These groups of people may have an increased risk of iron deficiency anemia: Women. Because women lose blood during menstruation, women in general are at greater risk of iron deficiency anemia.

Infants and children. Infants, especially those who were low birth weight or born prematurely, who don't get enough iron from breast milk or formula may be at risk of iron deficiency. Children need extra iron during growth spurts. If your child isn't eating a healthy, varied diet, he or she may be at risk of anemia.

People who don't eat meat may have a greater risk of iron deficiency anemia if they don't eat other iron-rich foods.

Frequent blood donors. People who routinely donate blood may have an increased risk of iron deficiency anemia since blood donation can deplete iron stores.

Low hemoglobin related to blood donation may be a temporary problem remedied by eating more iron-rich foods.

If you're told that you can't donate blood because of low hemoglobin, ask your doctor whether you should be concerned. However, left untreated, iron deficiency anemia can become severe and lead to health problems, including the following: Heart problems.

Iron deficiency anemia may lead to a rapid or irregular heartbeat. Your heart must pump more blood to compensate for the lack of oxygen carried in your blood when you're anemic. This can lead to an enlarged heart or heart failure. Problems during pregnancy. In pregnant women, severe iron deficiency anemia has been linked to premature births and low birth weight babies.

But the condition is preventable in pregnant women who receive iron supplements as part of their prenatal care. Growth problems. In infants and children, severe iron deficiency can lead to anemia as well as delayed growth and development. Additionally, iron deficiency anemia is associated with an increased susceptibility to infections.

You can reduce your risk of iron deficiency anemia by choosing iron-rich foods. Choose iron-rich foods Foods rich in iron include: Red meat, pork and poultry Seafood Beans Dark green leafy vegetables, such as spinach Dried fruit, such as raisins and apricots Iron-fortified cereals, breads and pastas Peas Your body absorbs more iron from meat than it does from other sources.

Choose foods containing vitamin C to enhance iron absorption You can enhance your body's absorption of iron by drinking citrus juice or eating other foods rich in vitamin C at the same time that you eat high-iron foods. Vitamin C is also found in: Broccoli Grapefruit Kiwi Leafy greens Melons Oranges Peppers Strawberries Tangerines Tomatoes.

Preventing iron deficiency anemia in infants To prevent iron deficiency anemia in infants, feed your baby breast milk or iron-fortified formula for the first year.

By Mayo Clinic Staff. Jan 04, Show References. Kaushansky K, et al. Iron deficiency and overload. In: Williams Hematology.

New York, N. Accessed Oct. Schrier SL, et al. Treatment of iron deficiency anemia in adults. Iron-deficiency anemia. American Society of Hematology.

Vitamin C: Fact sheet for health professionals. National Institutes of Health Office of Dietary Supplements. What is iron-deficiency anemia?

National Heart, Lung, and Blood Institute. Approach to the adult patient with anemia. Mahoney DH, et al. Iron deficiency in infants and young children: Treatment.

Iron: Fact sheet for health professionals. CBC with differential, blood. Mayo Medical Laboratories. Mesa RA expert opinion. Mayo Clinic, Rochester, Minn. October 17, News from Mayo Clinic. Can blood donors suffer iron deficiency?

Associated Procedures. Ferritin test. Hematocrit test. Hemoglobin test. Show more associated procedures. Upper endoscopy. Show the heart some love!

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Algorithm for evaluation of iron deficiency anemia in children 6 months to 12 years old. Risk factors for iron deficiency anemia in infants and young children. Dietary sources of iron.

Factors influencing the absorption and bioavailability of dietary iron. Dietary recommendations to reduce the risk of iron deficiency anemia infants and young children. Laboratory findings during the evolution of iron deficiency anemia.

Confounding factors in laboratory tests for iron deficiency anemia in children and adolescents. Prevalence of iron deficiency and iron-deficiency anemia in the United States population, to Anemia as a public health problem in preschool-aged children, by country.

Prevalence of iron deficiency and iron-deficiency anemia in the United States population, to Anemia as a public health problem in preschool-aged children, by country. Peripheral blood smear in iron deficiency anemia showing microcytic, hypochromic red blood cells.

Copyright The Author s , distributed under the terms of CC BY-NC. Southern Sudan Medical Journal. Home Archive News Research Clinical Guidance Search SSMJ About SSMJ. Preventing Iron Deficiency and Anaemia Author s : Joseph Mutuku, PhD Candidate, Wageningen University and Research Centre, Netherlands, formerly with Micronutrient Initiative, Kenya.

Related Links Undernutrition in Adults and Children: causes, consequences and what we can do More from the November issue. Disclaimer CMS website by Maple Design Ltd. Box 1. Improving diets There are two forms of iron in foods: Haem iron is type of iron in the blood, muscle and organs of animals, poultry, and fish — see pictures.

However the proportion absorbed depends on: Other foods in the meal. Meat, fish and vitamin C—rich foods fresh fruits and vegetables increase absorption. Some foods contain anti-nutrients that decrease absorption if taken with, or immediately after, foods containing non-haem iron.

These include tannins in tea and coffee and phytates in cereals. Iron needs. People with high iron needs e. pregnant women or people with anaemia absorb more than other people.

The association between iron deficiency anemia and diminished mental, motor, and behavioral development in infants is not a recent discovery. A possible link was noted in the late s, 6 and subsequent studies of to month-old infants in the past two decades confirmed those findings.

