” Thayer says. [everydayhealth.com]

• Pallor

  A thorough physical examination to identify features of ID and ID anemia like pallor, koilonychia, glossitis and even high output cardiac failure should be performed. [symptoma.com]

  Anterior segment examination in both eyes showed conjunctival pallor. Results of ophthalmoscopic examination and optical coherence tomography were consistent with macular preretinal hemorrhage in both eyes with macular star in the left eye. [ncbi.nlm.nih.gov]

  Symptoms include weakness, fatigue, and sometimes pallor, shortness of breath, coldness of extremities, changeable appetite, sore tongue, loss of hair, brittle fingernails, or dry skin. [britannica.com]

  Clinical history, presentation, and findings include fatigue, pallor, dyspnoea on exertion, and pica. Microcytic, hypochromic anaemia; low reticulocyte count. [bestpractice.bmj.com]

  At necropsy, these pigs will have pallor, a thin-walled heart, and edema of the lungs, muscles and connective tissues. [vetmed.iastate.edu]

• Malnutrition

  However, there is limited information on the diagnosis of and therapy for ID in HF in SSA, where infections and malnutrition are more likely to influence the situation. [ncbi.nlm.nih.gov]

  A very low ferritin level, 12 mcg/mL or lower, also indicates iron deficiency anemia. [ 5 ] Causes of Low Iron Levels There is a wide range of factors that influence your iron status, but in the developed world, the top causes are malnutrition or iron [globalhealingcenter.com]

  Diet-related Malnutrition – poverty, premature babies (milk is poor source of iron), young children who are picky eaters Strict vegetarian and vegan diets Cereal-based diets – decreases iron bioavailability, as phytates in grains reduce iron absorption [dermnetnz.org]

  Overall, inadequate intake and status of these vitamins and minerals may lead to suppressed immunity, which predisposes to infections and aggravates malnutrition. © 2007 S. [doi.org]

  This practice has the fortunate result of preventing general malnutrition, but the unfortunate result of allowing the development of mild iron deficiency. The normal rate of blood loss in the feces is 0.5-1.0 ml per day. [medical-dictionary.thefreedictionary.com]

• Weight Gain

  Iron deficiency also results in anaemia, abnormalities in weight gain, appetite, gastrointestinal function, exercise tolerance and immune response to infections. [starship.org.nz]

  Hypothyroidism if often missed -- six in 10 people with a thyroid disease don't know they have it, according to the American Thyroid Association -- so if you notice low energy levels, weight gain or even a lower body temperature, talk to your doc. [huffpost.com]

  How can we ensure we get enough precious iron into our bodies without putting ourselves at risk of weight gain or ill health then? The answer is all about portions, say experts. [dailymail.co.uk]

  Hypothyroidism if often missed -- six in 10 people with a thyroid disease don't know they have it, according to the American Thyroid Association -- so if you notice low energy levels, weight gain, or even a lower body temperature, talk to your doc. 19 [abcnews.go.com]

  The level of 12 mg/L was determined by calculating the total iron needs of the child from 0 to 12 months of age, assuming average birth weight and average weight gain during the first year. [pediatrics.aappublications.org]

• Anorexia

  Symptoms of iron poisoning include: Fatigue Anorexia Dizziness Nausea Vomiting Headache Weight loss Shortness of breath Grayish color to the skin The Food and Nutrition Board at the Institute of Medicine recommends the following: Infants and children [nlm.nih.gov]

  The specific symptoms of the upper gastrointestinal tract that patients were asked about included dysphagia, odynophagia, heartburn, dyspepsia, nausea, vomiting, anorexia, and upper abdominal pain related to eating or relieved by antacids. [doi.org]

  Symptoms are pallor, fatigue, anorexia, malaise, and weakness. Laboratory diagnosis includes hemoglobin, hematocrit, transferrin saturation, ferritin, and serum iron concentration. [medical-dictionary.thefreedictionary.com]

• Exertional Dyspnea

  Typical anemia symptoms include: Fatigue, weakness Irritability Exercise/feeding intolerance Exertional dyspnea Headache, vertigo Pale skin Symptoms of iron deficiency include: Pica (craving of non-food items – such as clay, dirt, paper, ice, baby powder [danafarberbostonchildrens.org]

  Distinct sensations include effort/work, chest tightness, and air hunger (the feeling of not enough oxygen).[1] Dyspnea is a normal symptom of heavy exertion but becomes pathological if it occurs in unexpected situations[2] or light exertion. [en.wikipedia.org]

