Complaints & connections · borters.ch
Too little iron means too little oxygen transport — so the tiredness has a measurable reason, and one that can be fixed.
Also known as: iron deficiency anemia
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Iron sits in the red blood pigment, where it carries oxygen. When it runs short the store empties first — ferritin falls, and something is felt before the blood count changes: tiredness, poor stamina, hair loss, cold hands. Only then does haemoglobin drop and the shortage becomes anaemia. The red cells grow smaller and paler, which shows in the MCV. The commonest reason in women before the menopause is heavy periods, in pregnancy the raised need, in children growth. In men and in women after the menopause the view reverses: iron deficiency without a visible source of bleeding is a reason to look at the gut — blood is often lost there unnoticed. Further reasons are impaired absorption (coeliac disease, the stomach lining, after stomach surgery, acid blockers) and a diet very low in meat. Refilling takes months, not weeks: the blood count recovers in four to eight weeks, the store needs three to six months — which is why the tablets are often stopped too early.
Recurring mouth ulcers, cracked corners of the mouth, a smooth, burning tongue: these signs often appear before the anaemia becomes visible in the blood count.
With lasting inflammation iron is held in the store. The ferritin is then normal or high although the marrow lacks material — and the transferrin saturation is the value that helps.
Iron from animal sources is best absorbed — red meat, liver, fish.
Vitamin C with the meal markedly boosts absorption of plant iron.
Effective when deficient; every-other-day dosing is often better absorbed and tolerated than daily.
Three to six months beyond the recovery of the blood count — otherwise the store is empty as soon as the tablets stop. Recheck ferritin, not just haemoglobin.
One dose briefly raises a hormone that brakes the next absorption. Taken every other day and on an empty stomach, more gets in overall — and the stomach tolerates it better.
Tannins and calcium markedly slow absorption. An hour either side of the dose is usually enough.
With a marked deficiency, impaired absorption or intolerance, iron is available as an infusion. That is a medical decision and works quickly.
When neither blood loss nor diet explains the deficiency: giardia disturbs uptake exactly where iron is absorbed.
Worldwide they are the commonest cause of iron shortage of all: they suck blood in the small bowel, often for years and without belly complaints. They are usually taken up barefoot through the skin. The search is in the stool, and the treatment takes a few days.
An iron deficiency with no visible source of bleeding in someone who walked barefoot in warm countries has a rare but very treatable cause.
With a heavy load the inflamed colon lining bleeds a little but constantly. Children in warm countries are most affected; the stool sample reliably finds the eggs.
Iron refills the store. The blood count improves in two to four weeks, the store needs three to six months — so it is taken longer than one feels well. Every other day is absorbed better than daily, because the hormone hepcidin damps uptake for a day after a dose.
About one in three women of childbearing age has empty iron stores without anaemia. On iron, haemoglobin rises by some 10 g/l within two to four weeks — if it does not, either the intake is wrong or there is ongoing bleeding. The store needs three to six months. A ferritin below 30 µg/l counts as empty, below 100 with inflammation as not interpretable.
The commonest sign and the least specific. It becomes telling when stamina goes with it: stairs, cycling, shopping bags suddenly cost more.
Pulling down the lower lid is the quickest look — pink is normal. Only the blood count is reliable.
Hair falls diffusely across the whole scalp, often two to three months after the low point. That is exactly why patience helps: regrowth lags just as much.
A pulling and an urge to move the legs as soon as you settle. Iron deficiency is one of the few correctable reasons — ferritin is especially worth measuring here.
An urge to chew things that are not food — usually ice cubes. Rare, but so characteristic that it alone should lead to an iron test.
Men and women past the menopause do not normally lose iron. A deficiency with no identifiable source belongs investigated before it is simply topped up.
The single most important hint of worms in the blood. They are raised with worms that travel through tissue — not with giardia, threadworms and amoebae, which stay in the bowel. A normal value therefore rules nothing out.
Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.
In pregnancy clearly established against neural-tube defects, otherwise mainly with deficiency. Can mask a B12 deficiency — watch both.
The kidney measures the oxygen and orders more through this hormone. With iron deficiency EPO rises, but the marrow cannot carry out the order — the building material is missing. This is why iron helps here and not EPO.
An underactive thyroid itself causes anaemia and worsens heavy periods — the most common reason for iron deficiency in women. Both values therefore belong measured together.
In pregnancy the iron requirement roughly doubles, and the blood volume rises more than the number of red cells. A somewhat lower haemoglobin is therefore expected — a low ferritin is not.
Reputed to be iron-rich; plant iron is, however, absorbed much less well than animal iron.
TCM knows “Blood deficiency” — pale lips, brittle nails, dizziness, thin hair. The description matches iron deficiency strikingly well; the treatment in the blood count does not.
The classic blood food of Chinese cooking, in almost every strengthening soup. It supplies barely any iron — the effect is tradition and warmth, not ferritin.