In recent years, it has become clear that these effects are long-lasting despite correction of the iron deficiency anemia. Mental, motor, and behavior effects develop only when iron deficiency is severe enough to cause anemia. Treatment with iron, with subsequent complete resolution of the anemia and the iron deficiency, does not correct all of the behavior effects.

These children were more likely to have repeated a grade, to have reduced arithmetic achievement and written expression, and to show differences in motor function, spatial memory and selective recall. In addition, their behavior was more likely to be characterized as problematic by parents and teachers.

Historically, the prevention of iron deficiency anemia has focused on the first 12 months of life. It appears that toddlers deserve the same degree of attention because of the risk of developmental effects from iron deficiency anemia and because the prevalence of iron deficiency anemia between one and three years of age may be greater than was formerly thought.

Two large-scale studies, the Third National Health and Nutrition Examination Survey NHANES III 14 and the Third Report on Nutrition Monitoring in the United States — , 15 reported the prevalence of iron deficiency anemia in one- to two-year-olds to be 3 percent, and in one- to three-year-olds to be 15 percent.

A more recent study, conducted in an urban setting with an equal mix of lower and middle socioeconomic groups, noted that 10 percent of one- to three-year-olds had iron deficiency anemia.

These findings might have been anticipated because one- to three-year-olds have the lowest daily iron intake of any age group across the lifespan. The primary prevention of iron deficiency anemia in infants and toddlers hinges on healthy feeding practices.

In infants, the introduction of cow's milk in the first year of life is the greatest dietary risk factor for the development of iron deficiency and iron deficiency anemia. Breastfeeding is the ideal feeding practice for many well-documented reasons, including lowering the risk of iron deficiency anemia.

Although breast milk is low in iron content, about 50 percent of the iron is bioavailable to the infant. Therefore, some form of dietary iron supplement that provides 1 mg elemental iron per kg per day is recommended for term infants starting at four 22 , 23 to six 12 , 20 months of age.

Iron-fortified cereal can help meet this requirement 24 ; however, many cereal-fed infants still develop iron deficiency anemia. To prevent iron deficiency, another option is a daily oral iron supplement, using ferrous sulfate drops 26 or infant vitamin drops with iron. Vitamin drops contain 10 mg of elemental iron per dropper, which is the RDA for children six months to six years of age.

Breastfed preterm and low-birth-weight infants require supplementation at a dosage of 2 mg of oral elemental iron per kg per day, starting at two to four weeks of age.

Infants started on formula at birth and those switched from breast milk to formula should receive iron-fortified formula. Low-iron formulas less than 6. Moreover, iron given at higher dosages to treat known iron deficiency anemia in month-old infants caused no more gastrointestinal side effects than placebo.

In the second year of life, cow's milk continues to cause problems in maintaining iron stores, and its consumption should be limited to less than 24 oz per day, 34 with some clinicians calling for a stricter limit of 16 oz per day.

Mothers who wish to continue to breast-feed after 12 months of age should be encouraged to do so, and iron supplementation should be maintained in some form.

If breast-feeding is stopped before 24 months, a recent suggestion has been to substitute iron-fortified formula for cow's milk because of the negative effects of cow's milk on iron status. Other preventive measures for toddlers include encouraging a diversified diet rich in sources of iron and vitamin C, continuing use of cereals fortified with iron instead of more advertised cereals, avoiding excessive juice intake, and giving an iron-containing vitamin.

Infants with one or more risk factors Table 1 should be screened for iron deficiency. Of these risks, the introduction of cow's milk in the first year of life is the most potent dietary factor for the development of iron deficiency.

Screening in the first year is performed between nine 26 and 12 months of age. After 12 months, any toddler who was at risk as an infant but not screened needs to be tested at that time for iron deficiency.

Other toddlers at risk e. A negative screen provides an opportunity to intervene with primary prevention. The ideal screening test would be capable of identifying iron deficiency in the absence of anemia. This would allow for the treatment of iron deficiency in the pre-anemic stage, preventing iron deficiency anemia and its associated mental, motor, and behavior effects.

No such test is widely used at this time. The standard test has been the hemoglobin or hematocrit level, which leads to the diagnosis only if the iron deficiency is severe enough to cause anemia.

This approach has been called into question because the developmental consequences of iron deficiency anemia suggest that identification of iron deficiency before anemia would be preferable. The serum ferritin level, transferrin saturation, and erythrocyte protoporphyrin level also can be used in the diagnosis of iron deficiency Figure 1.

Clinical studies have demonstrated its effectiveness as a screening tool. Practices with a large number of infant and toddler patients at risk for iron deficiency or a high prevalence of iron deficiency anemia may find it helpful to invest in an office hematofluorimeter to measure erythrocyte protoporphyrin.

As a screening test, it will miss some cases of iron deficiency even in the presence of anemia, making the combination of erythrocyte protoporphyrin and hemoglobin measurement a more effective screening strategy.

If erythrocyte protoporphyrin measurement is not an option, obtaining a red-cell distribution width RDW with the hemoglobin measurement could be a consideration.

However, this use of RDW is not currently standard practice, and cut-off values for RDW are instrument-specific and must be known by the ordering clinician. If obtaining a CBC or an erythrocyte protoporphyrin level is impractical, screening solely with hemoglobin should not be abandoned.

It is better to discover a patient who has developed iron deficiency anemia than to miss the diagnosis, as severity and chronicity of the condition may worsen the outcome.

