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]

• Chills

  View of Los Angeles' Hollywood Blvd Penguins chill at the Kansas City Zoo in Missouri More Privacy Policy Your CA Privacy Rights Children's Online Privacy Policy Interest-Based Ads Terms of Use Contact Us Search Menu Interest Successfully Added We'll [abcnews.go.com]

  They are quite susceptible to bacterial infection and have little resistance to environmental chilling. [vetmed.iastate.edu]

  Photo Credit Dolly Faibyshev for The New York Times Work Out and Chill? Cool temperature workouts may be the answer for those who want to exercise without becoming a hot mess. [nytimes.com]

  The following serious adverse reactions have been most commonly reported from the post-marketing spontaneous reports: urticaria, dyspnea, pruritus, tachycardia, erythema, pyrexia, chest discomfort, chills, angioedema, back pain, arthralgia, and syncope [injectafer.com]

  You may have fever or chills with your abdominal pain or blood in your stools. This may be a sign of infection, and you should notify your healthcare provider. You may bleed easily and often when you go to the bathroom with a bowel movement. [chemocare.com]

• 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]

• Constipation

  Floradix’s unique liquid formula really is the best non constipating iron supplement available in the market because it targets the need of iron without the unwanted side effect of constipation. [cheers4health.com]

  Drinking plenty of fluids if constipation develops. Iron tablets may make your stools (faeces) black. This is normal and nothing to worry about. [patient.info]

  Iron supplements may cause constipation or black stools. [healthline.com]

  This will promote bowel movements, and prevent constipation and trauma (damage) to the delicate tissues of your colon and rectum. [chemocare.com]

• Diarrhea

  Inflammatory bowel disease -Diarrhea, abdominal pain and mucous in your bowel movements are caused by inflammation (swelling and redness) of the lining of the colon. This may cause rectal bleeding. [chemocare.com]

  A good example of that is very heavy menstrual bleeding or bloody diarrhea from inflammatory bowel disease. [dukehealth.org]

  Causes include the following: Repeated blood transfusions Iron therapy given in excessive amounts or for too long Chronic alcoholism An overdose of iron Excess iron consumed all at once causes vomiting, diarrhea, and damage to the intestine and other [merckmanuals.com]

  Gastritic symptoms, heartburn, nausea, vomiting, and diarrhea may occur with oral iron repletion. [clinicaladvisor.com]

  Without adequate amounts of vitamin A the body cannot regulate iron leading to an iron deficiency. ( 2 ) People with gastrointestinal disorders -Diarrhea, ulcers, and other gastrointestinal disorders and diseases can lead to an inadequate iron absorption [healthaliciousness.com]

• 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]

• Restless Legs Syndrome

  In addition to anemia, iron deficiency may cause pica (a craving for nonfoods) and spoon nails and is associated with restless leg syndrome. Rarely, iron deficiency causes dysphagia due to postcricoid esophageal web. [msdmanuals.com]

  Restless Legs Syndrome Some people who have iron deficiency develop restless legs syndrome, a disorder that causes you to have a strong urge to move your legs. [everydayhealth.com]

• Ulcer

  Six patients had giant ulcers (>2 cm in diameter): five had duodenal ulcers, and one had a gastric ulcer. [doi.org]

  In women, iron deficiency may be due to heavy menstrual periods, but in older women and in men, the bleeding is usually from disease of the intestines such as ulcers, polyps and cancer. [labtestsonline.org.au]

  Stomach ulcers The acid in your stomach, which helps your body digest food, can sometimes eat into your stomach lining. When this happens, the acid forms an open sore (an ulcer). This is also known as a stomach ulcer or a peptic ulcer. [nhsinform.scot]

  Treatment for iron deficiency anaemia Once the reason you have anaemia has been found – for example, an ulcer or heavy periods – your GP will recommend treatment. [nhs.uk]

• 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]

• 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]

• Dizziness

  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]

  If your iron levels get so low that you become anaemic, you can get a range of symptoms, including feeling: extremely tired and weak short of breath your heart beating fast and irregularly, or both dizzy and light-headed. [healthdirect.gov.au]

  Adverse reactions reported by ≥2% of Injectafer-treated patients were nausea (7.2%); hypertension (3.8%); flushing/hot flush (3.6%); blood phosphorus decrease (2.1%); and dizziness (2.0%). [injectafer.com]

  Several symptoms occur in all types of anemia, including: Feeling tired Shortness of breath Dizziness Headache Feeling cold Weakness Pale skin Cleveland Clinic News & More Cleveland Clinic News & More [my.clevelandclinic.org]

• Irritability

  Iron deficiency can develop insidiously leading to increased fatigability, lassitude, poor immunity, irritability, and iron deficiency anemia. Causes of iron deficiency are several and early identification is the key to managing the condition. [symptoma.com]

  In some children, it may irritate the stomach and discolor bowel movements. [danafarberbostonchildrens.org]

  Iron supplements can cause irritation of the stomach and discoloration of bowel movements. They should be taken on an empty stomach or with orange juice to increase absorption. They are much more effective than dietary interventions alone. [childrensnational.org]

• Confusion

  Iron deficiency can often times be confused with low thyroid or hypothyroidism. Iron loss can contribute to a multitude of health problems – not just fatigue. [glutenfreesociety.org]

  To avoid confusion it should be ordered as elemental iron, specifying the quantity of drops, syrup, or tablets. Dose of elemental iron is 4 mg to 6 mg/kg/day divided q8–24h for 2 to 4 months. [kidsnewtocanada.ca]

  Symptoms of iron deficiency In her practice, Dr Jenkins sees a growing number of young women cutting out meat, thanks to such blanket messages as that found in the Eatwell guide along with confusing advice from unqualified people on Instagram and Twitter [dailymail.co.uk]

  In addition to elemental iron, the iron salt content (ferrous sulfate, fumarate, or gluconate) may also be listed on the package, which can make it confusing for consumers to know how many tablets or how much liquid to take to get the proper dosage of [hematology.org]

• Burning Sensation

  The feeling has been described as burning, tugging, tingling, or the sensation of insects crawling around inside your legs. [prevention.com]

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].

• 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]

• Colonic Ulcer

  The most common abnormality in the upper gastrointestinal tract was peptic ulceration (duodenal ulcer in 11 patients, gastric ulcer in 5, and anastomotic ulcer in 3). Cancers, detected in 11 patients, were the most common colonic lesions. [doi.org]

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]

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