Iron-deficiency anemia can cause symptoms that greatly impact your quality of life, and, if untreated, can have harmful consequences. Catherine Broome, MD, a hematologist/oncologist at Georgetown University Hospital, explains what patients should know about recognizing and treating iron-deficiency anemia. 1. Q: What is iron-deficiency anemia? A: Red blood cells carry oxygen to our body’s tissues, ensuring everything works the way it should. They do this by collecting oxygen molecules in the lungs and then releasing the oxygen into the tissues so they can perform whatever function they need to. Iron is a really important component involved in making red blood cells. When you don’t have enough iron, you don’t have enough red blood cells, which means you don’t have enough oxygen released into your body—this condition is called anemia. There are several causes of anemia, but when a lack of iron is the culprit, it’s known as iron-deficiency anemia. 2. Q: What are the symptoms of iron-deficiency anemia? A: Your organs and tissues can’t function correctly when they don’t get enough oxygen, so you’ll start to experience symptoms like fatigue and shortness of breath. Often, people will notice these symptoms when they’re trying to exercise or exert themselves in some way, because without enough oxygen circulating, your body will try to get more oxygen through your breathing. You’ll start breathing faster and feel more short of breath, and you may even get a little lightheaded or dizzy. Sometimes, patients hear what they describe as the sound of the ocean rushing in their ears—that’s because your heart is trying to beat more rapidly so red blood cells are pumped through your system more rapidly. You might also feel colder than ususal, especially in your fingers and toes, because oxygen isn’t reaching those areas. One set of symptoms that’s unique to iron-deficiency anemia is the concept of “pica,” which is a latin term for craving inert substances. Some people who are iron deficient eat chalk, starch, sand, or paper. And they don’t really have control over these cravings, believe it or not. They know in their heads that they shouldn’t be eating these things, but their bodies crave them. We don’t actually understand why this happens—it’s a bit of a medical puzzle at the moment. 3. Q: What causes iron-deficiency anemia? A: There are a few main things that can cause someone to become iron deficient. First, you may be losing iron through blood loss. Young women who are menstruating are the most common group of people we see with iron deficiency—when they have very heavy menstrual periods each month, they’re losing a fair amount of blood and over time, that can put a strain on the amount of iron they have stored in their body. Patients with inflammatory bowel diseases, like ulcerative colitis or Crohn’s disease, can experience bleeding in their stomach lining or intestines, and may lose iron that way. Women can also lose iron when pregnant: it takes a lot of iron from the mom’s body to build a baby, and that can really deplete the iron stores. Multiple pregnancies, especially over a relatively short period of time, can result in iron deficiency. And breastfeeding can also lead to this, since there’s a lot of iron in breastmilk. Sometimes, iron deficiency is a result of not taking in enough iron through your diet. We see it a lot in people with really restricted diets, like strict vegetarians, especially because red meat is one of the most iron-rich foods you can find. There’s also a lot of iron in leafy dark green vegetables: the darker the green color, the more iron there is. Kale, collards, and spinach are very high in iron, and often patients have to be intentional about choosing these foods to keep their iron levels normal. In some cases, patients can’t absorb iron, which leads to iron deficiency. People with Celiac disease sometimes develop an inability to absorb iron over time. And the most common reason people can’t absorb iron today is related to weight loss surgery. If parts of the small intestine or stomach are bypassed in a surgery, the body is less able to absorb iron, which can lead to iron deficiency. 4. Q: How is iron-deficiency anemia treated? A: Treating iron deficiency involves adding supplemental iron back into the body. There are two ways to do this: through oral tablets, or through intravenous (IV) methods. If iron absorbtion is not an issue for you, we turn to oral iron supplements. I usually have people take 325 mg of iron at least twice a day—preferably three times a day. However, having taken iron myself, I know that’s a big thing to request, because oral iron causes a lot of gastrointestinal side effects. Patients may experience gas, indigestion, and severe constipation, which is why I’ll often recommend people take a stool softener along with the iron tablet. Oral iron doesn’t work for about half my patients, either because they can’t tolerate the side effects, especially if they have inflammatory bowel disease, or because they have an absorption issue from gastric bypass or Celiac disease. In these cases, we turn to IV iron. For IV iron, patients must come to an infusion clinic, and the iron is administered quickly—the experience lasts only about 15 to 30 minutes. People usually don’t have any bad reactions to it. And because the iron is bypassing the gastrointestinal tract, they don’t suffer from upset stomach, constipation, or other symptoms. Patients typically need to take oral iron tablets for several months in order to build up enough reserves of iron in their bodies. But with IV iron, they only need a few once-weekly treatments and the process can be over with in less than a month. Your doctor will determine which method is best for your situation; by working together on a treatment plan, you can successfully restore your iron levels and overcome iron-deficiency anemia.