Private iron deficiency anaemia clinic in London, same-day endocrinology.

Symptoms

• tiredness that sleep does not fix, and breathlessness on stairs
• pale skin, palpitations, headaches and dizziness
• hair shedding, brittle or spoon-shaped nails
• restless legs at night — strongly associated with low ferritin
• sore, cracked corners of the mouth, and a smooth sore tongue
• pica — craving ice, soil or chalk — which is odd, specific and genuinely diagnostic
• reduced exercise tolerance and poor concentration

Where the iron goes

• Heavy periods — by far the commonest cause in women who menstruate, and frequently normalised for years.
• Pregnancy and breastfeeding, which have high demands.
• Gut blood loss — ulcers, inflammation, polyps, bowel cancer, and regular anti-inflammatory or aspirin use.
• Coeliac disease, which impairs absorption and is found in a meaningful proportion of unexplained cases.
• Diet — vegan and vegetarian diets, and iron-poor diets generally.
• Long-term acid-suppressing medication, which reduces absorption.
• Blood donation, endurance exercise, and after bariatric surgery.

Taking iron so that it works

• Alternate-day dosing is now often preferred to daily. Taking iron every day raises hepcidin, which blocks absorption of the next dose; alternate days absorbs more overall with fewer side effects.
• Take it on an empty stomach if you can tolerate it, with vitamin C or orange juice, which substantially improves absorption.
• Avoid tea, coffee, milk, calcium supplements and antacids within two hours — all markedly reduce absorption.
• Black stools are expected and harmless. Constipation is common — increase fluid and fibre rather than stopping.
• If one preparation upsets you, another may not. Do not simply abandon it.
• Continue for three months after ferritin normalises to refill the stores, or it will simply drop again.

When infusions are used

Intravenous iron corrects deficiency far faster than tablets and is used where tablets are not tolerated or not absorbed, where losses outstrip what tablets can replace, in significant anaemia before surgery, and in chronic kidney or inflammatory bowel disease. It is given in a single or small number of sessions.