Iron Deficiency and Iron Deficiency Anemia: What You Need to Know

Why Your Body Needs Iron

Iron, a mineral that typically is absorbed into the bloodstream through the digestion of food, supports numerous physiological processes and helps maintain healthy skin, hair, and nails.¹ Among its other roles, iron contributes to the production of hemoglobin, the molecule in blood that transports oxygen. The body also uses iron stored in the liver and other organs to create red blood cells.¹

Most people need to take in between 8 and 18 milligrams of iron daily.³ The recommended amount is higher for pregnant women and for those who follow a vegan or vegetarian diet.³ If you don’t get enough iron or experience blood loss due to a medical condition or procedure, iron deficiency can result.^1,3

In the early stages of iron deficiency, existing iron stores are “recycled” as older red blood cells are broken down and new ones created, so the body initially can compensate for the iron deficit.⁴ But if that deficit persists over time, the iron stores become further depleted and hemoglobin levels fall.⁵ Iron deficiency progresses to iron deficiency anemia when red blood cells become abnormally small or pale due to lack of hemoglobin,⁴ or when the body’s supply of red blood cells becomes significantly reduced due to blood loss.¹

Anemia from any cause is common in the United States, affecting nearly 1 in 10 Americans aged 2 years and older.⁵ Anemia is more prevalent in females than in males (13.5% vs 5.5%), and prevalence also is higher among adults aged 60 years and older (12.5%).⁵ Anemia also is alarmingly high among African Americans, affecting 1 in 5 Blacks overall and nearly 1 in 3 Black females.⁵

Meanwhile, research suggests that nearly 1 in 3 Americans are iron deficient to some extent.⁶

Joseph McLaughlin, MD, explains that many factors can contribute to iron deficiency. Dr. McLaughlin, a board-certified hematologist and medical oncologist who practices in RCCA’s Manchester, CT, office, says those factors include:

• Pregnancy
• Breastfeeding
• Recent childbirth
• Following a vegan or vegetarian diet
• Regular vigorous exercise, which can cause blood cells to break down and excrete iron before the body can use it.¹

He adds that iron deficiency anemia can result from conditions that cause significant blood loss, such as:

• Menstruation, particularly heavy menstrual bleeding
• Major surgery
• Physical trauma
• Ulcerative colitis, Crohn’s disease, and other benign (non-cancerous) gastrointestinal diseases, which can cause chronic internal blood loss or prevent the intestines from absorbing nutrients
• Colorectal cancer
• Peptic ulcers (sores in the digestive tract) that develop near a blood vessel

• Blood disorders such as sickle cell anemia (characterized by misshapen and fragile red blood cells) or thalassemia (abnormally small and pale blood cells)
• Kidney disease, which can interfere with the production of red blood cells¹ 

What Iron Deficiency or IDA May Feel Like

“One of the real challenges with iron deficiency and even iron deficiency anemia is that the onset is often gradual and the symptoms, particularly at first, are mild,” says Dr. McLaughlin. He explains that many cases of the conditions are identified from the results of routine blood work in people seeing their doctor for a regularly scheduled physical. Symptoms can include:

• Unexplained fatigue or lack of energy
• Cold hands or feet
• Pale or sallow skin
• Brittle nails or hair loss
• Unexplained generalized weakness
• Shortness of breath or chest pain, especially with activity
• Sore or smooth tongue
• Headache, especially with activity
• Rapid heartbeat
• Pounding or “whooshing” in the ears
• Unusual cravings for non-nutritive substances, such as ice, dirt, clay or starch⁷

When a person’s symptoms, initial blood test results, or both indicate that he or she may have iron deficiency or IDA, a primary care provider typically will take a thorough history, perform a comprehensive exam, and order further lab tests. Those tests often include measurement of vitamin B12; iron; ferritin, a protein that stores iron; and transferrin, a protein that carries iron to cells throughout the body.

Ferritin levels below 30 mg/L indicate iron deficiency, while the level usually dips below 10 or 12 mg/L in IDA. Similarly, hemoglobin counts of <13.0 g/dL in men, <12.0 g/dL in non-pregnant women, and <11.0 g/dL in pregnant women are widely used thresholds for diagnosing IDA. (Hemoglobin levels are measured as part of the complete blood count, or CBC, which is a routine first-line test.)