Another reason to keep hemoglobin as part of the screening strategy is that a baseline hemoglobin level is ultimately necessary in the confirmation of the diagnosis of iron deficiency. A therapeutic trial of iron is the preferred approach to diagnosing iron deficiency because it is more reliable and less expensive than obtaining an iron panel.

Other hematopoietic markers are being evaluated for their potential to simultaneously screen for and diagnose iron deficiency in infants and toddlers. The serum circulating transferrin receptor assay is a relatively new test, and the most recent test of iron status to be suggested is reticulocyte hemoglobin content.

After a positive screening test for iron deficiency and a diagnosis confirmed by a therapeutic trial of iron, the infant or toddler should complete a course of iron therapy. Elemental iron, at a dosage of 3 mg per kg, is given orally usually as ferrous sulfate syrup, which is 20 percent elemental iron once daily before breakfast.

Total length of treatment is three months, including the one-month therapeutic trial of iron. Katzman R, Novack A, Pearson H. Nutritional anemia in an inner-city community. Relationship to age and ethnic group. Yip R, Binkin NJ, Fleshood L, Trowbridge FL. Declining prevalence of anemia among low-income children in the United States.

Vazquez-Seoane P, Windom R, Pearson HA. Disappearance of iron-deficiency anemia in a high-risk infant population given supplemental iron.

N Engl J Med. Yip R, Walsh KM, Goldfarb MG, Binkin NJ. Declining prevalence of anemia in childhood in a middle-class setting: a pediatric success story?.

The symptoms of iron-deficiency anemia can be mild at first, and you may not even notice them. The symptoms of moderate to severe iron-deficiency anemia can include:.

According to the ASH, iron deficiency is the most common cause of anemia. There are many reasons that a person might become deficient in iron.

These include:. Eating too little iron over an extended amount of time can cause a shortage in your body. Foods such as meat, eggs, and some green leafy vegetables are high in iron. Because iron is essential during times of rapid growth and development, pregnant women and young children may need even more iron-rich foods in their diet.

Heavy menstrual bleeding is a common cause of iron-deficiency anemia in women of childbearing age. So is pregnancy, because your body needs more iron during this time in order to create enough oxygen for the baby.

Certain medical conditions can cause internal bleeding, which can lead to iron-deficiency anemia. Examples include a stomach ulcer , polyps in the colon or intestines, or colon cancer.

Regular use of certain pain relievers, such as aspirin, can also lead to bleeding in the stomach. Certain disorders or surgeries that affect the intestines can also interfere with how your body absorbs iron. Even if you get enough iron in your diet, celiac disease or intestinal surgery such as gastric bypass may limit the amount of iron your body can absorb.

If you have endometriosis , you may have heavy blood loss during menstrual periods. You may not even know you have endometriosis because it occurs hidden in the abdominal or pelvic area outside of the uterus. Some conditions — like celiac disease — that can make it difficult to absorb enough iron are passed down through families.

There are also genetic conditions or mutations that can add to the problem. One of these is the TMRPSS6 mutation. This mutation causes your body to make too much hepcidin.

Hepcidin is a hormone that can block your intestines from absorbing iron. Other genetic conditions may contribute to anemia by causing abnormal bleeding.

Examples include Von Willebrand disease and hemophilia. Anemia is a common condition and can occur in both men and women of any age and from any ethnic group. Some people may be at greater risk of iron-deficiency anemia than others, including:.

Pregnancy, significant menstrual bleeding, endometriosis, and uterine fibroids are all reasons that women are more likely to experience iron-deficiency anemia.

Heavy menstrual bleeding occurs when a woman bleeds more or longer than typical during menstruation. According to the Centers for Disease Control and Prevention CDC , typical menstrual bleeding lasts for 4 to 5 days and the amount of blood lost ranges from 2 to 3 tablespoons. Women with excess menstrual bleeding typically bleed for more than 7 days and lose twice as much blood as normal.

They occur when muscular tumors grow in the uterus. A complete blood count CBC is usually the first test a doctor will use. A CBC measures the amount of cellular or cell-related components in the blood, including:.

This information includes:. In iron-deficiency anemia, the hematocrit and hemoglobin levels are low. Also, RBCs are usually smaller in size than normal.

A CBC test is often performed as part of a routine physical examination. It may also be performed routinely before a surgery. Anemia can usually be confirmed with a CBC test. Your doctor might order additional blood tests to determine how severe your anemia is and help determine treatments.

They may also examine your blood through a microscope. These blood tests will provide information, including:. Ferritin is a protein that helps with iron storage in your body. Low levels of ferritin indicate low iron storage. Transferrin is a protein that transports iron.

Certain at-home test kits can check iron levels as well as ferritin levels and TIBC. You can buy a testing kit online through LetsGetChecked here.

If your doctor is concerned that internal bleeding is causing your anemia, additional tests may be needed.

One test you may have is a fecal occult test to look for blood in your feces. Blood in your feces may indicate bleeding in your intestine. Your doctor may also perform an endoscopy , in which they use a small camera on a flexible tube to view the linings of your gastrointestinal tract.

Here are the two types:.

Iron status can be assessed through several laboratory tests. Because each test assesses a different aspect of iron metabolism, results of one test may not always agree with results of other tests. Hematological tests based on characteristics of red blood cells i. Biochemical tests i. Although all of these tests can be used to assess iron status, no single test is accepted for diagnosing iron deficiency Detecting iron deficiency in a clinical or field setting is more complex than is generally believed.

