Iron deficiency anemia

Iron deficiency anaemia happens when the body's iron stores aren't enough to produce sufficient hemoglobin, the protein in red blood cells that carries oxygen to tissues. Without enough hemoglobin, red blood cells become small and pale (microcytic, hypochromic), and oxygen delivery to organs and muscles suffers.

Iron deficiency progresses through stages before anaemia develops:

1. Depleted iron stores: Ferritin falls as bone marrow iron reserves are exhausted. No anaemia yet, but the body is drawing on reserves.

2. Iron-deficient erythropoiesis: Transferrin saturation falls and red blood cell production becomes iron-limited. Hemoglobin remains normal but begins to decline.

3. Iron deficiency anaemia: Hemoglobin falls below normal. Symptoms of anaemia start to show.

Catching iron deficiency at stage 1 or 2, before anaemia sets in, is one of the clearest benefits of a comprehensive blood panel.

Iron deficiency anaemia symptoms reflect reduced oxygen delivery to tissues. They develop gradually and are frequently attributed to lifestyle factors. Common signs include:

• Persistent fatigue and low energy disproportionate to activity level.

• Shortness of breath on exertion. The body compensates for reduced oxygen capacity by breathing faster.

• Heart palpitations. The heart works harder to maintain oxygen delivery.

• Pale skin, inner eyelids, or nail beds.

• Dizziness or lightheadedness, particularly on standing.

• Headaches from reduced cerebral oxygen delivery.

• Cold hands and feet.

• Brain fog, poor concentration, and reduced cognitive performance.

• Brittle nails, sometimes with characteristic spoon-shaped deformity (koilonychia).

• Hair thinning or increased shedding.

• Restless legs syndrome. A strong and frequently overlooked association with iron deficiency.

• Pica, unusual cravings for non-food substances such as ice, clay, or starch.

Iron deficiency anaemia always has an underlying cause. It is never simply a dietary problem in isolation. Identifying that cause is clinically essential. Common contributing causes include:

• Inadequate dietary intake: low intake of hem iron (red meat, fish, poultry) or poor absorption of non-hem iron (plant sources) from vegan or vegetarian diets.

• Chronic blood loss: the most common cause in adults, whether from heavy menstrual bleeding (the leading cause in premenopausal women), gastrointestinal bleeding (peptic ulcer, colorectal polyps or cancer, inflammatory bowel disease, coeliac disease), or urological bleeding.

• Malabsorption: coeliac disease, inflammatory bowel disease, and previous gastrointestinal surgery can all impair iron absorption in the upper small intestine.

• Increased demand: pregnancy, breastfeeding, and adolescent growth spurts increase iron requirements significantly.

• Chronic kidney disease: impairs erythropoietin production and iron utilisation.

• Chronic inflammation: inflammatory conditions can trap iron inside cells (anaemia of chronic disease), which can coexist with, or look like, true iron deficiency.

Iron deficiency anaemia is one of the more straightforward conditions to detect through blood testing. A comprehensive iron panel covers stores, transport, and how the body is using what it has.

Blood tests Elfcare's panel includes a comprehensive iron and hematology profile:

• Ferritin: The earliest marker of depletion. Low levels confirm deficiency even if hemoglobin is normal.

• Hemoglobin and hematocrit: Measures how severe the anaemia is and the blood's oxygen-carrying capacity.

• MCV and MCH: Assesses red blood cell size and content. Small, pale cells indicate iron deficiency.

• Serum iron and transferrin saturation: Measures how much iron is currently circulating and being transported.

• TIBC: Elevated levels show the body is working harder to bind and transport iron.

• Reticulocyte count: Measures bone marrow activity to help classify the type of anaemia.

• CRP: Identifies inflammation that could falsely raise ferritin and mask a deficiency.

• tTG-IgA: Screens for coeliac disease, a frequent cause of iron malabsorption.

• Vitamin B12 and folate: Identifies other nutritional deficiencies that can coexist with or mimic iron deficiency.

Why early detection matters

Iron deficiency anaemia identified at stage 1, before hemoglobin falls, can often be corrected with dietary changes or supplementations before symptoms develop. Anaemia identified at stage 3 requires more intensive treatment and a proper investigation into the underlying cause.

More importantly, iron deficiency anaemia in an adult (particularly in a man or post-menopausal woman) is a red flag for gastrointestinal bleeding until proven otherwise. In these groups, it should always prompt investigation for colorectal cancer, peptic ulcer, or other gastrointestinal disease. Catching the anaemia early is what starts that investigation, and it can be life-saving.

How Elfcare can help

Elfcare's blood panel covers the complete iron deficiency anaemia profile: ferritin, hemoglobin, MCV, serum iron, transferrin saturation, TIBC, and CRP, picking up iron deficiency at all three stages, including before anaemia develops. This is one of the more clear-cut cases in medicine: a single blood test gives a definitive answer.

Our panel also includes tTG-IgA, B12, folate, and CRP, which help identify the most common underlying causes alongside confirming the deficiency itself.

If our blood tests identify iron deficiency or anaemia, we take care of further testing or refer you to the right specialist.