• Hemoptysis

  [citation needed] Pulmonary embolism[edit] Pulmonary embolism classically presents with an acute onset of shortness of breath.[2] Other presenting symptoms include pleuritic chest pain, cough, hemoptysis, and fever.[2] Risk factors include deep vein thrombosis [en.wikipedia.org]

• Overeating

  The continuance of the trichobezoar tail-shaped extension over the duodenum and jejunum is described in Rapunzel syndrome. Both conditions are rarely reported in children. [ncbi.nlm.nih.gov]

  Rice has a low iron content to start with, and studies revealed that people needed to consume a significant amount, about 4 to 5 cups of cooked rice, over nine months to achieve small effects, Haas said. [news.cornell.edu]

• Abdominal Pain

  You may have stomach pain or abdominal cramping with your bowel movements. You may have pain in your rectum or anal region when you are passing a bowel movement (defecating), if you have hemmorhoids that may be bleeding. [chemocare.com]

  In patients describing dysphagia, gastritic symptoms, nausea, vomiting, or upper abdominal pain upper GI lesions should be suspected. [clinicaladvisor.com]

  The specific lower gastrointestinal symptoms inquired about included hematochezia, a change in bowel habits, diarrhea, constipation, and lower abdominal pain that was colicky or changed with the passage of stool. [doi.org]

  This dose is rather high, and can lead to nausea, diarrhea, or abdominal pain in 10-20% of women taking this dose. [medical-dictionary.thefreedictionary.com]

• Dry Skin

  Symptoms include weakness, fatigue, and sometimes pallor, shortness of breath, coldness of extremities, changeable appetite, sore tongue, loss of hair, brittle fingernails, or dry skin. [britannica.com]

  Paleness of skin, palm creases and conjunctiva (inner part of eyelid) Angular cheilitis, painful cracks at the corners of the mouth Atrophic glossitis, loss of tongue papillae (smooth, shiny tongue) Pruritus (itch) and dry skin may occur. [dermnetnz.org]

• Alopecia

  […] dirt, paper, ice, baby powder, starch) Poor sleep or restless leg syndrome Angular cheilitis (sore lesions at the corners of the mouth) In rare cases, children with iron deficiency anemia may also experience: Nail changes (koilonychia or spoon nails) Alopecia [danafarberbostonchildrens.org]

• Fidgeting

  Can't stop fidgeting? About 15 percent of people with restless leg syndrome have iron deficiency, according to John Hopkins Medicine. The lower the iron levels, the worse the symptoms. Your head hurts. [huffpost.com]

  […] important to get your iron levels checked as iron deficiency can worsen existing heart problems. 15 Foods That Are High in Potassium quicklist: 6 category: Signs You May Have an Iron Deficiency title: You have restless leg syndrome url: text: Can't stop fidgeting [abcnews.go.com]

• Headache

  Headaches Headache, especially with activity, can be a sign of iron deficiency. Unfortunately, a headache is also a symptom people often ignore even though it can sometimes be life-threatening. [msn.com]

  Abstract We report a case in an adolescent male patient with a history of chronic fatigue, headache and unexplained iron deficiency anaemia since 2007. Numerous bluish-black lesions were found over his body surface. [ncbi.nlm.nih.gov]

  Other symptoms of the condition include spoon shaped or scooped nails, breathlessness, loss of consciousness, an irregular heartbeat, headaches, and dizziness. [the.ismaili]

  Symptoms include lack of energy, shortness of breath, headache, irritability, dizziness, or weight loss. Physical signs of iron deficiency are a pale tongue and spoon-shaped nails. [nlm.nih.gov]

  Unexplained Headaches Muscles in the face, neck, and shoulders deprived of oxygenated blood due to iron deficiency may become sore or tense, resulting in frequent and otherwise unexplainable headaches. 13. [naturallivingideas.com]

• Behavior Problem

  Children with the presence of both physical abuse experience and non-anemic iron deficiency have more behavior problems. [ncbi.nlm.nih.gov]

  When symptoms do happen, a child might: look pale seem moody be very tired get tired quickly from exercise feel dizzy or lightheaded have a fast heartbeat have developmental delays and behavioral problems want to eat ice or non-food items (called pica [kidshealth.org]

  It is well established that iron-deficient babies develop more slowly and show brain abnormalities such as slow language learning and behavioral problems. [urmc.rochester.edu]

