A lack of iron which leads to anaemia is common. The most common cause of lack of iron in the UK is heavy menstrual periods in women. However, there are many other causes. Bleeding into the gut is a common cause in older people. Various tests may be advised to find the cause of the anaemia. Treatment with iron tablets can correct the anaemia. Other treatments may be advised, depending on the cause.
Understanding blood
Blood is made up of a fluid called plasma which contains:
- Red blood cells - which take oxygen around the body.
- White blood cells - which are part of the immune system and defend the body from infection.
- Platelets - which help the blood to clot if we cut ourselves.
- proteins - and other chemicals that have various functions.
Red blood cells are made in the bone marrow, and millions are released into the bloodstream each day. A constant new supply of red blood cells is needed to replace old cells that break down. Red blood cells contain a chemical called haemoglobin. Haemoglobin binds to oxygen, and takes oxygen from the lungs to all parts of the body.
To constantly make red blood cells and haemoglobin, you need a healthy bone marrow, and nutrients from food such as iron and certain vitamins.
What is iron deficiency anaemia?
Anaemia means:
- you have less red blood cells than normal, or
- you have less haemoglobin than normal in each red blood cell.
In either case, a reduced amount of oxygen is carried around in the bloodstream. The most common cause of anaemia in the UK is a lack of iron. This is called iron deficiency anaemia.
What are the symptoms of iron deficiency anaemia?
- Common symptoms are due to the reduced amount of oxygen in the body. These include: tiredness, lethargy, feeling faint, becoming easily breathless.
- Less common symptoms include: headaches, palpitations, altered taste, sore mouth, and ringing in the ears (tinnitus).
- You may look pale.
- Various other symptoms may develop, depending on the underlying cause of the anaemia (see below).
Possible complications
Complications may develop if the anaemia becomes severe and is not treated. For example, you can develop: fragile and broken nails, heart failure, difficulty swallowing, and hair loss.
How is iron deficiency anaemia diagnosed?
A blood test can confirm that you are anaemic, and measure the amount of iron in the blood. If your anaemia is due to lack of iron, the cause for the low level of iron needs to be explained.
What are the causes of iron deficiency anaemia?
A normal balanced diet will usually contain enough iron for the body's needs. A low level of body iron leading to anaemia can result from various causes. Some are more serious than others, and include the following.
Heavy menstrual periods
Anaemia is common in women of all ages who have heavy periods. About 1 in 10 women will become anaemic at some stage due to heavy periods. The amount of iron that you eat may not be enough to replace the iron that you lose with the blood each period. Having heavy periods does not always lead to anaemia. Anaemia is more likely to develop if you have heavy periods and eat a diet that contains little iron.
Pregnancy
The growing baby needs iron and will take it from the mother. Anaemia is common in pregnant women. It is more likely to develop during pregnancy if you eat a diet that has little iron.
Poor absorption of iron
Some conditions of the guts (intestines) lead to poor absorption of various foods, including iron. Coeliac disease is an example.
Bleeding from the guts (intestines)
Several conditions of the guts can lead to 'internal bleeding'. Sometimes this is sudden, for example, after a burst duodenal ulcer.
Vomiting or passing blood is then obvious.
However, often the bleeding is not obvious. A constant trickle of blood into the guts can be passed unnoticed in the stools (faeces). The iron that you may lose with the bleeding may be more than you eat. Conditions causing this include: stomach or duodenal ulcers, colitis, inflammation of the oesophagus (gullet), piles (haemorrhoids), tumours of the bowel, and other rare bowel disorders. If you have one of these problems, you may have other gut symptoms such as stomach pains, constipation, or diarrhoea. However, in the early stages of these conditions, you may not have any symptoms, and anaemia may be the first thing that is noticed.
Medication
Some medicines which you may take for other conditions can sometimes cause bleeding into the guts without causing symptoms. The most common example is aspirin. Other anti-inflammatory painkillers, such as ibuprofen, naproxen, diclofenac, etc, also have this side effect in some people.
Bleeding from the kidney
A small but regular trickle of blood from diseases of the kidney or bladder may not be noticed in the urine. However, enough may be lost to cause anaemia.
A poor diet
Not eating enough iron is sometimes the cause of iron deficiency anaemia. This is uncommon as iron is in meat, liver, green vegetables, flour, eggs, and other foods. However, a poor diet may contribute to other causes. For example, a poor diet combined with a growth spurt in children, with pregnancy, or with heavy periods may lead to anaemia.
Hookworm infection
This gut infection is the most common cause of iron deficiency anaemia world-wide. It affects people living in, and visiting, certain tropical countries. The worm feeds off blood inside the guts.
Do I need any tests?
It is important to find the cause of the iron deficiency. The cause may be obvious in some people. For example, anaemia is common in pregnancy, and in women with heavy periods. In these situations, if you are otherwise well, then no further tests may be needed. However, further tests may be advised if the cause is not clear. For example:
- Tests to look into the guts may be advised to see if there is any internal bleeding, even if you do not have gut symptoms. The tests may include looking into the stomach with a special telescope (endoscopy). Checking the rectum and bowel may also be advised. This is sometimes done with a special X-ray examination (barium enema). Another method is by using a special telescope (sigmoidoscopy or colonoscopy).
- A biopsy (small sample) of the lining of the gut may be taken if coeliac disease is suspected as the cause.
- If you have recently been to the tropics, a stool sample may be done to rule out hookworm.
- Other tests may be advised if the cause is still unclear.
What is the treatment for iron deficiency anaemia?
Iron tablets are usually prescribed to correct the anaemia. Other treatments may also be advised, depending on the underlying cause.
Iron tablets
Various iron tablets and liquid medicines are available. A doctor will advise on one. The length of course will vary depending on how bad the anaemia is. A blood test after a few weeks will show if the treatment is working. Once the blood level is back to normal, you should continue to take iron for at least three further months. This will ensure that reserves of iron are built up in your body.
Side-effects from taking iron occur in some people. These include: feeling sick (nausea), an upset stomach, constipation, or diarrhoea. Tell a doctor if side-effects are a problem. Don't stop the iron, as the anaemia will not get better. Possible ways to reduce the problem with side-effects are:
- Take the iron tablets with meals. Food reduces the absorption of the iron and so you may need to take a longer course to correct the anaemia.
- Take a lower dose, but again a longer course will be needed to correct the anaemia.
Iron tablets may make your stools (faeces) black. This is normal and nothing to worry about.
REMEMBER to keep iron tablets away from children. An overdose of iron tablets can be very dangerous in children (who may think that they are sweets).
© EMIS and PIP 2004 Updated: September 2004 Review Date: October 2005 CHIQ Accredited PRODIGY Validated
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