Iron deficiency anaemia

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Deficiency in iron stores sufficient to impair erythropoiesis, leading to anaemia. It occurs when there is reduced intake, abnormal metabolism, or more commonly increased losses.

Characteristically, a full blood count will show a microcytic anaemia. A blood film may show hypochromic red blood corpuscles. Haematinics will show low serum iron, low ferritin and raised total iron binding capacity (TIBC).

It is often caused by chronic, insidious losses rather than acute, large volume bleeds. Common sites including the upper and lower GI tracts.


Symptoms and signs iron deficiency

There is evidence that iron deficiency produces symptoms independent of those due to haematologically demonstrated anaemia. Iron loss due to bleeding will present more often with anaemia and its symptoms, but any cause of chronic iron deficiency including blood loss might present with the symptoms that can be independent of demonstrable anaemia. Tissues with high cell turn over such as the skin and mucosa will be affected by subacute or chronic iron deficiency. Some of the associations are complex with for example equivocal evidence that correcting demonstrated iron deficiency associated with restless legs syndromes reduces symptoms as effectively as treating the symptoms in their own right.

Very frequent

  • Pallor (45-55% presentations)
  • Fatigue (44% of presentations)
  • Headaches (63% of presentations)[1]
  • Dysponea


  • Alopecia (30% of presentations)
  • Atrophic glossitis (27% of presentations)
  • Restless legs syndrome (24% of presentations)
  • Heart murmur (10% of presentations)
  • Tachycardia (9% of presentations)
  • Dermatological
    • Dry skin
    • Rough skin
    • Dry hair
    • Damaged hair (see also alopecia above)
  • Angina
  • Neurological
    • Dizziness/vertgo
    • Neurocognitive dysfunction



Set out in BSG guidelines.[2]

  • Full blood count
  • Haematinics