Physicians diagnose around 2.8 million cases of anemia per year, according to the Centers for Disease Control and Prevention. In other words, low iron is a pretty common condition. Its symptoms range from fatigue and anemia to mental disorders.
If left untreated, low iron levels can be dangerous enough to lead to death. However, iron-deficiency anemia is a common condition that can be diagnosed by a physician and managed with dietary changes, supplements or intravenous iron therapy.
Risks of Low Iron Levels
Dangerously low ferritin levels — which refers to the amount of iron stored in the liver — or current iron levels can also be life-threatening. Iron plays a significant role in the body as it helps maintain the health of your cells, skin, hair and nails, points out the UCSF Health.
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This mineral also carries oxygen in the blood through hemoglobin, an iron-rich protein. Hemoglobin lets those red blood cells bring oxygen from your lungs to the rest of your body, as well as take carbon dioxide back to the lungs to be exhaled. About 6 percent of the body's iron contributes to the formation of proteins and enzymes that support respiration, energy metabolism and collagen synthesis.
In 2017, 5,382 people died from anemia, according to the 2019 National Vital Statistics Report. The majority of anemia-linked deaths occurred in people age 85 and older. When you do the math, it's clear that death from low iron levels isn't common, but it can occur when the condition isn't diagnosed and treated properly.
There are multiple types of anemia, including B12-deficiency anemia, folate-deficiency anemia, pernicious anemia and sickle cell anemia. However, iron-deficiency anemia is the most commonly diagnosed form of the condition, according to the U.S. National Library of Medicine.
Iron-Deficiency Anemia Basics
Iron-deficiency anemia is diagnosed when a test reveals hemoglobin levels below 13.5 grams/dL in men or 12 grams/dL in women, says the American Society of Hematology. The condition occurs when your body doesn't have enough red blood cells or when those cells don't function properly. However, the true root cause — meaning, the reason why you don't have properly functioning or an adequate supply of red blood cells — varies from person to person.
While iron-deficiency anemia doesn't solely affect women, they are more likely than men to develop the condition because of their reproductive system. The Office on Women's Health reports that up to 5 percent of women of childbearing age develop this condition as a result of heavy bleeding during menstrual periods.
This problem also affects one in six pregnant people, who need nearly twice as much iron in order to support fetal development. A lack of iron during pregnancy increases the risk of premature birth or a low-birth-weight baby, the Office on Women's Health notes.
There are many causes of iron-deficiency anemia, states the Mayo Clinic. People who donate blood frequently are more likely to become anemic, though this can be remedied by filling up on iron-rich foods. Blood loss may also occur from other conditions, such as peptic ulcers, hiatal hernias, colon polyps and colorectal cancer, as well as the overuse of certain over-the-counter medications, including aspirin, which may cause gastrointestinal bleeding.
A person can also develop this disorder because of a lack of iron in the diet or the inability to absorb it from foods. The latter is typically due to a digestive or autoimmune condition, such as celiac disease, or because part of the small intestine was removed during surgery. People who are vegetarians risk having low levels of this mineral because they don't substitute iron-rich meat products with iron-rich vegetarian products.
Read more: How Many Mg of Iron Do I Need If I'm Anemic?
Symptoms of Low Iron Levels
While mild or borderline anemia probably won't cause any ill effects, the first indication that you might have moderately or severely low iron levels is unexplained fatigue or lack of energy that is often severe — to the point that you can't complete everyday tasks.
However, these are general symptoms that could indicate any number of diseases. With anemia, though, you might also realize upon looking in the mirror that your skin is unusually pale. You may experience shortness of breath and difficulty exercising or doing any sort of physical activity.
Common anemia symptoms include headaches, mouth or tongue sores, brittle nails and hair loss. Those who are anemic are often sensitive to cold and develop pica, or the craving for ice, clay and other non-nutritive products. As their condition gets worse, they might start to feel chest pain, a rapid heartbeat and dizziness.
Furthermore, a June 2013 study published in BMC Psychiatry determined that children with iron-deficiency anemia had a higher risk of developing psychiatric disorders, including bipolar disorder, anxiety, autism and ADHD.
Risks of Severe Anemia
As with other conditions, this disorder becomes more life-threatening as it progresses. Severe anemia may lead to hypoxemia, or low oxygen in the blood. When your heart needs to pump more blood to compensate for the lack of oxygen, it may become enlarged or fail. Severe anemia may also increase the occurrence of myocardial ischemia, or reduced blood flow to the heart, according to a review published in Vascular Health and Risk Management in May 2018.