Lack of standardization among the tests and a paucity of laboratory proficiency testing limit comparison of results between laboratories Laboratory proficiency testing is currently available for measuring Hb concentration, hematocrit, red blood cell count, serum ferritin concentration, and serum iron concentration; provisional proficiency testing was added in for total iron-binding capacity in the College of American Pathologists survey and was added to the American Association of Bioanalysts survey in As of April , three states New York, Pennsylvania, and Wisconsin had proficiency testing programs for erthrocyte protoporphryin concentration.

Regardless of whether test standardization and proficiency testing become routine, better understanding among health-care providers about the strengths and limitations of each test is necessary to improve screening for and diagnosis of iron-deficiency anemia, especially because the results from all of these tests can be affected by factors other than iron status.

Only the most common indicators of iron deficiency are described in this section. Other indicators of iron deficiency e.

Hb Concentration and Hematocrit. Because of their low cost and the ease and rapidity in performing them, the tests most commonly used to screen for iron deficiency are Hb concentration and hematocrit Hct.

These measures reflect the amount of functional iron in the body. The concentration of the iron-containing protein Hb in circulating red blood cells is the more direct and sensitive measure. Hct indicates the proportion of whole blood occupied by the red blood cells; it falls only after the Hb concentration falls.

Because changes in Hb concentration and Hct occur only at the late stages of iron deficiency, both tests are late indicators of iron deficiency; nevertheless, these tests are essential for determining iron-deficiency anemia.

Because iron deficiency is such a common cause of childhood anemia, the terms anemia, iron deficiency, and iron-deficiency anemia are often used interchangeably 3.

The only cases of anemia that can be classified as iron-deficiency anemia, however, are those with additional evidence of iron deficiency. The concept of a close association between anemia and iron deficiency is closest to correct when the prevalence of iron deficiency is high.

In the United States, the prevalence and severity of anemia have declined in recent years; hence, the proportion of anemia due to causes other than iron deficiency has increased substantially. As a consequence, the effectiveness of anemia screening for iron deficiency has decreased in the United States.

Iron deficiency may be defined as absent bone marrow iron stores as described on bone marrow iron smears , an increase in Hb concentration of greater than 1.

The recent recognition that iron deficiency seems to have general and potentially serious negative effects has made identifying persons having iron deficiency as important as identifying persons having iron-deficiency anemia. The case definition of anemia recommended in this report is less than 5th percentile of the distribution of Hb concentration or Hct in a healthy reference population and is based on age, sex, and among pregnant women stage of pregnancy 45, Lowering the Hb concentration or Hct cut-off would result in identifying fewer people who have anemia due to causes other than iron deficiency false positives but also in overlooking more people with iron deficiency true positives The distributions also differ by altitude, smoking status, and race.

Among pregnant women, Hb concentration and Hct decline during the first and second trimesters because of an expanding blood volume 18, Among pregnant women who do not take iron supplements, Hb concentration and Hct remain low in the third trimester, and among pregnant women who have adequate iron intake, Hb concentration and Hct gradually rise during the third trimester toward the prepregnancy levels 39, Because adequate data are lacking in the United States, the cutoff values for anemia are based on clinical studies of European women who had taken iron supplementation during pregnancy , For pregnant women, a test result greater than 3 standard deviations SD higher than the mean of the reference population i.

High Hb concentration or Hct has been associated with hypertension and poor pregnancy outcomes e. Hence, a high Hb concentration or Hct in the second or third trimester of pregnancy should not be considered an indicator of desirable iron status. The effectiveness of screening for anemia is lowered if the cutoff values are not adjusted for these factors 72,79, Adjustment allows the positive predictive value of anemia screening to be comparable between those who reside near sea-level and those who live at high altitude and between smokers and nonsmokers In the United States, the distribution of Hb concentration values is similar among whites and Asian Americans 81 , and the distribution of Hct values is similar among whites and American Indians The distributions are lower among blacks than whites, however, even after adjustment for income 83, These different distributions are not caused by a difference in iron status indicators e.

For this reason, the Institute of Medicine recommends lowering Hb concentration and Hct cutoff values for black children aged less than 5 years by 0.

Because the reason for this disparity in distributions by race has not been determined, the recommendations in this report do not provide race-specific cutoff values for anemia.

Regardless, health-care providers should be aware of the possible difference in the positive predictive value of anemia screening for iron deficiency among blacks and whites and consider using other iron status tests e. Accurate, low-cost, clinic-based instruments have been developed for measuring Hb concentration and Hct by using capillary or venous blood 85, Small diurnal variations are seen in Hb concentration and Hct measurements, but these variations are neither biologically nor statistically significant 87, A potential source of error of using capillary blood to estimate Hb concentration and Hct in screening is improper sampling technique.

For example, excessive squeezing i. Confirmation of a low reading is recommended by obtaining a second capillary blood sample from the finger or by venipuncture. Although measures of Hb concentration and Hct cannot be used to determine the cause of anemia, a diagnosis of iron-deficiency anemia can be made if Hb concentration or Hct increases after a course of therapeutic iron supplementation 23, Alternatively, other laboratory tests e.

In the United States in recent years, the usefulness of anemia screening as an indicator of iron deficiency has become more limited, particularly for children. Studies using transferrin saturation a more sensitive test for iron deficiency have documented that iron deficiency in most subpopulations of children has declined such that screening by Hb concentration no longer efficiently predicts iron deficiency 3,45,51, Causes of anemia other than iron deficiency include other nutritional deficiencies e.

