In patients such as men, postmenopausal women, or younger women with severe anemia, the doctor may recommend additional testing. These tests may include the following:. Sometimes it is difficult to diagnose the cause of iron deficiency, or your doctor may be concerned that there is a problem other than iron deficiency causing the anemia.
These may include inherited blood disorders called thalassemiasin which red blood cells also appear small and pale, hemoglobinopathies such as sickle cell disease but not sickle cell trait alone , or other blood disorders. People with chronic infections or conditions such as kidney failure, autoimmune diseases, and inflammatory disorders may also have small red blood cells.
When the cause of the anemia is not clear, your doctor may refer you to a hematologist, a medical specialist in blood disorders,for consultation and further evaluation. Even if the cause of the iron deficiency can be identified and treated, it is still usually necessary to take medicinal iron more iron than a multivitamin can provide until the deficiency is corrected and the body's iron stores are replenished. In some cases, if the cause cannot be identified or corrected, the patient may have to receive supplemental iron on an ongoing basis.
The amount of iron needed to treat patients with iron deficiency is higher than the amount found in most daily multivitamin supplements.
The amount of iron prescribed by your doctor will be in milligrams mg of elemental iron. Most people with iron deficiency need mg per day of elemental iron 2 to 5 mg of iron per kilogram of body weight per day.
Ask your doctor how many milligrams of iron you should be taking per day. If you take vitamins, bring them to your doctor's visit to be sure. There is no evidence that any one type of iron salt, liquid, or pill is better than the others, and the amount of elemental iron varies with different preparations.
To be sure of the amount of iron in a product, check the packaging. 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 iron. Iron is absorbed in the small intestine duodenum and first part of the jejunum. This means that enteric-coated iron tablets may not work as well. If you take antacids, you should take iron tablets two hours before or four hours after the antacid.
Listen to your lungs for rapid or uneven breathing. Feel your abdomen to check the size of your liver and spleen. Blood tests. Based on results from blood tests to screen for iron-deficiency anemia, your doctor may order the following blood tests to diagnose iron-deficiency anemia: Complete blood count CBC to see if you have lower than normal red blood cell counts, hemoglobin or hematocrit levels, or mean corpuscular volume MCV that would suggest anemia.
Iron to measure the amount of iron in your blood. The level of iron in your blood may be normal even if the total amount of iron in your body is low.
For this reason, other iron tests are also done. Ferritin is a protein that helps store iron in your body. Reticulocyte count to see if you have lower than normal numbers of these very young red blood cells.
Peripheral smear to see if your red blood cells look smaller and paler than normal when viewed under a microscope. Different tests help your doctor diagnose iron-deficiency anemia. Normal levels are 40 to for men and 20 to for women.
More testing may be needed to rule out other types of anemia. Tests for gastrointestinal bleeding. Fecal occult blood test to check for blood in the stool. Blood in the stool would suggest bleeding in the GI tract and may require further testing.
Upper endoscopy to look for bleeding in the esophagus, stomach, and the first part of the small intestine. A tube with a tiny camera is inserted through your mouth down to your stomach and upper small intestine to view the lining of your upper digestive tract. Colonoscopy to look for bleeding or other abnormalities, such as growths or cancer of the lining of the colon. For this test, a small camera is inserted into the colon under sedation to view the colon directly.
What if my doctor thinks something else is causing my iron-deficiency anemia? To find the cause of your iron-deficiency anemia, your doctor may order additional tests: Inflammation marker tests may help your doctor determine if inflammation is causing iron-deficiency anemia.
Blood tests allow your doctor to look at the amount of other nutrients in your blood, such as vitamin B12 or folic acid. Visit our Pernicious Anemia Health Topic to learn more. Bone marrow tests help your doctor see whether your bone marrow is healthy and making new blood cells. Visit our Aplastic Anemia Health Topic to learn more. Return to Causes to review how blood loss, not consuming the recommended amount of iron, and medical conditions can lead to iron-deficiency anemia.
Return to Risk Factors to review family history, lifestyle, unhealthy environments, or other factors that increase your risk of developing iron-deficiency anemia. Return to Signs, Symptoms, and Complications to review common signs and symptoms of iron-deficiency anemia.
