Iron Deficiency Anemia

Iron deficiency anemia is a common type of anemia (low hemoglobin level). It happens when there is not enough iron in the blood. The body needs iron to make hemoglobin. Hemoglobin carries oxygen throughout the body. When you don’t have enough iron in your blood, your body can’t get the oxygen that it needs. Iron is also needed for your muscles to work.

What causes iron deficiency anemia?

You may be at risk for getting iron deficiency anemia if:

• You are a woman who has heavy periods.
• You are a woman who is pregnant, just gave birth, or is breastfeeding.
• You recently had a major surgery or injury.
• You have a history of celiac disease, ulcerative colitis, or Crohn’s disease.
• You have had gastric bypass or other weight loss surgery.
• You are a vegetarian or vegan with a diet that lacks iron-rich foods.
• You have bleeding in your gastrointestinal (GI) tract because of inflammation (swelling) of the stomach or esophagus, ulcers in your stomach or bowel, hemorrhoids, diverticulitis, or cancers in your GI tract.
• You have a history of frequent nose bleeds with major blood loss.
• You donate blood often.

What are the symptoms of iron deficiency anemia?

Iron deficiency anemia symptoms may include:

• Feeling tired and having low energy.
• Feeling short of breath, having chest pain, or rapid heartbeat.
• Feeling weak.
• Headaches, dizziness, or lightheadedness.
• Pale skin.
• Swollen or sore tongue or mouth. Wanting to chew non-food items that have no nutritional value, like ice, clay, dirt, chalk, or paper. This is commonly called pica.
• Brittle or weak nails.

How is iron deficiency anemia diagnosed?

If you are having symptoms, your provider will order blood tests to check a complete blood count (CBC). Tests may be ordered to also measure your:

• Ferritin.
• Serum iron.
• Total iron-binding capacity.
• Iron saturation.

Your provider will want to find the cause of your iron deficiency anemia, which is often bleeding. Tests to check for bleeding can include:

• Endoscopy or colonoscopy.
• Testing the stool and urine for blood.

If it is caused by heavy periods, your provider may have you see a gynecologist (a doctor that specializes in female reproductive health). They may do a pelvic ultrasound or uterine biopsy.

How is iron deficiency anemia treated?

There are many ways to treat iron deficiency anemia. These include:

• Adding more iron to your diet through the foods you eat.
  • It’s important to include iron-rich foods in your diet. Foods that are high in iron include shellfish like clams, mussels and oysters, spinach, beef or chicken liver, beans, peas, chickpeas, soybeans and lentils (legumes), red meat, quinoa, broccoli, and tofu. You may want to ask to speak with a dietitian about your diet.
• Taking iron supplements by mouth (oral FESO4). Do not take any supplements without first talking to your provider.
• Red blood cell transfusions.
• Intravenous (IV) iron replacement therapy.

Intravenous (IV) Iron Replacements

Iron sucrose (Venofer®), Ferric carboxymaltose injection (Injectafer®) and ferumoxytol injection (Feraheme®) are medications used for the treatment of iron deficiency anemia. They are given by intravenous (into a vein) infusion.

There is a risk of reactions to these medications. You will be monitored during, and for 30 minutes after you get your infusion. Symptoms of a reaction include low blood pressure, fainting, and unresponsiveness. Tell your provider right away if you have any symptoms during or after the infusion.

It is not known if these medications could harm unborn babies. Talk with your healthcare provider before getting pregnant or breastfeeding if you take any of these medications.

Ferumoxytol Injection (Feraheme®) can interfere with MRI studies for up to three months after you have been given the medication. MRI studies should be done before a ferumoxytol injection (Feraheme®) is given or three months after.

Iron sucrose (Venofer®), ferumoxytol injection (Feraheme®), and Ferric carboxymaltose injection (Injectafer®) can cause other side effects that may include:

Iron sucrose (Venofer®) and Ferymoxytol injection (Feraheme®)

• Can cause low blood pressure (hypotension). You should have your blood pressure checked regularly during therapy. Any hypotension should be treated. Symptoms from low blood pressure include feeling tired, lightheaded, dizzy, nauseous, and clammy skin. Report any of these symptoms to your care team.
• Can cause iron overload. Your healthcare provider will check your blood levels during and after your treatment. Side effects from iron overload may include nausea, fatigue, headache, dizziness, muscle cramps, and diarrhea.

Ferric carboxymaltose injection (Injectafer®)

• Can cause high blood pressure (hypertension). You should have your blood pressure checked regularly during therapy. Any hypertension should be treated. If hypertension cannot be controlled, the medication may be stopped. Report any headaches, vision changes, or dizziness to your care team as these can be signs of high blood pressure.
• Can cause nausea, flushing, dizziness, and low levels of phosphorus in the blood. Your healthcare provider will check your blood levels during and after your treatment.

What happens after treatment for iron deficiency anemia?

Your provider will continue to check your blood tests. You may continue to take oral iron supplements after getting IV iron therapy. You may also need to receive IV iron again in the future. Make sure to report any symptoms to your healthcare provider.