The current pattern of iron-deficiency anemia in the United States 28,45 indicates that selective anemia screening of children at known risk for iron deficiency or additional measurement of indicators of iron deficiency e. children 3, The costs and feasibility of screening using additional indicators of iron deficiency may preclude the routine use of these indicators.

Mean Cell Volume. Mean cell volume MCV , the average volume of red blood cells, is measured in femtoliters liters. This value can be calculated as the ratio of Hct to red blood cell count or measured directly using an electronic counter.

MCV is highest at birth, decreases during the first 6 months of life, then gradually increases during childhood to adult levels 23, A low MCV corresponds with the 5th percentile for age for the reference population in NHANES III If cases of lead poisoning and the anemias of infection, chronic inflammatory disease, and thalassemia minor can be excluded, a low MCV serves as a specific index for iron-deficiency anemia 28,87,94, Red Blood Cell Distribution Width.

Red blood cell distribution width RDW is calculated by dividing the SD of red blood cell volume by MCV and multiplying by to express the result as a percentage:. A high RDW is generally set at greater than The RDW value obtained depends on the instrument used 51, An RDW measurement often follows an MCV test to help determine the cause of a low MCV.

For example, iron-deficiency anemia usually causes greater variation in red blood cell size than does thalassemia minor Thus, a low MCV and an RDW of greater than Erythrocyte Protoporphyrin Concentration.

Erythrocyte protoporphyrin is the immediate precursor of Hb. The concentration of erythrocyte protoporphyrin in blood increases when insufficient iron is available for Hb production.

The normal range of erythrocyte protoporphyrin concentration is higher for children aged years than for adults, but no consensus exists on the normal range for infants 28, Infection, inflammation, and lead poisoning as well as iron deficiency can elevate erythrocyte protoporphyrin concentration 23, This measure of iron status has several advantages and disadvantages relative to other laboratory measures.

For example, the day-to-day variation within persons for erythrocyte protoporphyrin concentration is less than that for serum iron concentration and transferrin saturation A high erythrocyte protoporphyrin concentration is an earlier indicator of iron-deficient erythropoiesis than is anemia, but it is not as early an indicator of low iron stores as is low serum ferritin concentration Inexpensive, clinic-based methods have been developed for measuring erythrocyte protoporphyrin concentration, but these methods can be less reliable than laboratory methods Serum Ferritin Concentration.

Nearly all ferritin in the body is intracellular; a small amount circulates in the plasma. Serum ferritin concentration is an early indicator of the status of iron stores and is the most specific indicator available of depleted iron stores, especially when used in conjunction with other tests to assess iron status.

Although low serum ferritin concentration is an early indicator of low iron stores, it has been questioned whether a normal concentration measured during the first or second trimester of pregnancy can predict adequate iron status later in pregnancy 6.

The cost of assessing serum ferritin concentration and the unavailability of clinic-based measurement methods hamper the use of this measurement in screening for iron deficiency. In the past, methodological problems have hindered the comparability of measurements taken in different laboratories 87 , but this problem may be reduced by proficiency testing and standardized methods.

Factors other than the level of stored iron can result in large within-individual variation in serum ferritin concentration For example, because serum ferritin is an acute-phase reactant, chronic infection, inflammation, or diseases that cause tissue and organ damage e.

This elevation can mask depleted iron stores. Transferrin Saturation. Transferrin saturation indicates the extent to which transferrin has vacant iron-binding sites e. Saturation is highest in neonates, decreases by age 4 months, and increases throughout childhood and adolescence until adulthood 23, Transferrin saturation is based on two laboratory measures, serum iron concentration and total iron-binding capacity TIBC.

Transferrin saturation is calculated by dividing serum iron concentration by TIBC and multiplying by to express the result as a percentage:.

Serum iron concentration is a measure of the total amount of iron in the serum and is often provided with results from other routine tests evaluated by automated, laboratory chemistry panels. Many factors can affect the results of this test. For example, the concentration of serum iron increases after each meal 71 , infections and inflammations can decrease the concentration 69 , and diurnal variation causes the concentration to rise in the morning and fall at night The day-to-day variation of serum iron concentration within individuals is greater than that for Hb concentration and Hct 88, TIBC is a measure of the iron-binding capacity within the serum and reflects the availability of iron-binding sites on transferrin Thus, TIBC increases when serum iron concentration and stored iron is low and decreases when serum iron concentration and stored iron is high.

Factors other than iron status can affect results from this test. For example, inflammation, chronic infection, malignancies, liver disease, nephrotic syndrome, and malnutrition can lower TIBC readings, and oral contraceptive use and pregnancy can raise the readings 87, Nevertheless, the day-to-day variation is less than that for serum iron concentration 87, TIBC is less sensitive to iron deficiency than is serum ferritin concentration, because changes in TIBC occur after iron stores are depleted 17,31, The factors that affect serum iron concentration and TIBC, such as iron status, diurnal variation 87, , and day-to-day variation within persons , can affect the measured transferrin saturation as well.

The diurnal varation is larger for transferrin saturation than it is for Hb concentration or Hct 87, Transferrin saturation is an indicator of iron-deficient erythropoiesis rather than iron depletion; hence, it is less sensitive to changes in iron stores than is serum ferritin concentration 30, The cost of assessing transferrin saturation and the unavailability of simple, clinic-based methods for measuring transferrin saturation hinder the use of this test in screening for iron deficiency.

These recommendations are intended to guide primary health-care providers in preventing and controlling iron deficiency in infants, preschool children, and women of childbearing age especially pregnant women.

