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The World Health Organization considers iron deficiency the number one nutritional disorder in the world. It affects more than 30% of the world’s population. 

When your need for iron increases or a loss of iron from bleeding exceeds your dietary iron intake, a negative iron balance may occur. Initially this results in iron depletion, in which the storage form of iron is decreased while blood hemoglobin level remains normal. Iron deficiency occurs when blood and storage levels of iron are low, and the blood hemoglobin level falls below normal. 

Iron deficiency anemia may result from a low dietary intake, inadequate intestinal absorption, excessive blood loss, and/or increased needs. Women of childbearing age, pregnant women, older infants and toddlers, and teenage girls are at greatest risk of developing iron deficiency anemia because they have the greatest needs. 

Individuals with renal failure, especially those receiving dialysis, are at high risk for developing iron deficiency anemia. This is because their kidneys cannot create enough erythropoietin, a hormone needed to make red blood cells. Iron and erythropoietin can also be lost with blood during dialysis, which can result in an iron deficiency. Extra iron and erythropoietin are usually needed to help prevent iron deficiency in these individuals.

Iron deficiency could also be caused by low vitamin A status. Vitamin A helps to mobilize iron from its storage sites, so a deficiency of vitamin A limits the body’s ability to use stored iron. This results in an “apparent” iron deficiency because hemoglobin levels are low, even though the body can maintain normal amounts of stored iron. While uncommon in the U.S., this problem is seen in developing countries where vitamin A deficiency often occurs. 

The anemia that may occur with inflammatory disease differs from iron deficiency anemia. It occurs in people who have chronic infectious, inflammatory, or malignant disorders. It is not associated with a shortage of dietary iron, and may not respond to iron supplementation. A physician should manage anemia associated with an inflammatory disorder. 

Signs of iron deficiency anemia include feeling tired and weak, decreased work and school performance, slow cognitive and social development during childhood, difficulty maintaining body temperature, and decreased immune function, which may decrease resistance to infection. During pregnancy, iron deficiency is associated with increased risk of premature deliveries, giving birth to infants with low birth weight, and maternal complications.

Who may need extra iron to prevent a deficiency?

Iron deficiency and iron deficiency anemia are relatively common in women of childbearing age, older infants and toddlers, and teenage girls, so they should periodically be screened for iron deficiency. Within these groups, iron deficiency is more common among women with heavy menstrual losses, women belonging to minority and low-income groups, and women who have had more than one child. Women taking oral contraceptives may experience less bleeding during their periods and have a lower risk of developing an iron deficiency while women using an intrauterine device (IUD) may experience more bleeding and have a greater risk of developing an iron deficiency. If laboratory tests indicate iron deficiency, iron supplements may be recommended. Many physicians routinely prescribe iron supplements during pregnancy because of the high incidence of iron deficiency anemia in pregnant women and the potential benefits for the mother and the fetus. Pregnancy increases a woman’s need for iron due to increased blood volume, increased needs of the fetus, and blood losses that occur during delivery. 

Excluding all meat and meat products, poultry, and fish from your diet may reduce your total iron intake and will decrease your intake of heme iron, which is easily absorbed by your body. It will also influence your iron status because animal proteins can improve the absorption of nonheme iron found in plant foods. Vegetarians who exclude all animal products from their diet may need twice as much dietary iron because the intestinal absorption of nonheme iron is lower in plant foods. Vegetarians should also consider consuming nonheme iron sources together with a good source of vitamin C, such as citrus fruits or certain vegetables, to enhance absorption of nonheme iron.