Physical findings  :
Initial laboratory testing should include  
Additional laboratory testing to identify comorbid conditions  :
Other procedures to further identify possible cause :
Serum ferritin is a glycoprotein that indicates available iron stores. It is the first test to become abnormal as iron deficiency begins to develop. It is the best test to assess the degree of iron deficiency as it is not affected by recent ingestion of iron .
The treatment of iron deficiency anemia involves a two-step approach; restoring iron stores  and treating the underlying etiology. Management of the causative disease process will usually improve hemoglobin levels .
Other dietary recommendations:
Treatment of iron deficiency anemia should also include patient education including :
Excess iron can be toxic, and can lead to cell death and organ damage. Therefore, iron supplementation needs to be carefully monitored .
Iron deficiency anemia is defined as a hemoglobin level less than 11g/dL (not associated with hemoglobinopathies)   .
Iron status can be classified as iron sufficient, iron depleted, or iron deficiency anemia .
Iron sufficiency indicates that iron supplies are sufficient to supply normal and atypical body requirements for hematopoiesis . In iron depletion, the total stored iron, serum ferritin concentration, is decreased, but the amount of transport iron remains normal  . In iron deficiency anemia both stored iron and transport iron are decreased . Therefore, the amount of iron is insufficient to provide what is needed for normal function. This results in inadequate hemoglobin production   .
Iron deficiency anemia may also be classified by the underlying cause of the disorder    :
Chronic iron deficiency anemia is a common occurrence in the elderly   and in chronic disease. Anemia in diabetes and chronic kidney disease is a result of the kidney‘s inability to produce erythropoietin in response to abnormally low hemoglobin .
The prevalence of iron deficiency anemia is affected by diet and socioeconomic factors. It is seen more frequently in those living in poverty . It varies worldwide from 10% in developed nations to 50% in less developed societies .
Prevalence of iron deficiency anemia in the elderly increases with age from 8 % at age 65, 12% at age 75, and 23% at age 85+ .
The incidence of iron deficiency anemia is higher in men than in women in all age groups .
Studies have reported the prevalence of iron deficiency anemia in elderly African Americans to be 3 times higher than in Caucasians, Hispanics, and Asian Americans . However, normal hemoglobin levels are lower in those of African descent, a factor that is not always taken into account .
Iron is necessary for the production of hemoglobin, myoglobin, and enzymes of cellular metabolism. Iron deficiency results in abnormal hemoglobin synthesis leading to reduced ability of the red blood cells to carry oxygen . Iron is involved in the development of the central nervous system, immune system, endocrine system and cardiovascular system  .
Iron absorption is regulated to replace body losses. Hepcidin is the key regulator of iron absorption in the intestinal tract and the distribution from body stores  . Hepcidin, produced in the liver, responds to iron levels and needs by activating ferroportin  . Ferroportin is present on the surface of duodenal mucosal cells and facilitates iron absorption. Decreased levels of ferroportin inhibit the absorption of iron into the plasma .
Iron deficiency anemia of chronic disease is the result of reduced glomerular filtration rate, reduced plasma flow, impaired erythropoietin production, and hemodilution  . These findings are associated with elevated levels of inflammatory cytokines which indicate an autoimmune inflammatory process  .
Iron is also important in the production of myoglobin and myelin in the brain . Iron deficiency, therefore, affects neurotransmitter metabolism, interfering with psychomotor, intellectual, and emotional function. These effects are seen particularly in children, but may also be responsible for symptoms in the elderly .
Iron deficiency anemia is defined as a decrease in red blood cells (RBCs), hemoglobin, and/or red blood cell volume a result of insufficient iron . Iron deficiency is a major public health concern and the most common nutritional deficiency, affecting more than 2 billion people worldwide   . Although it is more prevalent in underdeveloped countries, it is still a problem in developed nations  . The World Health Organization defines anemia as a hemoglobin (Hgb) level less than 12-13 g/dL . Approximately 50% of anemia is due to iron deficiency .
The causes of iron deficiency anemia include: Nutritional deficits, malabsorption, excessive blood loss, and chronic disease  . The cause of anemia is determined by patient history, dietary history, and the indices of iron status .
The effects and complications of iron deficiency anemia are significant. Iron deficiency may interfere with psychomotor development and cognitive function in children . It may increase maternal and fetal morbidity and mortality. Iron deficiency anemia in the elderly and chronically ill decreases quality of life, independence, and productivity. It has an important economically impact by diminishing the individual’s ability to work and perform physical labor .
What are the symptoms of iron deficiency anemia?
Mild to moderate iron deficiency anemia is often asymptomatic. The symptoms of iron deficiency anemia include:
What causes iron deficiency anemia?
Iron deficiency anemia is caused by a decreased intake or absorption of iron and/or an increased need for or loss of hemoglobin. Chronic diseases, such as diabetes, chronic renal disease, and chronic heart disease, may also contribute to iron deficiency anemia.
Who gets iron deficiency anemia?
Anyone, at any age, may develop iron deficiency anemia. Individuals living in poverty or in developing parts of the world, where malnutrition and poor health conditions abound, are at highest risk.
Also at high risk are:
How is iron deficiency anemia diagnosed?
Iron deficiency anemia is diagnosed by simple blood tests and is often found with routine blood screening. It may be suspected by symptoms of fatigue and activity intolerance.
How is iron deficiency anemia treated?
Iron deficiency anemia is treated by increasing the intake and absorption of iron. This may be done by increasing the iron in the diet or by supplementing with iron medications. Treating any other underlying cause is also needed.
What are the complications of iron deficiency anemia?
There are many possible complications of iron deficiency anemia. Iron is essential for the production of hemoglobin and for proper development and functioning of the nervous system.
Iron deficiency anemia may cause:
How can iron deficiency anemia be prevented?
Iron deficiency anemia can be prevented by a balanced diet containing sufficient iron, from meats and non-meat sources, folic acid, and Vitamins C and B-12. It may also be prevented by iron supplementation of those at risk for developing iron deficiency anemia. Complications of iron deficiency anemia may be prevented by early detection and treatment through routine screening.