Both primary prevention through appropriate dietary intake and secondary prevention through detecting and treating iron-deficiency anemia are discussed. Primary Prevention. Primary prevention of iron deficiency means ensuring an adequate intake of iron.

A reliable source of dietary iron is essential for every infant and child's growth and development, because a rapid rate of growth and low dietary iron may predispose an infant to exhaustion of iron stores by ages months Primary prevention of iron deficiency is most important for children aged less than 2 years, because among all age groups they are at the greatest risk for iron deficiency caused by inadequate intake of iron 28,45,47,48, The adequacy of the iron content of an infant's diet is a major determinant of the iron status of the infant as a young child, as indicated by declines in the prevalence of iron-deficiency anemia that correspond with improvements in infant feeding practices In infants and young children, iron deficiency may result in developmental and behavioral disturbances 33, The evidence for the effectiveness of primary prevention among pregnant women is less clear.

Although iron-deficiency anemia during pregnancy is associated with preterm delivery and delivering a low-birthweight baby 38 , well designed, randomized control trials are needed to evaluate the effectiveness of universal iron supplementation on mitigating adverse birth outcomes.

Some studies have indicated that adequate iron supplementation during pregnancy reduces the prevalence of iron-deficiency anemia 6,10,,66, , but over the last few decades, the recommendation by the Council on Foods and Nutrition and other groups to supplement iron intake during pregnancy has not resulted in a reduced prevalence of anemia among low-income, pregnant women 4,9, Evidence on iron supplement use is limited, however, so it is not known how well the recommendation has been followed.

Conclusive evidence of the benefits of universal iron supplementation for all women is lacking, but CDC advocates universal iron supplementation for pregnant women because a large proportion of women have difficulty maintaining iron stores during pregnancy and are at risk for anemia 6,18,63 , iron-deficiency anemia during pregnancy is associated with adverse outcomes 38 , and supplementation during pregnancy is not associated with important health risks 10,65, Potential Adverse Effects of Increasing Dietary Iron Intake.

Approximately 3. Hemochromatosis is a genetic condition characterized by excessive iron absorption, excess tissue iron stores, and potential tissue injury. If undetected and untreated, iron overload may eventually result in the onset of morbidity e. Clinical expression of iron overload depends on the severity of the metabolic defect, the presence of sufficient quantities of absorbable iron in the diet, and physiological blood loss from the body e.

Transferrin saturation is the recommended screening test for hemochromatosis; a repeated high value indicates hemochromatosis Preventing or treating the clinical signs of hemochromatosis involves repeated phlebotomy to remove excess iron from the body Although increases in iron intake would seem contraindicated in persons with hemochromatosis, there is no evidence that iron fortification of foods or the use of a recommended iron supplementation regimen during pregnancy is associated with increased risk for clinical disease due to hemochromatosis Even when their dietary intake of iron is approximately average, persons with iron overload due to hemochromatosis will require phlebotomy to reduce their body's iron stores Secondary Prevention.

Secondary prevention involves screening for, diagnosing, and treating iron deficiency. Screening tests can be for anemia or for earlier indicators of iron deficiency e. The cost, feasibility, and variability of measurements other than Hb concentration and Hct currently preclude their use for screening.

The decision to screen an entire population or to screen only persons at known risk for iron deficiency should be based on the prevalence of iron deficiency in that population The percentage of anemic persons who are truly iron deficient i.

In the United States, children from low-income families, children living at or below the poverty level, and black or Mexican-American children are at higher risk for iron deficiency than are children from middle- or high-income families, children living above the poverty level, and white children, respectively 2,3, Routine screening for anemia among populations of children at higher risk for iron deficiency is effective, because anemia is predictive of iron deficiency.

Because the iron stores of a full-term infant of normal or high birthweight can meet the body's iron requirements up to age 6 months 23 , anemia screening is of little value before age 6 months for these infants.

Anemia among pregnant women and anemia among all nonpregnant women of childbearing age should be considered together, because childbearing increases the risk for iron deficiency both during and after pregnancy 41,42 , and iron deficiency before pregnancy likely increases the risk for iron deficiency during pregnancy Periodic screening for anemia among adolescent girls and women of childbearing age is indicated for several reasons.

First, most women have dietary intake of iron below the recommended dietary allowance 46, Finally, the relatively high prevalence of iron deficiency and iron-deficiency anemia among nonpregnant women of childbearing age 45 and of anemia among low-income, pregnant women 4 suggests that periodic screening for anemia is indicated among adolescent girls and nonpregnant women of childbearing age during routine medical examinations 73 and among pregnant women at the first prenatal visit.

Among men and postmenopausal women, in whom iron deficiency and iron-deficiency anemia are uncommon 45 , anemia screening is not highly predictive of iron deficiency.

Primary prevention of iron deficiency in infants and preschool children should be achieved through diet. Information on diet and feeding is available in the Pediatric Nutrition Handbook 8 , Guide to Clinical Preventive Services 10 , Nutrition and Your Health: Dietary Guidelines for Americans 14 , Breastfeeding and the Use of Human Milk , and Clinician's Handbook of Preventive Services: Put Prevention into Practice For secondary prevention of iron deficiency in this age group, screening for, diagnosing, and treating iron-deficiency anemia are recommended.

Primary Prevention Milk and Infant Formulas. Encourage exclusive breast feeding of infants without supplementary liquid, formula, or food for months after birth. For infants aged less than 12 months who are not breast fed or who are partially breast fed, recommend only iron-fortified infant formula as a substitute for breast milk.

