Symptoms of Iron Deficiency Anemia

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Iron deficiency anemia (IDA) occurs when the body lacks the right amount of iron to produce enough healthy red blood cells to carry oxygen to the body’s tissues. While there are different types of anemia, IDA is the most common worldwide, affecting over 1.2 billion people.

People with IDA that is mild or moderate may not experience symptoms. More severe cases of iron deficiency will cause chronic fatigue, shortness of breath, or chest pain.

IDA needs to be addressed and treated. Left untreated, it can lead to depression, heart problems, increased infection risk, developmental delays in children, and pregnancy complications.

Keep reading to learn about the symptoms and complications of IDA and when to see a doctor.

Symptoms of anemia

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Common Symptoms

Signs and symptoms of IDA depend on a variety of factors, including severity, how fast the condition develops, your age, and your health.

Some people with iron deficiency anemia may experience no symptoms, while others will experience some of the more common symptoms of the condition. These symptoms include extreme fatigue, shortness of breath, heart palpitations, pale skin, headaches, and cold hands and feet.

Extreme Fatigue

Fatigue is one of the most common symptoms of IDA. It occurs when your body is unable to deliver enough oxygen to its cells, causing you to lack energy and feel tired.

The type of fatigue associated with IDA causes people to feel sluggish, weak, and unable to focus. While fatigue is a symptom associated with many different conditions, anytime you experience severe fatigue that doesn’t go away with adequate rest, you should reach out to your doctor to determine the source.

Shortness of Breath

For most healthy people, abundant oxygen makes its way to their heart, muscles, and organs. However, with anemia, your lungs need to compensate for all that reduced oxygen, which can lead to breathing problems, particularly shortness of breath.

According to the American Lung Association, shortness of breath is described as a “frightening sensation of being unable to breathe normally” or the feeling that you are being suffocated. Shortness of breath, medically called dyspnea, can leave you struggling to take a full, deep breath as if you are not getting enough air into your lungs.

Symptoms you might experience with shortness of breath include:

  • A tight feeling in your chest
  • The need to breathe more or much quicker
  • Feeling like your body can’t seem to get enough oxygen quickly enough

With anemia, shortness of breath may come on gradually over time, or it can happen suddenly and out of the blue. You may even experience it when you are resting or sitting down.

Heart Palpitations

Heart palpitations can be described as having a fast-beating, fluttering, or pounding heart. Heart palpitations are usually triggered by a medical condition, like anemia. Other causes include stress, medications, and exercise. In rare cases, heart palpitations are a symptom of a heart condition that requires treatment.

With anemia, heart palpitations are a sign your body is trying to compensate for a lack of oxygen. The body is circulating blood faster to make use of the little hemoglobin that is available. Hemoglobin is the iron-containing protein in red blood cells that carries oxygen from the lungs to all the body's organs and tissues.

An ongoing rapid heart rate is not good for the heart or the body. Having low levels of oxygen makes the heart work extra hard, putting a lot of pressure on the heart and causing it to beat faster.

Pale Skin

Pale skin in people with anemia is the result of a lack of red blood cells and a lack of hemoglobin in the red blood cells. When the number of red blood cells becomes severely low, there are not enough cells to reach the skin’s surface.

With the red blood cell count being so limited, the body compensates by funneling more blood to the vital organs and depriving other parts, including the skin. As a result, the skin may appear pale, gray, or ash colored.

Headaches

IDA may cause the brain to get less oxygen than it needs to function. As a result, blood vessels in the brain might swell, causing pressure and headaches. These headaches might be accompanied by light-headedness and dizziness.

IDA may also contribute to migraine headaches—recurrent throbbing headaches that usually affect one side of the head and can be accompanied by nausea and vision changes.

A 2019 study looked into the connection between IDA and the incidence of migraine. Researchers focused on a link between IDA, hemoglobin, blood iron levels, and migraine in females.

The researchers concluded that there is an association between IDA and the incidence of migraines in females and that iron supplementation could be an effective treatment in people who experience migraines related to this type of anemia.

Cold Hands and Feet

Cold hands and feet could mean IDA. This type of anemia causes poor blood circulation throughout the body from the lack of red blood cells and the reduced oxygen to body tissues. The lack of oxygen will adjust sensations of hot and cold throughout the body.

Rare Symptoms

There are other signs your iron is low. These are less common and might include tinnitus (ringing in the ears), restless legs syndrome, dry and damaged skin and hair, swelling and soreness of the tongue and mouth, pica (craving and eating nonfood items), and changes in fingernails.

