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Iron deficiency

Iron is essential for carrying and storing oxygen in our blood, for energy production, and for cell growth. Learn about the effects of iron deficiency on our health.

What is iron deficiency?

Iron deficiency is one of the leading contributors to the global burden of disease1. Iron is an essential nutrient that is normally acquired from food1. The total amount of iron in the body of a healthy person is approximately 3 to 4 grammes, which corresponds to a concentration of 40-50 mg of iron per kilogramme of body weight1.

Iron plays a vital role in the transport and storage of oxygen, in oxidative metabolism and in cellular growth. Iron is an essential building block for haemoglobin, a protein present in the red blood cells that carry oxygen from the lungs to the tissues and organs, where iron is needed to make energy.2

Haemoglobin depends on iron for its formation and oxygen-carrying properties, and a lack of iron can cause a drop in the haemoglobin level and result in a condition called iron deficiency anaemia.3

Iron deficiency is thought to be the most common cause of anaemia globally, although other nutritional deficiencies (e.g. folic acid and vitamin B12), inflammation, parasitic infections, and disorders that affect haemoglobin or red blood cell production, can also cause anaemia.4

An estimated 2 billion people are anaemic worldwide, of whom more than 1 billion live with iron deficiency anaemia.5

  1. Pasricha SR, Tye-Din J, Muckenthaler MU, Swinkels DW. Iron deficiency. Lancet. 2021 Jan 16;397(10270):233-248.

  2. Yiannikourides A, Latunde-Dada GO. A short review of iron metabolism and pathophysiology of iron disorders. Medicines. 2019;6:85. doi: 10.3390/medicines6030085

  3. Ems T, St Lucia K, Huecker MR. Biochemistry, iron absorption. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. [Updated 2023 Apr 17]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448204/

  4. Camaschella C. Iron deficiency: new insights into diagnosis and treatment. Hematology Am Soc Hematol Educ Program. 2015;2015:8-13. doi:10.1182/asheducation-2015.1.8

  5. Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME); 2020. Available from http://ghdx.healthdata.org/gbd-results-tool.

Facts

Iron is used to produce red blood cells, which help store and carry oxygen in the blood1.

If you have fewer red blood cells than normal, your organs and tissues will not get as much oxygen as they usually would1. 

Iron deficiency adversely affects3-5:

  • Cognitive performance, behaviour and physical growth in children

  • Immune status and morbidity from infections in all age groups

  • Physical capacity and work performance in adolescents and adults

  • Untreated iron deficiency can lead to iron deficiency anaemia

  • Increased risk of hospitalisation and/or death in patients with iron deficiency, heart failure and chronic kidney disease

Anaemia is the most common and widespread nutritional disorder in the world.2, Anaemia contributes to 20% of all maternal deaths6.

  1. NHS. Iron deficiency anaemia. NHS; [updated 2022 Dec 1; cited 2024 Aug 6]. Available from: https://www.nhs.uk/conditions/iron-deficiency-anaemia/

  2. World Health Organization. Anaemia. WHO; [updated 2023 May 1; cited 2024 Aug 6]. Available from: https://www.who.int/health-topics/anaemia#tab=tab_1

  3. Doom JR, Georgieff MK. Institutional care and iron deficiency increase ADHD symptomology and lower IQ 2.5-5 years post-adoption. Dev Sci. 2015;18(3):484-494. doi:10.1111/desc.12223.

  4. Dosman CF, Brian JA, Drmic IE, Senthilselvan A, Harford MM, Smith RW, Sharieff W, Zlotkin SH, Moldofsky H, Roberts SW. Children with autism: effect of iron supplementation on sleep and ferritin. Pediatr Neurol. 2007;36(3):152-158. doi:10.1016/j.pediatrneurol.2006.11.004.

  5. Falkingham M, Abdelhamid A, Curtis P, Fairweather-Tait S, Dye L, Hooper L. The effects of oral iron supplementation on cognition in older children and adults: a systematic review and meta-analysis. Nutr J. 2010;9:4. doi:10.1186/1475-2891-9-4.

  6. Zage AU, et al. Maternal anemia and risk of neonatal mortality: a review. Neonatal. 2024;4(1):16

Symptoms

A typical symptom of iron deficiency with or without anaemia – and the most common reason for seeking medical care – is fatigue, which can have a negative effect on the ability to perform daily activities and functions1. Other symptoms are dizziness, balance disturbances, headache, mild shortness of breath, abnormal heartbeat, mild depression and irritation, and reduced cognitive performance affecting concentration, memory and learning, as well as affected vision, and feeling cold.2-5

  1. Haas JD, et al. Maternal anemia and risk of neonatal mortality: a review. J Nutr. 2001;131(2S-2):676S-688S; discussion 688S-690S.