For breast-fed infants who receive insufficient iron from supplementary foods by age 6 months i. Encourage use of only breast milk or iron-fortified infant formula for any milk-based part of the diet e. Suggest that children aged years consume no more than 24 oz of cow's milk, goat's milk, or soy milk each day.

Solid Foods. At age months or when the extrusion reflex disappears, recommend that infants be introduced to plain, iron-fortified infant cereal. Two or more servings per day of iron-fortified infant cereal can meet an infant's requirement for iron at this age.

By approximately age 6 months, encourage one feeding per day of foods rich in vitamin C e. Suggest introducing plain, pureed meats after age 6 months or when the infant is developmentally ready to consume such food.

Secondary Prevention Universal Screening. In populations of infants and preschool children at high risk for iron-deficiency anemia e. Selective Screening. In populations of infants and preschool children not at high risk for iron-deficiency anemia, screen only those children who have known risk factors for the condition.

These children are described in the next three bulleted items. Consider anemia screening before age 6 months for preterm infants and low-birthweight infants who are not fed iron-fortified infant formula.

Annually assess children aged years for risk factors for iron-deficiency anemia e. Screen these children if they have any of these risk factors.

At ages months and 6 months later at ages months , assess infants and young children for risk factors for anemia. Screen the following children:. Infants fed a diet of non-iron-fortified infant formula for greater than 2 months. Breast-fed infants who do not consume a diet adequate in iron after age 6 months i.

Children who have special health-care needs e. Check a positive anemia screening result by performing a repeat Hb concentration or Hct test. If the tests agree and the child is not ill, a presumptive diagnosis of iron-deficiency anemia can be made and treatment begun.

Counsel the parents or guardians about adequate diet to correct the underlying problem of low iron intake. Repeat the anemia screening in 4 weeks. If iron-deficiency anemia is confirmed, reinforce dietary counseling, continue iron treatment for 2 more months, then recheck Hb concentration or Hct.

Reassess Hb concentration or Hct approximately 6 months after successful treatment is completed. If after 4 weeks the anemia does not respond to iron treatment despite compliance with the iron supplementation regimen and the absence of acute illness, further evaluate the anemia by using other laboratory tests, including MCV, RDW, and serum ferritin concentration.

School-Age Children Persons Aged 5- less than 12 Years and Adolescent Boys Males Aged less than 18 Years. Among school-age children and adolescent boys, only those who have a history of iron-deficiency anemia, special health-care needs, or low iron intake should be screened for anemia.

Treatment for iron-deficiency anemia includes one mg iron tablet each day for school-age children and two mg iron tablets each day for adolescent boys and counseling about dietary intake of iron.

Follow-up and laboratory evaluation are the same for school-age children and adolescent boys as they are for infants and preschool children. Adolescent Girls Females less than 18 Years and Nonpregnant Women of Childbearing Age.

Primary prevention of iron deficiency for adolescent girls and nonpregnant women of childbearing age is through diet. Information about healthy diets, including good sources of iron, is available in Nutrition and Your Health: Dietary Guidelines for Americans Screening for, diagnosing, and treating iron-deficiency anemia are secondary prevention approaches.

Most adolescent girls and women do not require iron supplements, but encourage them to eat iron-rich foods and foods that enhance iron absorption. Women who have low-iron diets are at additional risk for iron-deficiency anemia; guide these women in optimizing their dietary iron intake.

Secondary Prevention Screening. Starting in adolescence, screen all nonpregnant women for anemia every years throughout their childbearing years during routine health examinations. Annually screen for anemia women having risk factors for iron deficiency e.

Diagnosis and Treatment. Confirm a positive anemia screening result by performing a repeat Hb concentration or Hct test. If the adolescent girl or woman is not ill, a presumptive diagnosis of iron-deficiency anemia can be made and treatment begun.

Counsel these patients about correcting iron deficiency through diet. Follow up adolescent girls and nonpregnant women of childbearing age as is done for infants and preschool children, except that for a confirmed case of iron-deficiency anemia, continue iron treatment for more months.

In women of African, Mediterranean, or Southeast Asian ancestry, mild anemia unresponsive to iron therapy may be due to thalassemia minor or sickle cell trait.

Pregnant Women. Primary prevention of iron deficiency during pregnancy includes adequate dietary iron intake and iron supplementation.

Information about healthy diets, including good sources of iron, is found in Nutrition and Your Health: Dietary Guidelines for Americans More detailed information for pregnant women is found in Nutrition During Pregnancy and Lactation: An Implementation Guide Secondary prevention involves screening for, diagnosing, and treating iron-deficiency anemia.

Encourage pregnant women to eat iron-rich foods and foods that enhance iron absorption. Pregnant women whose diets are low in iron are at additional risk for iron-deficiency anemia; guide these women in optimizing their dietary iron intake.

Screen for anemia at the first prenatal care visit. If the pregnant woman is not ill, a presumptive diagnosis of iron-deficiency anemia can be made and treatment begun. If Hb concentration is less than 9. Counsel pregnant women about correcting iron-deficiency anemia through diet.

During the second or third trimester, if Hb concentration is greater than Postpartum Women. Women at risk for anemia at weeks postpartum should be screened for anemia by using a Hb concentration or Hct test. Risk factors include anemia continued through the third trimester, excessive blood loss during delivery, and a multiple birth.