Tinnitus

Tinnitus can be described as hearing ringing, buzzing, or hissing noises from the inner ear. When someone has anemia, increased blood flow to the heart causes it to work harder to pump blood between the heart and the brain. To do this, blood will flow through the middle ear, resulting in ringing and other sounds.

Restless Legs Syndrome

Restless legs syndrome (RLS) is characterized by a feeling of pins and needles in the legs and feet and an uncontrollable urge to move the legs, especially at night. Some studies have shown that RLS affects up to 40% of people with IDA.

Dry and Damaged Skin and Hair

Having dry, damaged skin and hair could indicate IDA. Because iron deficiency lowers hemoglobin in the blood, it can reduce the cells that promote hair growth and skin regeneration. The oxygen depletion also causes hair and skin to become dry and weak. 

Swelling and Soreness of the Tongue and Mouth

Your doctor might become suspicious that you have iron deficiency simply by looking inside and around your mouth. IDA can cause your tongue to become swollen, inflamed, and pale. It may also cause the skin around your mouth to be dry or cracked. You might also experience a burning feeling in the mouth or mouth ulcers.

Pica

Anemia is associated with a symptom called pica, an intense craving for eating nonfood and nonnutritive items, such as dirt, ice, and paper. Researchers think pica may be one way the body tries to make up for a lack of nutrients, including iron.

Brittle and Spoon-Shaped Nails

A condition called koilonychia, in which fingernails appear brittle or spoon shaped, can occur with IDA. Koilonychia affects around 5% of people with IDA.

The first sign of koilonychia is brittle nails that chip and crack very easily. As IDA becomes worse, the nails will start to appear spoon shaped, with a dip in the middle part of the nail and edges that are raised and rounded like a spoon.

Complications

For most people, the outlook for IDA is good with proper treatment. But left untreated, iron deficiency anemia can cause serious complications. Your risk for serious IDA complications can be reduced by following the treatment plan your doctor prescribes for you.

Complications associated with IDA include the following:

Frequent Infections

Research has found that IDA can affect the immune system. This increases the body’s risk for infection.

The types of infections associated with anemia are chronic (long term) and may include bacterial infections associated with severe sepsis, a life-threatening complication of infection.

Heart Problems

IDA can cause a rapid or irregular heartbeat. The lack of hemoglobin-carrying red blood cells causes the heart to work harder to move oxygen-rich blood throughout the body.

When the heart has to work harder, many different conditions can result, including a heart murmur, an enlarged heart, or heart failure. Untreated anemia can also worsen underlying heart problems.

Growth Problems in Children

For infants and children, iron deficiency can lead to delayed growth and developmental problems. IDA in childhood can affect the ability to gain weight and can lead to impaired behavior, cognition, and psychomotor skills.

Pregnancy Complications

In pregnant people, severe IDA can lead to premature births and low birth weight babies. Pregnancy complications associated with IDA are preventable by taking iron supplements as a routine part of prenatal care.

Depression

In addition to the physical symptoms, IDA can increase your risk for depression, anxiety, and other mental health disorders. A large study reported in 2020 in the journal BMC Psychiatry found people with IDA had higher incidences and an increased risk for anxiety, depression, sleep disorders, and psychotic disorders.

When to See a Doctor

Make an appointment with your doctor if you think you have symptoms of IDA. It is never a good idea to diagnose or treat anemia on your own. Overloading with iron can be dangerous because too much iron or iron toxicity can damage the liver and cause other problems.

If your doctor suspects you have anemia, you may undergo tests to check for several properties in your blood.

Blood work might include:

  • Complete blood count (CDC) to evaluate red blood cell size and color: With IDA, red blood cells are smaller and paler in color.
  • Hematocrit testing to check the percentage of blood volume: According to the American Red Cross, normal levels of hematocrit for men are 41%–51%, while normal levels for women are 36%–48%.
  • Hemoglobin testing to check levels of hemoglobin: Low hemoglobin indicates anemia. Normal hemoglobin ranges in grams per deciliter (g/dL) for men are 13.5 g/dL–17.5 g/dL and for women are 12.0 g/dL–15.5 g/dL.
  • Ferritin level testing to evaluate levels of this blood protein: Low quantities of ferritin indicate low levels of stored iron.

Your doctor may order additional testing to determine an underlying cause of the iron deficiency. Additional testing is usually considered if treatment with iron supplementation has not been helpful.

Summary

Iron deficiency anemia reduces the capacity to get oxygen to the tissues of the body. Common symptoms include shortness of breath, fatigue, pale skin, headaches, heart palpitations, and cold hands and feet.

Because untreated iron deficiency anemia can lead to complications, it's best to see your doctor if you suspect you have IDA. Self-treatment is not recommended since taking in too much iron can result in iron toxicity.

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19 Sources
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