Finding the Cause and Treating the Condition 

Dr. Dave says identifying iron deficiency or IDA is the beginning, not the end, of the evaluation process. “Understanding which factors are contributing to iron deficiency can enable people to make helpful lifestyle changes, while determining what is giving rise to IDA is critical to finding or ruling out potentially life-threatening underlying causes, such as colon cancer,” he notes. Depending on a person’s medical history, age, symptoms, and blood test results, evaluations to investigate the cause of IDA may include urinalysis, ultrasound scans, colonoscopy, or other steps, the hematologist notes.

Treatment of iron deficiency or IDA is tailored to each person’s specific situation, he continues, with oral iron supplements often used as initial therapy. “It’s important to talk with your doctor about what dose of iron you should take and about when and how you should take it,” Dr. Dave says. He explains that such guidance is critical for avoiding taking an excessive dose and for minimizing common side effects of iron supplementation, such as stomach upset and constipation. Physicians also typically advise patients to increase their iron intake by eating iron-rich foods, such as meat and fish (if the patient is not vegan/vegetarian), poultry, leafy green vegetables, legumes, and iron-enriched grains.

When oral supplements and dietary changes are not sufficient to resolve iron deficiency or IDA, intravenous iron infusions can be an effective option. 

Dr. McLaughlin says, “Iron deficiency is a common condition that can have a significant impact on health and quality of life. IDA, while less common, is more serious, and requires prompt attention. The good news, however, is that both conditions are highly treatable, and correcting them can make a huge difference in people’s lives. The first steps are to have regular wellness visits with your primary care provider and – whether at those visits or when you first notice possible signs of an issue – to talk with your provider about your symptoms or concerns,” he adds.

Find Outstanding Care at RCCA

Drs. Dave and McLaughlin are among 100+ medical oncologists and hematologists who practice with RCCA at 26 locations across New Jersey, Connecticut, Massachusetts, Maryland, and the Washington, D.C., area. RCCA’s cancer specialists see more than 30,000 new patients each year and provide care to more than 265,000 established patients, collaborating closely with those patients’ other physicians. RCCA physicians offer patients innovative therapies, including immunotherapies and targeted therapy, as well as access to approximately 300 clinical trials. In addition to serving patients who have solid tumors, blood-based cancers, and benign blood disorders, RCCA care centers also provide infusion services to people with a number of non-oncologic conditions—including multiple sclerosis, Crohn’s disease, asthma, iron-deficiency anemia, and rheumatoid arthritis—who take intravenously-administered medications.

To learn more about Regional Cancer Care Associates, call 844-928-0089 or visit RCCA.com.

References 

1. Iron-deficiency anemia. American Society of Hematology.https://www.hematology.org/education/patients/anemia/iron-deficiency. Accessed January 17, 2025.

2. Gvirtzman R, Livovsky DM, Tahover E, Goldin E, Koslowsky B. Anemia can predict the prognosis of colorectal cancer in the pre-operative stage: a retrospective analysis. World J Surg Oncol. 2021;19(1):341.

3. Iron. National Institutes of Health, Office of Dietary Supplements.https://ods.od.nih.gov/factsheets/Iron-Consumer/. Updated August 17, 2023. Accessed January 17, 2025.

4. About iron deficiency and iron deficiency anemia. Injectafer.https://injectaferhcp.com/iron-deficiency-anemia-treatment/what-is-ida. Accessed January 17, 2025.

5. Williams AM, Ansai NA, Ahluwalia N, Nguyen DT. Anemia prevalence: United States, August 2021-August 2023. U.S. Centers for Disease Control and Prevention, National Center for Health Statistics.https://www.cdc.gov/nchs/products/databriefs/db519.htm. Updated December 4, 2024. Accessed January 17, 2025.

6. Tawfik YMK, Billingsley H, Bhatt AS. Absolute and functional iron deficiency in the US, 2017-2020. JAMA Netw Open. 2024;7(9):e2433126.

7. Iron deficiency anemia. Mayo Clinic.https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/symptoms-causes/syc-20355034. Published January 4, 2022. Accessed January 17, 2025.