  2. Mayo Clinic. Iron deficiency anemia - Symptoms & causes. Mayo Clinic; [cited 2024 Aug 6]. Available from: https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/symptoms-causes/syc-20355034

  3. Mayo Clinic. Anemia - Symptoms and causes. Mayo Clinic; [cited 2024 Aug 6]. Available from: https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360

  4. Verywell Health. Anemia: Signs, Symptoms, and Complications. Verywell Health; [cited 2024 Aug 6]. Available from: https://www.verywellhealth.com/anemia-signs-symptoms-complications-5093144

  5. Cleveland Clinic. Anemia: Symptoms, Causes & Treatment. Cleveland Clinic; [cited 2024 Aug 6]. Available from: https://my.clevelandclinic.org/health/diseases/3929-anemia

Causes

Iron deficiency can be caused by a nutritional deficit of iron in the diet, by an underlying disease affecting the uptake and absorption of iron into the blood stream, or by substantial or recurrent blood loss. Furthermore, in a condition called functional iron deficiency, the body’s iron stores are not empty, but the release of iron from the stores is compromised.

The cells of the human body require iron for both mental and physical health, and when the body’s need for iron exceeds the supply of iron, the body becomes iron deficient.

Iron deficiency anaemia is prevalent in patients suffering from chronic inflammatory conditions such as heart failure, Inflammatory Bowel Disease and Chronic Kidney Disease1,2. It is also common in women due to heavy menstruation, pregnancy or after childbirth. Other underlying causes of iron deficiency anaemia include loss of iron through bleeding, such as during surgery3-5.

  1. Mehdi U et al. Diabetes Care. 2009;32(7):1320-1326

  2. Stein J et al. Nat Rev Gastroenterol Hepatol. 2010;7(11):599-610

  3. Verywell Health. Heavy Menstrual Periods Leading to Iron Deficiency Anemia. Verywell Health; [cited 2024 Aug 6]. Available from: https://www.verywellhealth.com/heavy-menstrual-bleeding-iron-deficiency-anemia-5218940

  4. Munro MG. How heavy menstrual bleeding impacts iron deficiency and anemia. Contemporary OB/GYN; [cited 2024 Aug 6]. Available from: https://www.contemporaryobgyn.net/view/how-heavy-menstrual-bleeding-impacts-iron-deficiency-and-anemia

  5. Mayo Clinic. Iron deficiency anemia during pregnancy: Prevention tips. Mayo Clinic; [cited 2024 Aug 6]. Available from: https://www.mayoclinic.org/diseases-conditions/pregnancy/expert-answers/iron-deficiency-anemia-during-pregnancy/faq-20432390

Treatment

Iron deficiency is a prevalent medical disorder than can be caused by inadequate intake or absorption of iron from the diet. Increased iron loss, due to gastrointestinal or menstrual bleeding, or during surgery, can also contribute to iron deficiency. Another cause is an increased demand for iron, such as during pregnancy and childhood1,2.

The goal of treating iron deficiency is to replenish iron stores and normalise haemoglobin levels in anaemic patients. Initially, most patients are prescribed iron tablets. However, correcting iron deficiency with oral iron supplementation may take several months, and iron tablets are poorly tolerated by some patients. Therefore, if oral iron supplementation is ineffective or poorly tolerated, or if there is an urgent need to restore iron stores, patients may receive intravenous iron treatment3.

The underlying cause of the iron deficiency should always be considered, as this may require separate intervention. In some cases, it will be possible to cure the underlying cause and thereby prevent iron deficiency from re-occurring. In other cases, the underlying cause is not easily correctable, particularly in chronic conditions such as inflammatory bowel disease, heart failure or chronic kidney disease. These patients often require repeated iron treatment over many years1,4,5.

Because iron deficiency is frequently a consequence of other diseases and not the primary cause of the illness, it can often be neglected or underestimated6.

  1. Johns Hopkins Medicine. Iron-deficiency anemia. Johns Hopkins Medicine; [cited 2024 Aug 6]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/irondeficiency-anemia

  2. MSD Manual Professional Edition. Iron deficiency anemia. MSD Manual Professional Edition; [cited 2024 Aug 6]. Available from: https://www.msdmanuals.com/professional/hematology-and-oncology/anemias-caused-by-deficient-erythropoiesis/iron-deficiency-anemia

  3. Pasricha SR, Tye-Din J, Muckenthaler MU, Swinkels DW. Iron deficiency. Lancet. 2021 Jan 16;397(10270):233-248.

  4. Gasche C, Lomer MCE, Cavill I, Weiss G. Iron, anaemia, and inflammatory bowel diseases. Gut. 2004 Aug;53(8):1190-7. doi: 10.1136/gut.2003.035758.

  5. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005 Mar 10;352(10):1011-23. doi: 10.1056/NEJMra041809.

  6. Cleveland Clinic. Iron-Deficiency Anemia: Symptoms, Treatments & Causes. Cleveland Clinic; [cited 2024 Aug 6]. Available from: https://my.clevelandclinic.org/health/diseases/16250-iron-deficiency-anemia

Pharmacosmos is...

A global pioneer in carbohydrate chemistry and a leader in the development of innovative treatments for patients suffering from iron deficiency and iron deficiency anaemia.

Pharmaceuticals

We want to change the way iron deficiency is prevented and treated, and have brought to market innovative treatments for patients suffering from iron deficiency and iron deficiency anaemia.

Carbohydrates

We are a leader in the development and production of glucose poly- and oligosaccharides and their derivatives for pharmaceutical, high-tech and medical use.

Animal Health

Our expertise in iron extends to veterinary medicine, where we produce ferric hydroxide complex according to the same standards as required for human medicines.