What are the symptoms and treatment for iron deficiency anemia?

Understanding Your Iron Deficiency

You have iron deficiency, which means your body doesn't have enough iron to make healthy red blood cells that carry oxygen throughout your body—this causes fatigue, weakness, and other symptoms that will improve with iron replacement therapy. 1

What Symptoms You May Experience

Iron deficiency causes symptoms because your blood cannot carry enough oxygen to your tissues, and these symptoms often worsen as the day progresses because daily activities deplete your limited oxygen reserves 2:

Common Symptoms Include:

• Fatigue and exhaustion that gets worse throughout the day 3, 1
• Shortness of breath and difficulty exercising 1, 4
• Difficulty concentrating and irritability 1, 4
• Lightheadedness and feeling weak 1
• Restless legs syndrome (affects 32-40% of people with iron deficiency) 1
• Unusual cravings, especially for ice (called pagophagia, affects 40-50% of patients) 3, 1

Less Common but Important Signs:

• Cracks at the corners of your mouth (angular stomatitis) 3
• Sore or smooth tongue (glossitis) 3
• Brittle, spoon-shaped nails (koilonychia) 3
• Pale skin or blue-tinged whites of eyes 3

Why Iron Replacement Is Critical

Iron repletion is essential to improve your quality of life and decrease the risk of serious complications related to anemia 3:

Immediate Benefits:

• Restores oxygen delivery to all your organs and tissues 2, 1
• Improves energy levels and reduces fatigue 1, 4
• Enhances mental function, concentration, and mood 1
• Prevents worsening of heart problems if you have underlying heart conditions 1

Long-Term Health Protection:

• Prevents developmental delays and learning problems (especially important in children) 5, 4
• Maintains immune function and resistance to infections 5
• Avoids complications like heart failure that can occur with severe, untreated anemia 4

Your Treatment Plan

Oral Iron Therapy (First-Line Treatment):

Most patients start with oral iron supplements, typically ferrous sulfate 325 mg daily or every other day 3, 1:

• Expected improvement: Your hemoglobin should rise by approximately 2 g/dL after 3-4 weeks of proper therapy 2
• Duration: Continue treatment for 3 months after your anemia is corrected to fully replenish your iron stores 2
• Target: Ferritin levels should reach up to 400 μg/L to prevent recurrence 2

Common Side Effects and How to Manage Them:

Oral iron frequently causes gastrointestinal side effects 3, 6:

• Nausea, abdominal pain, and constipation are common 3
• Take with meals to minimize stomach upset 6
• Black stools are normal and not concerning 6
• Lower the dose if side effects are intolerable 7

When Intravenous (IV) Iron Is Needed:

IV iron should be used if you cannot tolerate oral iron, have absorption problems, or have certain medical conditions 3, 1:

• Inflammatory bowel disease with active inflammation 3
• Celiac disease not responding to oral iron 3
• Ongoing bleeding that doesn't respond to oral therapy 3
• Chronic kidney disease, heart failure, or cancer 1
• Pregnancy (second and third trimesters) 1
• Previous bariatric surgery affecting absorption 1

Important Safety Information

Critical Warnings:

• Keep iron supplements away from children under 6—accidental overdose is a leading cause of fatal poisoning in young children 6
• Do not take iron within 2 hours of tetracycline antibiotics, as they interfere with each other's absorption 6
• Do not exceed recommended dosage 6

When to Seek Further Evaluation:

Your doctor needs to find and treat the underlying cause of your iron deficiency 3, 5:

• Men and postmenopausal women should undergo gastrointestinal evaluation (gastroscopy and colonoscopy) to look for sources of bleeding, including cancer 3, 5
• Premenopausal women under 40 typically don't need endoscopy unless there are concerning symptoms 7
• All patients should be screened for celiac disease, which affects 3-5% of people with iron deficiency anemia 3

Why Symptoms May Persist Initially

Even with treatment, you may still feel tired because your hemoglobin levels take time to normalize, and your body's oxygen reserves remain limited until iron stores are fully replenished 2:

• Morning energy may be better after overnight rest, but exhaustion worsens throughout the day as activities deplete available oxygen 2
• Oral iron absorption is limited, making full recovery a slow process that requires months of consistent therapy 2
• Do not stop treatment early—this is the most common mistake that leads to recurrence 2