Obesity and Bariatric Surgery

Iron-Deficiency Anemia

What is iron-deficiency anemia?

The most common cause of anemia is a lack of iron. This is called iron deficiency. Iron is needed to make hemoglobin. Hemoglobin is the part of red blood cells that carries oxygen to the body. Most of your body’s iron is stored in hemoglobin.

What causes iron-deficiency anemia?

Iron-deficiency anemia may be caused by the following:

A diet low in iron. You get iron from foods you eat. But only 1 mg of iron is absorbed for every 10 mg to 20 mg of iron you take in. If you have a poor diet, you may have some level of iron-deficiency anemia.
Body changes. Your body needs more iron and more red blood cells when it’s going through certain changes. These changes include growth spurts, pregnancy, and lactation.
GI (gastrointestinal) tract problems. Your body can’t absorb iron well after some forms of GI surgery. Most of the iron taken in by foods is absorbed in the upper small intestine. Any problems in the GI tract could affect how well you absorb iron. Surgery or medicines that stop stomach acid production will also decrease how much iron you absorb.
Blood loss. Loss of blood can cause a decrease of iron. Sources of blood loss may include GI bleeding, urinary tract bleeding, menstrual bleeding, or injury.

Who is at risk for iron-deficiency anemia?

People who have a greater need for iron are at risk for this condition. This includes:

Babies, young children, and teens because of their rapid growth
Teen girls and women of childbearing age because of their periods
Pregnant women
Anyone with blood loss
People with kidney failure
People who have had gastric-bypass surgery because they absorb less iron
People with celiac disease

What are the symptoms of iron-deficiency anemia?

Each person’s symptoms will vary. Symptoms may include:

Paleness or lack of skin color
Irritability
Lack of energy or tiring easily (fatigue)
Increased heart rate (tachycardia)
Sore or swollen tongue
Wanting to eat nonfood things, such as dirt or ice (a condition called pica)
Feeling dizzy
Headaches

The symptoms of iron-deficiency anemia may look like other blood conditions or health problems. Always see your healthcare provider for a diagnosis.

How is iron-deficiency anemia diagnosed?

Your healthcare provider may think you have iron-deficiency anemia based on your symptoms and a complete health history and physical exam. This condition is often found through a blood test that measures the amount of hemoglobin present, and the amount of iron in your blood. Other tests may include:

Additional blood tests. These are done to test for iron.
Bone marrow aspiration or biopsy. A small amount of bone marrow fluid (aspiration) or solid bone marrow tissue (called a core biopsy) are taken. These are often taken from the hip bones. The sample is checked for the number, size, and maturity of blood cells or abnormal cells. A bone marrow biopsy is not often needed to make a diagnosis of iron deficiency. Blood tests are often enough.
Upper or lower endoscopy. These tests may help rule out a source of blood loss. An upper GI evaluates the upper GI tract for celiac disease.

How is iron-deficiency anemia treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment may include the following.

Iron-rich diet

Eating a diet with iron-rich foods can help. Good sources of iron include:

Meats, such as beef, pork, lamb, liver, and other organ meats
Poultry, such as chicken, duck, turkey (especially dark meat), and liver
Fish, such as shellfish, including clams, mussels, oysters, sardines, and anchovies
Leafy greens of the cabbage family, such as broccoli, kale, turnip greens, and collards
Legumes, such as lima beans and green peas
Dry beans and peas, such as pinto beans, black-eyed peas, and canned baked beans
Yeast-leavened, whole-wheat bread and rolls
Iron-enriched white bread, pasta, rice, and cereals

Iron supplements

Iron supplements are taken by mouth (orally). They can be taken over a few months to raise iron levels in your blood. These supplements can cause an upset stomach and discolor bowel movements. Take them on an empty stomach or with orange juice. This can help increase how much iron is absorbed. Supplements work much better than dietary changes alone.

You can also get iron by IV if supplements don't give you enough iron or you can't tolerate taking them by mouth.

Checking for a source of blood loss

This may include having an upper endoscopy or colonoscopy.

Can iron-deficiency anemia be prevented?

The best way to prevent iron-deficiency anemia is to eat a well-balanced diet that includes iron-rich foods. Talk with your healthcare provider about taking an iron supplement if you or your child:

Can’t eat an iron-rich diet
Have heavy monthly periods
Have other risk factors

Living with iron-deficiency anemia

Iron-deficiency may be short-term (temporary). But if you have heavy monthly periods or other risk factors, you may need to address this all your life. Eat a well-balanced diet that includes iron-rich foods. Also talk with your healthcare provider about taking an iron supplement. Be sure to address any underlying blood loss or condition that may cause your anemia.

Key points about iron-deficiency anemia

Iron-deficiency anemia is the most common cause of anemia. It's due to a low level of iron in the blood.
Causes include a diet that is low in iron, body changes, problems in the GI tract, and blood loss.
Those most at risk include children and teens, women of childbearing age, and people with kidney failure.
Common symptoms include fatigue, paleness, irritability, and fast heart rate.
Treatment includes eating iron-rich foods, taking an iron supplement or an iron infusion, and finding out if there is underlying blood loss.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your healthcare provider if you have questions.