Overview#
Iron deficiency anemia (IDA) occurs when the body lacks sufficient iron to produce adequate haemoglobin, the protein in red blood cells that carries oxygen. It is the most common nutritional deficiency worldwide. In India, over 50 % of women of reproductive age and 58 % of children under 5 are anemic (NFHS-5, 2019-21). The high prevalence is driven by vegetarian diets with low bioavailable iron, chronic infections, and poor access to iron-rich foods.
Causes & Risk Factors#
- Inadequate dietary iron – vegetarian diets provide non-heme iron, which has lower absorption (5-12 %) compared to heme iron from meat (15-35 %).
- Blood loss – heavy menstrual periods are the leading cause in women; gastrointestinal bleeding (ulcers, piles) in men and post-menopausal women.
- Increased demand – pregnancy, breastfeeding, adolescent growth spurts, and intense physical training.
- Poor absorption – coeliac disease, chronic gastritis, tea/coffee consumption with meals (tannins inhibit iron absorption).
- Hookworm and parasitic infections – still prevalent in rural India and cause chronic blood loss.
Signs & Symptoms#
- Persistent fatigue and weakness
- Pale skin, conjunctiva, and nail beds
- Shortness of breath on mild exertion
- Dizziness and lightheadedness
- Brittle, spoon-shaped nails (koilonychia)
- Pica – cravings for ice, clay, or starch
- Cold hands and feet
- Frequent headaches
Diagnosis#
- Complete Blood Count (CBC) – low haemoglobin (< 12 g/dL in women, < 13 g/dL in men), low MCV (microcytic anemia). Book CBC
- Serum Ferritin – the most sensitive marker; < 30 ng/mL indicates depleted iron stores. Book Iron Studies
- Serum Iron, TIBC, Transferrin Saturation – low iron, high TIBC, and low transferrin saturation confirm IDA.
- Peripheral Blood Smear – microcytic, hypochromic red blood cells.
- Stool examination – for occult blood or parasitic infections if the cause is unclear.
Treatment Options#
Iron supplementation:
- Oral ferrous sulfate (325 mg, containing 65 mg elemental iron) 1-2 times daily on an empty stomach.
- Take with vitamin C (lemon juice, amla, orange) to enhance absorption by 2-3 times.
- IV iron (ferric carboxymaltose) for severe anemia, malabsorption, or intolerance to oral iron.
Dietary modifications:
- Include iron-rich Indian foods: ragi, bajra, green leafy vegetables (palak, methi), jaggery (gud), dates, black chana, rajma, and sesame seeds (til).
- Avoid tea and coffee within 1 hour of meals – tannins reduce iron absorption by up to 60 %.
- Combine iron-rich foods with vitamin C sources (tomato, lemon, amla) at every meal.
Treat underlying cause: Address heavy periods, treat parasitic infections, or investigate GI bleeding.
Prevention#
- Iron and folic acid supplementation for all pregnant women (as per Government of India's IFA programme).
- Include at least one iron-rich food in every major meal.
- Cook in cast-iron vessels – this can increase iron content of food by 1.5-2 times.
- Deworm children and adults in endemic areas every 6 months.
- Adolescent girls should receive weekly iron-folic acid supplements as per school health programmes.
When to See a Doctor#
Consult a doctor if you experience persistent fatigue, pallor, or shortness of breath. Seek urgent care if haemoglobin falls below 7 g/dL – this may require blood transfusion. Pregnant women with haemoglobin below 11 g/dL should start iron supplementation immediately under medical supervision.