Furthermore, a study published in April 2018 in Clinical and Experimental Nephrology, which was conducted on more than 60,000 Japanese people, determined that having anemia is an independent risk factor for dying from any cause. Even though the study was meant to assess the relationship between anemia and chronic kidney disease (CKD), researchers found that subjects who were anemic had higher mortality rates, no matter what their CKD status.
Diagnosing Anemia Through Testing
When a doctor suspects anemia, he will run a complete blood count to determine the levels of hemoglobin, a protein in red blood cells, or hematocrit, the ratio of red blood cells to the total blood volume. If they are low, the physician may order an iron test, which determines current levels of iron, or a ferritin test to measure the amount of stored iron stored. He may also evaluate transferrin and iron-binding capacity to determine your body's ability to store iron in the blood.
In the case of severe iron deficiency, a white blood count test might come back low and a platelet count could come back abnormal, according to the American Society of Hematology. If a doctor suspects severe anemia, particularly without an obvious cause, he might also run tests to look for blood in the stool or urine or abnormalities in the gastrointestinal tract.
These tests are more common in anemic men and people after menopause because it's not as clear what might be contributing to low iron levels in male patients. In women with severe blood loss from menstruation, the doctor might recommend a pelvic ultrasound or uterine biopsy.
Can Borderline Anemia Be Reversed?
The best way to reverse low iron levels depends on how severe the deficiency is. Borderline anemia can likely be treated with a change in diet to include more iron-rich foods. Top choices include legumes, fortified grains, leafy greens and animal-based proteins, such as beef, pork, chicken and fish. Organ meat is particularly high in iron.
The body absorbs iron better from meat than it does from vegetarian sources. Therefore, if you don't eat animal-based protein, you will have to increase your consumption of iron-rich vegetarian options to absorb the same amount as omnivores.
Mild anemia may also be treated with an over-the-counter iron supplement. However, these products may cause an upset stomach, the American Society of Hematology notes. You may also experience nausea, vomiting, diarrhea or constipation. To minimize these side effects, take your supplements with a little bit of food.
Additionally, your physician might recommend taking vitamin C — whether in supplement form or from foods, such as orange juice, strawberries and tomatoes. Antacids, which relieves heartburn symptoms, may interfere with iron absorption, notes the U.S. National Library of Medicine. Therefore, you should take your supplements two hours before or four hours after using antacids.
How to Treat Severe Anemia
When iron levels are significantly low, you might need prescription iron, which is significantly more concentrated than over-the-counter versions. The American Society of Hematology states that people with severe iron deficiency need 150 to 200 milligrams per day of elemental iron, or 2 to 5 milligrams of iron per kilogram of body weight per day. Talk to your doctor about the proper type of iron to take — enteric-coated tablets don't work as well because of how it is absorbed.
If your physician doesn't think you absorb iron well in the gastrointestinal tract or if the deficiency is due to chronic blood loss, they might recommend intravenous (IV) iron. This is also an option for people who don't tolerate oral iron well.
IV iron comes in three preparations — iron dextran, iron sucrose and ferric gluconate. More iron can be given in one dose with the former, but some people may have allergic reactions to it. The symptoms of an allergic reaction include hives, itching and joint and muscle pain. The latter two forms of iron have less of a chance of causing these side effects but require more frequent doses and, therefore, more trips to the physician.
For life-threatening iron deficiency, a doctor might want to do a red blood cell transfusion, particularly in patients who are actively bleeding. This treatment won't fix the deficiency, but it will provide temporary relief by replacing deficient red blood cells. Once the transfusion is complete, additional treatment will be needed to determine and fix the cause of low iron levels.
- Centers for Disease Control and Prevention: "Anemia or Iron Deficiency"
- Mayo Clinic: "Iron Deficiency Anemia"
- American Association of Clinical Chemistry: "Iron Tests"
- Clinical and Experimental Nephrology: "Anemia as a Risk Factor for All-Cause Mortality: Obscure Synergic Effect of Chronic Kidney Disease"
- American Association of Clinical Chemistry: "Ferritin"
- American Society of Hematology: "Iron-Deficiency Anemia"
- Centers for Disease Control and Prevention: "2019 National Vital Statistics Report"
- Office on Women's Health: "Iron-Deficiency Anemia"
- BMC Psychiatry: "Association Between Psychiatric Disorders and Iron Deficiency Anemia Among Children and Adolescents: A Nationwide Population-Based Study"
- Mayo Clinic: "Hypoxemia"
- American Association of Clinical Chemistry: "Transferrin and Iron-Binding Capacity (TIBC, UIBC)"
- U.S. National Library of Medicine: "Anemia"
- University of California San Francisco: UCSF Health: "Hemoglobin and Functions of Iron"
- American Society of Hematology: "Anemia"
- Vascular Health and Risk Management: "Anemia and Acute Coronary Syndrome: Current Perspectives"