  Signs and symptoms of iron deficiency anemia might include: Pale skin Fatigue Slowed growth and development Poor appetite Abnormally rapid breathing Behavioral problems Frequent infections Unusual cravings for non-nutritive substances, such as ice, dirt [mayoclinic.org]

  Obese Children Often Suffer From Iron Deficiency, Causing Behavioral Problems 2/20/2008 - Overweight toddlers are nearly three times as likely to suffer from iron deficiency compared to those of healthy weight, according to the results of a new study [naturalnews.com]

• Difficulty Concentrating

  "For the adult population patients often talk about feeling foggy headed, forgetful or they have difficulty concentrating in meetings." Dr Bromley said one of the best ways to avoid iron deficiency was to address your diet. [abc.net.au]

  Symptoms of anemia during pregnancy may include the following: Fatigue Weakness Rapid heartbeat Difficulty concentrating Shortness of breath Pale skin Chest pain Lightheadedness Cold hands and feet You may have a greater risk of developing anemia if you [americanpregnancy.org]

  Symptoms tend to appear gradually and may include: Fatigue Weakness Paleness of the skin, gums and nail beds Reduced ability to fight infections Difficulty concentrating Headaches Shortness of breath when exercising Angina (heart related chest pain). [southerncross.co.nz]

  concentrating Dizziness Fatigue, or feeling tired, is the most common symptom. [nhlbi.nih.gov]

• Apathy

  Related: 7 Brain Tumor Symptoms You Need To Know About Apathy, Another byproduct of that altered neurotransmitter synthesis? Apathy toward anything and everything—friends, family, work, even the latest episode of The Bachelor, says Morriss. [womenshealthmag.com]

• Vertigo

  Typical anemia symptoms include: Fatigue, weakness Irritability Exercise/feeding intolerance Exertional dyspnea Headache, vertigo Pale skin Symptoms of iron deficiency include: Pica (craving of non-food items – such as clay, dirt, paper, ice, baby powder [danafarberbostonchildrens.org]

ID can develop insidiously with or without anemia. Therefore early diagnosis of the condition is difficult. In all patients, a detailed history of symptoms, history of chronic intake of NSAIDS and blood loss in urine or stools or excessive menstrual blood loss should be obtained. NSAID enteropathy is associated with significant amounts of blood loss [9]. A thorough physical examination to identify features of ID and ID anemia like pallor, koilonychia, glossitis and even high output cardiac failure should be performed.

Routine laboratory tests like complete blood count, hemoglobin levels, hematocrit, urinalysis for hematuria and stool test for occult blood as well as other tests like liver enzymes, renal function tests, echocardiography are indicated depending on the history and physical examination findings. Specific tests for iron deficiency detection include serum ferritin, serum iron, and transferrin saturation.

Tests to detect the cause of the ID include celiac disease serology, gastroscopy and colonoscopy [1]. Repeated endoscopies or capsule endoscopies may be necessary to detect persistent ID [1].

• Iron Increased

  […] tool=bestpractice.com Iron deficiency is a lack of iron in the body resulting from inadequate iron intake, increased iron loss, or excessive iron requirements of which iron deficiency anaemia (IDA) is the end-stage result. [bestpractice.bmj.com]

  Some examples of this are: A bleeding ulcer, colon polyp, or colon cancer Regular use of NSAIDs Urinary tract bleeding POOR DIET 1,4 + POOR DIET 1,4 + There are certain stages in your patients’ lives where their need for iron increases, for example, pregnancy [injectafer.com]

  Causes iron deficiency Iron deficiency can be the result of numerous and multiple causes. These fall into two broad categories: an increased need for iron and/or decreased intake or absorption of iron. [irondisorders.org]

  […] cholesterol and increased uptake of cholesterol into the erythrocyte membrane, causing the abnormal shape. i·ron de·fi·cien·cy a·ne·mi·a hypochromic microcytic anemia characterized by low serum iron, increased serum iron-binding capacity, decreased serum [medical-dictionary.thefreedictionary.com]

  The compensatory increase in iron absorption causes an increase in iron-binding capacity (transferrin level). During stage 2, erythropoiesis is impaired. [merckmanuals.com]

• Colitis

  Of the two patients with colitis, one had radiation colitis, and the other idiopathic ulcerative colitis. One of the cecal ulcers was idiopathic, and one was tuberculous. [doi.org]

  It may also occur due to an autoimmune disease such as rheumatoid arthritis or ankylosing spondylitis, eye injury or inflammatory disorders such as Crohn’s disease or ulcerative colitis. [colinclement.com.au]

