Iron Deficiency Anemia: Find the Cause, Not Just the Pill

Fatigue, breathlessness, pallor, hair loss, restless legs, brittle nails, sometimes pica (craving non-food items).

Diagnosis

Low ferritin is the most specific test. In inflammation, ferritin can be falsely normal; transferrin saturation helps.

Find the source

• Premenopausal women: heavy menstrual bleeding most common
• Men and postmenopausal women: investigate digestive tract bleeding
• Coeliac disease screening in unexplained cases

Treatment

Oral iron, preferably alternate-day dosing for better absorption. IV iron for intolerance, malabsorption, or severe deficiency.

Adult-onset iron deficiency without obvious bleeding requires endoscopic evaluation.