Iron Deficiency

What Is It?

Iron deficiency is an abnormally low level of iron in the body.

Iron is an essential mineral found in red meat and certain fruits and vegetables. It is absorbed through the uppermost portion of the small intestine, carried in the bloodstream by a glycoprotein called transferrin, and stored in an iron-protein complex called ferritin. In the body, iron is needed to form the myoglobin of muscle cells, and it is essential for certain enzymes that drive the body's chemical reactions. In the bone marrow, iron is used to make hemoglobin, the oxygen carrying chemical inside the body's red blood cells. If iron levels fall too low, iron deficiency anemia can occur. When this happens, red blood cells become smaller than normal and contain a decreased concentration of hemoglobin.

Iron deficiency can happen because of any of the following:

• An inadequate diet
• Poor absorption of iron resulting from the surgical removal of part or all of the stomach
• Inflammatory bowel disease
• An intestinal disorder called celiac sprue
• Chronic blood loss caused by any of the following:
  • Abnormally heavy menstrual periods
  • Bleeding into the urine, which is rare, or into the gastrointestinal tract, which is common and can be seen only under a microscope
  • Excessive blood donation
  • Massive destruction of red blood cells inside the body (intravascular hemolysis)
  • A parasitic hookworm infestation

Iron deficiency can occur in infants, adolescents and pregnant women because of the heavy demands for iron associated with rapid body growth. Iron deficiency is especially common in premenopausal women because of regular loss of iron with menstrual periods.

Symptoms

Mild iron deficiency may not cause any symptoms. When iron deficiency has progressed to actual anemia, there can be fatigue, breathlessness, unusually pale skin, and a decreased ability to exercise. People who have had severe iron deficiency for a prolonged period sometimes complain of trouble swallowing or have a sore mouth or tongue. In some cases, there can be unusually brittle fingernails or an abnormal curling and softness of the nails called spooning.

Diagnosis

Your doctor will ask about your diet and symptoms, including any signs of abnormal menstrual, rectal or urinary-tract bleeding. Your doctor will perform a physical examination to check for unusual paleness in your skin and fingernails, and for other nail abnormalities. He or she may examine your rectum to see whether blood is being lost in the gastrointestinal tract.