Iron deficiency: why finding the cause matters

Your blood test has shown that your iron is low. Many people ask, “So should I take iron tablets to fix it?” The short answer is: not before a doctor has looked into the cause. This article explains why.

What does iron deficiency do?

Iron is part of hemoglobin, the protein that carries oxygen around the body in the red blood cell. When iron is low, fewer healthy red cells are made and anemia follows. Common symptoms: tiredness, shortness of breath, a racing heart, paleness and headache. Some people also have hair loss, a change in taste, a sore tongue, nail changes or a craving to eat things that are not food. If left untreated, the risk of infection and of heart and lung problems goes up.

Where does the iron go?

The main reasons are these:

• Blood loss. It is the most important cause. Heavy periods, slow bleeding from the stomach or bowel (for example with a stomach ulcer, bowel inflammation, hemorrhoids, the use of some painkillers and, less commonly, cancer), or any other bleeding.
• Pregnancy, because the need for iron rises and food is sometimes not enough.
• Diet and absorption. Food low in iron, or trouble absorbing it. Large amounts of tea, coffee, milk and dairy reduce iron absorption.

Why aren’t iron tablets enough?

Because if the cause of the shortage is bleeding and it is not found, you take iron but it is still being lost. This is why the doctor first finds the cause and then suggests treatment.

The doctor usually does these things:

• Asks questions: about periods, diet, pregnancy, medicines (including painkillers that irritate the stomach) and digestive symptoms.
• Orders tests: a complete blood count (CBC) and usually iron tests, including ferritin, which shows the body’s iron store.
• Suggests a digestive check, in some people. In men and in women who no longer have periods, because digestive bleeding is an important cause, an endoscopy and colonoscopy are usually needed to rule out a digestive problem, including cancer. This does not mean cancer is present; it means the cause is being followed seriously. In some cases a test for hidden blood in the stool or a referral to a specialist is also suggested.

How is it treated?

After the cause is found, treatment usually includes dealing with the cause of the bleeding or shortage and restoring the body’s iron. If your iron is low, the doctor may prescribe iron tablets. Only the doctor decides the amount and how long. Safety points:

• Iron tablets may cause constipation or diarrhea, stomach pain, heartburn, nausea and dark stools. Taking them with or after food is said to help. If side effects bother you, check with the doctor; do not stop on your own.
• Too much iron is harmful. Do not take more than the prescribed amount. Taking too much iron, especially for children, can be dangerous and even fatal. Keep the tablets out of children’s reach.
• Do not start or stop without the doctor’s advice.

Diet helps, but it is not everything

Most people get enough iron from a varied diet. Sources of iron: red meat (in moderation), leafy green vegetables, legumes, nuts, dried fruits such as dried apricots, and fortified grains. Do not drink a lot of tea and coffee with the main meal. If eating these foods is hard for you, a dietitian can help. Once iron deficiency is confirmed, diet alone is not always enough.

Follow-up

The doctor may ask for the tests again a few months later to see whether iron and hemoglobin have risen. Take the second test seriously.

When to see a doctor

• Tiredness, paleness or shortness of breath that continues
• Black or bloody stools, or unusual bleeding from anywhere in the body
• 115 (Iran’s emergency number): sudden shortness of breath, chest pain or fainting

Every patient’s treatment plan is different; ask your doctor about your own situation.