Michael Auerbach, MD
Michael Auerbach, MD a clinical professor of medicine at Georgetown University School of Medicine, Washington, D.C., and a hematologist/oncologist at Auerbach Hematology and Oncology Associates.
There are many kinds of anemia. Some are rare genetic conditions. Others are caused by vitamin deficiencies, cancers that affect the bone marrow, or chronic conditions, such as kidney disease. The most common kind, however, is caused by iron deficiency. Iron-deficiency anemia is serious business. Whether it’s discovered because of routine blood tests or because you go to your doctor feeling unwell, it’s important to find out exactly what’s causing it.
When you see your doctor for a checkup or an illness, you often get blood tests that are part of what’s called a complete blood count (CBC). Anemia is diagnosed when these tests show low levels of red blood cells, abnormal red blood cells, or low levels of hemoglobin, a molecule that contains iron and carries oxygen to all the tissues in your body.
Your doctor may suspect you have iron-deficiency anemia, rather than some rarer condition, based on your blood counts and medical history.
You might have no symptoms, but if you do, they could include tiredness, shortness of breath, brittle nails, or a sore tongue. Iron deficiency is also associated with cravings for chewing on ice (called pagophagia) or dirt (a condition known as pica). Scientists don’t yet know why.
Every case of iron deficiency needs to be explained because the possible underlying causes include some serious conditions. These causes fall into three main categories: blood loss, low iron intake, and poor iron absorption owing to conditions such as kidney disease, inflammatory bowel disease, and the after-effects of weight-loss surgery. Blood loss is the most common cause, followed by poor absorption. If there is no obvious cause, expect more tests. These could include a colonoscopy or an upper endoscopy to detect bleeding and pick up cancers, ulcers, and other problems that cause bleeding. You also might get blood tests to check for conditions such as celiac disease and infection with Helicobacter pylori, a bacterium that causes stomach ulcers.
Once you have iron deficiency, you can’t reverse it by dietary changes alone: You need much higher doses than food can provide. Most people will be prescribed oral iron supplements. These pills are safe, inexpensive, and effective, but they do come with side effects, such as metallic taste, nausea, constipation, and vomiting, which bother some people enough that they stop taking their pills. (See the sidebar.)
If you can’t tolerate the side effects of iron supplements or have a condition that limits the absorption of iron by your digestive tract, you should be offered intravenous iron supplementation. To get this treatment, you go to a doctors’ office or hospital, where an iron solution is infused into a vein. One or two treatments usually restore iron levels, making this an excellent option for people with persistent iron deficiency or supplement intolerance.
Older versions of intravenous iron carried a higher risk of a severe allergic reaction than today’s versions, which cause minor reactions in fewer than 1 percent of patients. Most of the time, the reactions cause passing side effects, such as flushing and back pain, during the infusion. Some people may need a steroid to lower risks before the infusion.
Don’t take an iron supplement without checking with your health-care provider. People who don’t need the extra iron could end up with excess iron, which can cause health problems.
