Symptoms and Signs of Iron Deficiency in Adults
Adults with iron deficiency present with general manifestations of anemia (breathlessness, fatigue, heart failure) and specific iron deficiency features including angular stomatitis, glossitis, koilonychia (spoon nails), restless legs syndrome, pagophagia (ice craving), and blue sclerae. 1
General Anemia Manifestations
- Fatigue and exercise intolerance are the most common presenting symptoms, occurring across all severity levels of iron deficiency 2
- Breathlessness and dyspnea develop as hemoglobin levels decline 1, 2
- Lightheadedness may occur with more severe anemia 2
- Heart failure can be precipitated or worsened by iron deficiency anemia 1, 2
Specific Iron Deficiency Features
These manifestations are more specific to iron deficiency itself rather than anemia from other causes:
- Angular stomatitis (cracks at the corners of the mouth) 1
- Glossitis (inflamed, smooth tongue) 1
- Koilonychia (spoon-shaped nails with central depression) 1
- Restless legs syndrome affects 32-40% of patients with iron deficiency 1, 2
- Pagophagia (compulsive ice craving/chewing) occurs in 40-50% of cases 1, 2
- Blue sclerae (bluish discoloration of the whites of the eyes) 1
Neuropsychiatric Symptoms
- Irritability and mood changes are common 2
- Depression may develop with chronic iron deficiency 2
- Difficulty concentrating and impaired cognitive function 2
Physical Examination Findings
Physical examination is generally unremarkable in most cases, but specific findings may occasionally provide diagnostic clues 1:
- Signs of hereditary hemorrhagic telangiectasia (visible telangiectasias) may explain chronic blood loss 1
- Pallor of conjunctivae and mucous membranes (though this is a late and insensitive finding)
- The specific mucocutaneous changes described above (angular stomatitis, glossitis, koilonychia, blue sclerae) 1
Important Clinical Considerations
Many patients with iron deficiency are completely asymptomatic, particularly in early stages or when anemia develops gradually 2. Symptom prevalence varies significantly based on:
- Age of the patient 2
- Presence of comorbidities (chronic kidney disease, heart failure) 2
- Severity and rate of development of iron deficiency 2
The absence of symptoms does not exclude clinically significant iron deficiency, particularly in men and postmenopausal women where approximately one-third have underlying gastrointestinal pathology requiring investigation 1, 3.