Health Insights · Endocrine & metabolic
Iron deficiency anaemia: causes and treatment
Iron deficiency is the commonest nutritional deficiency in the world and one of the commonest causes of persistent tiredness. Correcting it matters — but so does answering the question that gets skipped: where has the iron gone? In an adult, that question sometimes has a serious answer.
Seek urgent assessment if you have
- chest pain, severe breathlessness or fainting
- black tarry stools, or vomiting blood
- visible blood in the stool, or a persistent change in bowel habit
- unexplained weight loss, or a lump in the abdomen
- a very low haemoglobin with palpitations or collapse
In men of any age, and in women after the menopause, iron deficiency anaemia requires investigation of the gut — it is a recognised presentation of bowel cancer. Being given iron tablets without that investigation is not adequate care.
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
Ask for ferritin, not just haemoglobin
Haemoglobin is the last thing to fall. Iron stores can be exhausted for months or years before anaemia appears, and during that time you can have every symptom of iron deficiency with a 'normal' full blood count. Ferritin is the test that shows the stores. Ferritin below 30 indicates deficiency in most people; below 15 is definitive. Ferritin rises with inflammation, so it is interpreted alongside CRP. If you have been told your blood count is normal but you have the symptoms above, ask specifically for ferritin.
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.
Why come to us. We test ferritin alongside a full blood count as standard, not haemoglobin alone, and add B12, folate, coeliac screening and thyroid function where the picture suggests it — all in-house, with results explained by a clinician in the same visit. We then look for the cause rather than simply prescribing iron: women's health assessment for heavy periods, gastroenterology review, with endoscopy arranged through our CQC-registered partners where the gut needs investigating. Open 7 days a week, no referral needed.
Private assessment for iron deficiency anaemia in East London
Low iron causes tiredness, breathlessness and pallor, and it is important both to treat it and to find the cause. A private GP in East London can arrange blood tests and treatment, and our gastroenterology team can investigate the cause with endoscopy where needed, particularly in men and women after the menopause. Tower Bridge Hospital is on Whitechapel Road in East London, a short journey from Canary Wharf and the City, with same-day appointments and no referral required.
Iron deficiency anaemia in London: common questions
What causes iron deficiency?
Heavy periods, diet, poor absorption (such as coeliac disease), and blood loss from the gut; the cause guides investigation.
Why investigate the cause?
Especially in men and post-menopausal women, iron deficiency can indicate bleeding from the gut that needs assessment.
How is it treated?
With iron supplements, dietary advice, and sometimes an iron infusion; treating the cause prevents it returning.
Can I be seen the same day?
Yes — same-day private GP appointments are available most days.
Ferritin tested, and the cause found
Bloods in-house, results the same visit. 7 days a week, no referral.