Iron Deficiency Anemia: “Low Iron”

Joseph R. Anticaglia MD
Medical Advisory Board

Iron deficiency anemia is due to a low level of iron in the blood. There is a decrease in the number of red blood cells (RBCs) in the body which appear under the microscope to be smaller in size and paler in color.

Source Graham Beards Human blood I.D.A.

The body needs iron to make hemoglobin, which carries oxygen from the lungs to the rest the body. With less circulating RBCs, there is less hemoglobin and less oxygen delivered to the tissues. This causes a person to feel fatigued, run down with no energy — the most common symptoms of this anemia.

Iron deficiency anemia (I.D.A.) is the most common anemia in the U.S. Poor iron-diet is more likely to be found in people over the age of 65, pregnant women and young children who have a greater need for iron in their diet. The most common cause of iron deficiency anemia in adults is blood loss.

What follows are some other causes of I.D.A.

  • Diet — poor dietary intake
    • Pregnancy
    • People over the age of 65
    • Children during growth spurts
    • Vegans
  • Blood Loss
    • Menstruation
    • Intestinal bleeding
    • Secondary to accidents
  • Absorption Problems
    • A; Gastric by-pass
      • Celiac disease
    • B: Inhibitors of Iron Absorption
      • Tea and coffee
      • Dairy products
      • Nuts, legumes, seeds and grains
      • Medications

Signs and Symptoms: ‘Low’ Iron

People with significant I.D.A. look, feel and act tired. They lack energy and stamina. Physical exertion quickly tires them. People have used the mnemonic, low iron to help remember the sign and symptoms of I.D.A.

  • Lethargy — Tired, wiped out feeling.
  • Overexertion — Walking up a moderately steep incline or two-three flights of steps can cause shortness of breath and the heart to beat faster.
  • Weird food cravings — Pica is an unusual craving for specific foods. People with significant I.DA. have been known to eat clay, dough and other bizarre stuff. One might know a pregnant woman with weird food cravings.
  • Inflammation of the tongue that can redden, smoothen and become sore (glossitis).
  • Reduced number of red blood cells leads to a reduced level of hemoglobin.
  • Oxygen — reduced oxygen level in the blood. Observing the blood smear, the RBSs are small and pale.
  • Nails — the fingernails are spoon shaped (koilonychias).
  • Neuro-psychologically, these individuals are tired mentally, have trouble concentrating and become moody.

The diagnosis is made utilizing the above signs and symptoms and an abnormal ferritin value, which is a very reliable I.D.A. indicator.

Treatment depends on the cause, but most often diet and/or iron supplementation will suffice.

Tips: It’s advisable to take supplemental iron with Vitamin C (orange juice) on an empty stomach since they both promote the absorption of iron. Drink lots of fluids since iron can cause constipation. Because iron can stain teeth, people find it useful to drink liquid iron through a straw and to brush their teeth afterwards. It’s not unusual that iron turns stools black. Look for foods that are rich in iron.

Iron deficiency anemia as noted is the most common anemia in the United States It affects more than 1.5 billion people worldwide and with the correct diagnosis and proper infrastructure, it is readily treatable.


  1. S. Killip et al; Iron-deficiency anemia; Am. Fam Physician, Mar 1. 2007
  2. UCSF; Hemoglobin and the functions of iron; 2002
  3. T Johnson-Wimbley, D Graham; Diagnosis and management of iron deficiency anemia in the 21st century; Therap Adv Gastroenterol, 2011
  4. Am Society of Hematology; Iron-deficiency anemia
  5. CDC; Recommendations to control and prevent iron-deficiency in the United States; April 3, 1998
  6. NIH; Iron Fact Sheet for Consumers, Feb 17, 2016

This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.