Return to Screening and Prevention to review tests to screen for and strategies to prevent iron-deficiency anemia. Treatment - Iron-Deficiency Anemia. Iron supplements. If iron supplements alone are not able to replenish the levels of iron in your body, your doctor may recommend a procedure, including: Iron therapy, or intravenous IV iron. This is sometimes used to deliver iron through a blood vessel to increase iron levels in the blood.
One benefit of IV iron is that it often takes only one or a few sessions to replenish the amount of iron in your body. People with severe iron-deficiency anemia or who have chronic conditions such as kidney disease or celiac disease may be more likely to receive IV iron. You may experience vomiting, headache, or other side effects right after the IV iron, but these usually go away within a day or two.
Red blood cell transfusions. These may be used for people with severe iron-deficiency anemia to quickly increase the amount of red blood cells and iron in the blood. Your doctor may recommend this if you have serious complications of iron-deficiency anemia, such as chest pain.
Surgery, upper endoscopy or colonoscopy, to stop bleeding. Healthy lifestyle changes. To help you meet your daily recommended iron levels, your doctor may recommend that you: Adopt healthy lifestyle changes such as heart-healthy eating patterns. Increase your daily intake of iron-rich foods to help treat your iron-deficiency anemia. See Prevention strategies to learn about foods that are high in iron. It is important to know that increasing your intake of iron may not be enough to replace the iron your body normally stores but has used up.
Increase your intake of vitamin C to help your body absorb iron. Avoid drinking black tea, which reduces iron absorption. Other treatments. Living With will discuss what your doctor may recommend, including lifelong lifestyle changes and medical care to prevent your condition from recurring, getting worse, or causing complications.
Research for Your Health will discuss how we are using current research and advancing research to treat people with iron-deficiency anemia. Participate in NHLBI Clinical Trials will highlight our ongoing clinical studies that are investigating treatments for iron-deficiency anemia. Living With - Iron-Deficiency Anemia. Follow your treatment plan. Monitor your condition. Your doctor may: Ask about your signs and symptoms , including whether you have any new or worsening symptoms.
Repeat blood tests , such as complete blood count and iron studies. Prevent complications over your lifetime. Learn the warning signs of serious complications and have a plan. Learn about other precautions to help you stay safe. Return to Treatment to review possible treatment options for iron-deficiency anemia. Return to Signs, Symptoms, and Complications to review signs and symptoms as well as complications from iron-deficiency anemia.
Research for Your Health. Improving health with current research. Recipient Epidemiology Donor Studies program findings help to protect blood donors. This is the largest study to have looked at iron levels in blood donors. Results from the REDS program have led to other research and newer recommendations to increase the length of time between donations to protect blood donors.
Cardiovascular Health Study identifies predictors of future health problems in older adults. This was associated with a greater risk of death even with mild anemia. Now, anemia in older adults is recognized as an important condition.
Parenteral therapy may be used in patients who cannot tolerate or absorb oral preparations. Iron deficiency anemia is diminished red blood cell production due to low iron stores in the body. It is the most common nutritional disorder worldwide and accounts for approximately one-half of anemia cases. Enlarge Print. Measurement of the serum ferritin level is the most accurate test to diagnose iron deficiency anemia.
All adult men and postmenopausal women with iron deficiency anemia should be screened for gastrointestinal malignancy. Screening serology for celiac disease should be considered for all adults with iron deficiency anemia. Diagnosis of iron deficiency anemia requires laboratory-confirmed evidence of anemia, as well as evidence of low iron stores. Adapted with permission from Van Vranken M.
Evaluation of microcytosis. Am Fam Physician. A complete blood count can be helpful to determine the mean corpuscular volume or red blood cell size. Although iron deficiency is the most common cause of microcytic anemia, up to 40 percent of patients with iron deficiency anemia will have normocytic erythrocytes.
