Causes and symptoms of iron deficiency

Iron deficiency is common in Australia. It may be caused by:

• inadequate dietary intake of iron (eg toddlers or adolescents, people with a vegan or vegetarian diet, anorexia nervosa)
• malabsorption (eg coeliac disease, pernicious anaemia or after gastrectomy or bariatric surgery)
• increased iron requirements (eg pregnancy or breastfeeding, during periods of rapid growth [toddlers and adolescents], heavy menstrual loss or chronic gastrointestinal blood loss).

Iron deficiency in adults is often secondary to gastrointestinal blood loss. Refer the patient to a gastroenterologist if gastrointestinal blood loss is suspected.

Iron deficiency may cause fatigue and a microcytic hypochromic anaemia. Other less common symptoms of iron deficiency include pica and restless leg syndrome.

Many patients may be asymptomatic despite significant anaemia. Anaemia associated with iron deficiency may be well tolerated even when the haemoglobin is low, because it typically develops gradually. However, anaemia can cause breathlessness, angina, claudication as well as fatigue. Fatigue may also be present in an iron-deficient patient with normal haemoglobin.

For residents of an aged-care facility, consider whether an advance care plan is in place, and whether investigation for, or treatment of, iron deficiency is appropriate for each patient. For information on advance care plans, see the Palliative Care guidelines.