  […] whose periods have stopped, iron deficiency anaemia can be a sign of bleeding in the stomach and intestines caused by: taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin stomach ulcers swelling of the large intestine (colitis [nhs.uk]

  Those with malabsorption issues, such as celiac disease and colitis are another high risk group. Living with iron deficiency anemia can make it difficult to do heavy work for long periods, as Amina explains: "I was only able to do the bare minimum. [the.ismaili]

  Even if you get enough iron in your diet, celiac disease and inflammatory bowel diseases like Crohn's and ulcerative colitis can lead to problems absorbing nutrients, iron included. [huffpost.com]

• Polyps

  Surgery may be needed to repair a bleeding ulcer or remove a polyp in the colon. A blood transfusion may be necessary if the anemia is severe. [merckmanuals.com]

  Although less likely, small ulcers or polyps may have led to chronic bleeding. Finally, abnormalities such as polyps or vascular ectasias may have been missed during the endoscopic examination. [doi.org]

  Most older people who become deficient do so not because they consume too little iron but because of chronic internal bleeding usually caused by ulcers, polyps, or tumors. [healthcentral.com]

Demographics, medical diagnoses and treatments were extracted. [ncbi.nlm.nih.gov]

Prognosis Iron deficiency anemia is an easily treated disorder with an excellent outcome; however, it may be caused by an underlying condition with a poor prognosis, such as neoplasia. [emedicine.com]

N/A What should you tell the patient and the family about prognosis? The patient and family should be told that the prognosis for iron deficiency itself is excellent, and that an excellent response to either oral or parenteral iron can be expected. [cancertherapyadvisor.com]

For those responding to steroid therapy the prognosis is good. [medical-dictionary.thefreedictionary.com]

Causes Once iron deficiency anemia is identified, the goal is to determine the underlying etiology. [aafp.org]

Evaluation for the etiology of bleeding is paramount, most notably including evaluation of the gastrointestinal tract for culprit lesion(s), which may include carcinoma as outlined above. [clinicaladvisor.com]

Management Treatment of iron deficiency anemia consists of correcting the underlying etiology and replenishing iron stores. [emedicine.com]

The lack of adequate and robust epidemiological data in SSA makes it difficult to recognise the significance of anaemia and ID in HF. [ncbi.nlm.nih.gov]

[email protected] and Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria. [ncbi.nlm.nih.gov]

Other steps you can take to prevent iron deficiency include: Serve iron-rich foods. [mayoclinic.org]

Abstract The US Preventive Services Task Force (USPSTF) makes recommendations to primary care providers regarding preventive services for asymptomatic patients. [ncbi.nlm.nih.gov]

Return to Screening and Prevention to review tests to screen for and strategies to prevent iron-deficiency anemia. Treatment - Iron-Deficiency Anemia Treatment for iron-deficiency anemia will depend on its cause and severity. [nhlbi.nih.gov]

Handbook of Preventive Services: Put Prevention into Practice (111). [cdc.gov]

1. Bermejo F, Garcia-Lopez S. A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases. Worl J Gasteroenterol. 2009 Oct 7;15(37): 4638 -4643
2. Goddard AF, McIntyre AS, Scott BB. Guidelines for the management of iron deficiency anaemia. British Society of Gastroenterology. Gut. 2000;46 Suppl 3-4:IV1–IV5.
3. Sayer JM, Long RG. A perspective on iron deficiency anaemia. Gut. 1993;34:1297–1299.
4. Vaucher P, Druais PL, Waldvogel S, Favrat B. Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial. CMAJ. 2012;184:1247–1254.
5. Verdon F, Burnand B, Stubi CL, et al. Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial. BMJ. 2003;326:1124.
6. Krayenbuehl PA, Battegay E, Breymann C, et al. Intravenous iron for the treatment of fatigue in nonanemic, premenopausal women with low serum ferritin concentration. Blood. 2011;118:3222–3227.
7. Peeling P, Dawson B, Goodman C, et al. Athletic induced iron deficiency: new insights into the role of inflammation, cytokines and hormones. Eur J Appl Physiol. 2008;103:381–391.
8. Robertson JD, Maughan RJ, Davidson RJ. Faecal blood loss in response to exercise. Br Med J (Clin Res Ed) 1987;295:303–305.
9. Bowen B, Yuan Y, James C, et al. Time course and pattern of blood loss with ibuprofen treatment in healthy subjects. Clin Gastroenterol Hepatol. 2005;3:1075–1082.