Treating anemia from iron deficiency

Anemia is the most prevalent blood disorder in the United States, affecting about 3 million Americans. Iron deficiency anemia is the most common type of anemia, and if left unchecked, it can cause a number of health issues. The good news is that in most cases iron deficiency anemia is treatable.

Anemia is defined as the lack of healthy red blood cells, and in the case of iron deficiency anemia, it’s caused by not having enough iron. A lack of iron prevents your body from making hemoglobin, the protein that allows your red blood cells to carry oxygen to the other cells in your body.

Yes, iron deficiency anemia always needs to be treated. The first task is to find out the underlying cause, which a healthcare provider can determine and treat.

Our bodies usually get iron through our diets. Eating more iron-rich foods is often a part of treating iron deficiency anemia. There are two different types of iron found in food: heme and nonheme iron. Heme iron is more easily absorbed in the body and is found in the following foods:

• Meat, such as beef, lamb, pork, dried beef, veal and ham
• Shellfish, such as shrimp, scallops, clams and oysters
• Poultry (chicken and turkey)
• Liver and liverwurst

Sources of nonheme iron include:

• Eggs
• Vegetables, such as spinach, sweet potatoes, peas, broccoli and string beans
• Breads and cereals
• Fruits, such as strawberries, raisins, dates, figs, prunes, dried apricots and watermelon
• Tofu
• Beans, such as kidney beans, chickpeas and white beans
• Tomato products, such as tomato paste

The underlying cause of the anemia needs to be treated, and that treatment will vary, depending on the cause and severity of anemia.

However, if you simply need more iron and cannot get enough through your diet, your healthcare provider may recommend iron supplementation. Don’t take an iron supplement without talking to your provider first. Excess iron can harm your liver and lead to complications.

Ask your provider about the dosage you need. It may depend on the severity of the anemia. Remember these tips when taking oral iron supplements:

• Try to take iron on an empty stomach. However, iron can upset your stomach, so you may need to take it with a meal.
• Don’t take iron with an antacid. Heartburn relief medications can interfere with iron absorption. Take iron two hours before or four hours after taking an antacid.
• Take iron with vitamin C. This vitamin helps iron absorption, so take iron with some orange juice, grapefruit, melon, broccoli, leafy greens or other foods or beverages that contain vitamin C.
• Iron can cause constipation, so your healthcare provider may recommend or prescribe a stool softener. Note that iron may turn stools black. Don’t worry if this harmless side effect occurs.
• It takes time to resolve iron deficiency anemia. Your treatment might extend for months to a year or more.

Some people don’t tolerate oral iron supplementation or can’t take oral iron due to surgery on their stomach or small intestine. In these cases, iron is given in other ways. You may receive an intravenous (IV) infusion of iron or iron shots in the buttocks.

Some symptoms of iron deficiency anemia may include:

• Fatigue or tiredness
• Shortness of breath or chest pain
• Weakness
• Pale skin
• Headache, dizziness or lightheadedness
• Fast heart rate
• Cold hands or feet
• Brittle nails
• Tongue inflammation or soreness
• Poor appetite, especially in infants and children
• Pica (the abnormal craving and eating of nonfood substances, such as ice or dirt)

To diagnose iron deficiency anemia, your healthcare provider will likely do blood tests.

Low iron is usually due to either not consuming enough iron or losing iron stores from blood loss. Reasons for needing more iron include:

• Not enough iron in your diet. Not consuming enough iron over time can lead to an iron deficiency. Infants and children also need iron to grow and develop.
• Inability to absorb iron: Some conditions, such as celiac disease or a shortening of the small intestine from surgery, can interfere with the absorption of iron.
• Pregnancy: Iron needs increase during pregnancy, so your usual intake of iron may not be sufficient.

Some reasons for blood loss include:

• Heavy menstrual periods
• Slow, chronic blood loss from conditions such as a peptic ulcer or colorectal cancer
• Gastrointestinal bleeding from frequent, regular use of some over-the-counter pain relievers, such as aspirin

Iron deficiency anemia is very common and should be treated. If you feel you may have low iron, see your healthcare provider so they can test you for iron deficiency anemia.

Clinically reviewed and updated by Julie McDaniel, MSN, RN, CRNI September 2023.