The following diagnostic approach is recommended in patients with anemia and is outlined in Figure 1. Ferritin reflects iron stores and is the most accurate test to diagnose iron deficiency anemia. In patients with chronic inflammation, iron deficiency anemia is likely when the ferritin level is less than 50 ng per mL Information from references 2 , and 6 through In patients with no inflammatory states and in whom the ferritin level is indeterminate 31 to 99 ng per mL [ Values consistent with iron deficiency include a low serum iron level, low transferrin saturation, and a high total iron-binding capacity.
Soluble transferrin receptor and erythrocyte protoporphyrin testing, or bone marrow biopsy can be considered if the diagnosis remains unclear. Asymptomatic men and postmenopausal women should not be screened for iron deficiency anemia. Testing should be performed in patients with signs and symptoms of anemia, and a complete evaluation should be performed if iron deficiency is confirmed.
Preventive Services Task Force, and Centers for Disease Control and Prevention recommend routine screening of asymptomatic pregnant women for iron deficiency anemia.
The American Academy of Pediatrics recommends universal hemoglobin screening and evaluation of risk factors for iron deficiency anemia in all children at one year of age. Preventive Services Task Force found insufficient evidence for screening in asymptomatic children six to 12 months of age and does not make recommendations for other ages.
Once iron deficiency anemia is identified, the goal is to determine the underlying etiology. Causes include inadequate iron intake, decreased iron absorption, increased iron demand, and increased iron loss Table 2. Information from references 5 , 7 , 18 , and Premenopausal women with a negative evaluation for abnormal uterine bleeding can be given a trial of iron therapy.
In children and pregnant women, iron therapy should be tried initially. Current guidelines recommend empiric treatment in children up to two years of age and in pregnant women with iron deficiency anemia; however, if the hemoglobin level does not increase by 1 g per dL 10 g per L after one month of therapy in children or does not improve in pregnant women, further evaluation may be indicated. The evaluation should begin with a thorough history and physical examination to help identify the cause of iron deficiency.
The history should focus on potential etiologies and may include questions about diet, gastrointestinal GI symptoms, history of pica or pagophagia i. Patients with iron deficiency anemia are often asymptomatic and have limited findings on examination. Further evaluation should be based on risk factors Figure 2. Information from references 10 , 15 , and 17 through Excessive menstruation is a common cause of iron deficiency anemia in premenopausal women in developed countries; however, a GI source particularly erosive lesions in the stomach or esophagus is present in 6 to 30 percent of cases.
Excessive or irregular menstrual bleeding affects 9 to 14 percent of all women and can lead to varying degrees of iron deficiency anemia. Initial evaluation includes a history, physical examination, and pregnancy and thyroid-stimulating hormone tests. An endometrial biopsy should be considered in women 35 years and younger who have conditions that could lead to unopposed estrogen exposure, in women older than 35 years who have suspected anovulatory bleeding, and in women with abnormal uterine bleeding that does not respond to medical therapy.
In men and postmenopausal women, GI sources of bleeding should be excluded. Current recommendations support upper and lower endoscopy; however, there are no clear guidelines about which procedure should be performed first or if the second procedure is necessary if a source is found on the first study.
In patients in whom endoscopy may be contraindicated because of procedural risk, radiographic imaging may offer sufficient screening.
The sensitivity of computed tomographic colonography for lesions larger than 1 cm is greater than 90 percent. If initial endoscopy findings are negative and patients with iron deficiency anemia do not respond to iron therapy, repeat upper and lower endoscopy may be justified. In some instances, lesions may not be detected on initial examination e. Additional evaluation of the small intestine is not necessary unless there is inadequate response to iron therapy, the patient is transfusion dependent, or fecal occult blood testing suggests that the patient has had obscure GI bleeding with the source undiscovered on initial or repeat endoscopy.
This protein helps store iron in your body, and a low level of ferritin usually indicates a low level of stored iron. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Kaushansky K, et al. Iron deficiency and overload. In: Williams Hematology. New York, N.
Accessed Oct. Schrier SL, et al. Treatment of iron deficiency anemia in adults. Iron-deficiency anemia. American Society of Hematology. Vitamin C: Fact sheet for health professionals. What is iron-deficiency anemia? National Heart, Lung, and Blood Institute. Approach to the adult patient with anemia.
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