Treatment and follow-up for iron-deficiency anemia in postpartum women are the same as for nonpregnant women. If no risk factors for anemia are present, supplemental iron should be stopped at delivery.

Men Males Aged greater than or equal to 18 Years and Postmenopausal Women. No routine screening for iron deficiency is recommended for men or postmeno-pausal women. Iron deficiency or anemia detected during routine medical examinations should be fully evaluated for its cause.

Men and postmenopausal women usually do not need iron supplements. In the United States, iron deficiency affects 7. Primary health-care providers can help prevent and control iron deficiency by counseling individuals and families about sound iron nutrition during infancy and beyond and about iron supplementation during pregnancy, by screening persons on the basis of their risk for iron deficiency, and by treating and following up persons with presumptive iron deficiency.

Implementing these recommendations will help reduce manifestations of iron deficiency e. References Yip R, Walsh KM, Goldfarb MG, Binkin NJ. Declining prevalence of anemia in childhood in a middle-class setting: a pediatric success story? Pediatrics ;80 3 Yip R, Binkin NJ, Fleshood L, Trowbridge FL.

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Iron status in breast-fed infants. J Pediatr ; 3 Symptoms of moderate iron deficiency may be slower to appear. In some cases, iron deficiency leads to weight gain.

Scientists think this can be due to fatigue, which causes you to be less active. Others suspect iron deficiency may slow your metabolism. Either way, research shows treating iron deficiency anemia helps to promote weight loss.

Extreme iron deficiency anemia can cause tachycardia or rapid heart rate. It can also cause low blood pressure.

In children, extreme iron deficiency may contribute to learning and concentration problems. Pregnant women who have an iron deficiency can have low energy. They also have an increased risk of low birth weight babies and premature birth. A complete blood count CBC is a blood test that counts your platelets and your red and white blood cells.

This test can only suggest iron deficiency anemia, because there are also other causes. Your healthcare provider will try to identify the cause based on your medical history and exam.

Tests to see if you have gastrointestinal GI bleeding may also be done. If your healthcare provider doesn't suspect GI blood loss, you may need to start a trial of iron supplements with close follow-up.

If there is no improvement after a few weeks or if it's still unclear what is causing your anemia, you may need iron studies. These blood tests usually measure:. If the cause still can't be found, bone marrow biopsy is the gold standard for diagnosis.

During this procedure, a sample of bone marrow is taken using a hollow needle. For many conditions, a physical exam is the most important diagnostic tool. Symptoms of iron deficiency, though, don't usually develop until weeks or months after you have an abnormal blood test.

These late symptoms include:. This is why a physical exam usually can't identify an iron deficiency. It's very important to find the cause of iron deficiency anemia. One of the first things many doctors do is look for occult blood loss. This is hidden or unnoticed blood loss. The most common cause is bleeding from the colon.

The first step toward identifying this cause is to look for blood in a stool sample. If there is no blood, your doctor may still order a colonoscopy or endoscopy , especially if there is no other obvious cause.

During this test, a healthcare provider looks at the inside of your GI system with a camera attached to a long, flexible tube. Colonic polyps, bleeding ulcers, and even gastrointestinal cancer can cause iron deficiency.

Some other conditions include:. Treatment of iron deficiency is based on two important approaches:. Iron levels can be corrected by increasing iron in the diet or taking iron supplement pills. If your body can't absorb iron or you have an intestinal problem, however, taking a pill or eating food rich in iron won't correct the problem.

In this case, you may receive an injectable form of iron. Some causes may require other types of intervention. For example, a bleeding polyp in your colon may need to be removed. A biopsy can test for cancer. For some people, stomach bleeding may be related to the use of blood thinners. When this happens, you may need a lower dose or a different blood thinner.

If you have had a major episode of blood loss due to something like surgery or trauma, you may need a blood transfusion. Healthy people can usually prevent iron deficiency with diet.

Recommended intake differs for various people:. After menopause, healthy women need less iron because they do not experience blood loss due to menstruation. Good dietary sources of iron include:.

You can help your body absorb non-heme iron by combining vegan sources of iron with a food rich in vitamin C. For example, drink a glass of orange juice with a plate of spinach, or add green peppers to beans.

You may need higher amounts if you have a condition that interferes with your iron levels. You may also need iron injections if you can't get enough through your diet or with an oral supplement.

Most males and postmenopausal females get enough iron from food and should not take iron supplements unless prescribed by a doctor. Pregnant females should take prenatal vitamins, which usually contain iron. Women who have heavy periods may also need to take iron supplements.

If you need to take an iron supplement, don't take more than 45 mg per day unless your doctor tells you to. Even at recommended doses, iron supplements can cause constipation. They can also cause more serious side effects , such as iron toxicity.

Iron supplements are especially dangerous for people who have hemochromatosis , a condition characterized by iron overload. Adult iron supplements can be toxic for young children, so keep them in tightly capped, childproof bottles. Iron deficiency is caused by not having enough iron in the blood.

It can result due to one's diet, problems with iron absorption, or a health condition like Crohn's disease. If iron deficiency leads to iron deficiency anemia, it can cause symptoms like weakness, dry skin and nails, and poor concentration. In severe cases, you may have heart palpitations and shortness of breath.

Iron deficiency can be diagnosed with blood tests, endoscopy, or a bone marrow biopsy. Treatment involves correcting the underlying cause and replacing lost iron. In otherwise healthy people, the condition can usually be prevented by making sure to get plenty of dietary iron.

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