Iron deficiency causes tiredness, breathlessness on stairs, hair shedding and poor concentration, and it starts long before anaemia shows on a blood count. Ferritin is the test that finds it. The Core panel including ferritin is £350 and a doctor reads it with you.
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Any of these needs to be seen the same day. If you are severely unwell, go to your nearest emergency department or call 999.
Iron deficiency means the body’s iron stores are low. Anaemia is what happens when they are low enough that the blood cannot carry oxygen properly, and it is the late stage rather than the condition itself.New England Journal of Medicine Camaschella, 2015
It is the commonest nutritional deficiency in the world and the commonest cause of anaemia. Anaemia is defined by the World Health Organization as haemoglobin below 120 grams per litre in a non pregnant woman and below 130 in a man.World Health Organization WHO/NMH/NHD/MNM/11.1, 2011
Tiredness, breathlessness climbing stairs, poor concentration, hair shedding, brittle nails, restless legs and a craving for ice or chalk. Many people have had these for a year or more before anybody measures a ferritin.New England Journal of Medicine Camaschella, 2015
In women who menstruate, blood loss is the usual cause. In men, and in women past the menopause, the cause is assumed to be bleeding from the gut until proven otherwise, and that changes the appointment from a prescription into an investigation.Gut Snook, 2021
Where periods are the cause, treating the bleeding is part of treating the iron. Reducing blood loss and replacing stores together is what stops the cycle repeating every year.NICE NG88, 2021
Send us what you are seeing and we will tell you what it is likely to be.
Ferritin is the test. A level below 30 micrograms per litre indicates iron deficiency in most people. Ferritin also rises with inflammation, so a normal reading alongside a raised inflammatory marker does not exclude it and transferrin saturation is checked instead.Gut Snook, 2021
A full blood count comes with it, because the size of the red cells tells you how long the deficiency has been running. Coeliac testing is part of the work up and only works while you are still eating gluten.Gut Snook, 2021
Thyroid goes in the same draw. An underactive thyroid produces the same tiredness, the same cold hands and the same hair shedding, and finding one without checking the other leaves half the answer on the table.NICE NG145, 2019
Iron deficiency anaemia in a man, or in a woman past the menopause, is a reason for an urgent gastrointestinal investigation whatever else is going on. We arrange it rather than treat around it.NICE NG12, 2015
Finding and treating the cause
Heavy periods, coeliac disease, a gut source of bleeding, or a diet with no iron in it. Replacing iron without answering this is a treatment that has to be repeated indefinitely, and in women who menstruate the bleeding is the usual answer.Royal College of Obstetricians and Gynaecologists RCOG guidance, 2022
Diet alone
Useful for maintaining stores and too slow to correct a deficiency. Red meat, pulses and dark leafy vegetables with vitamin C, away from tea and coffee.
Oral iron on alternate days
Alternate day dosing is absorbed better than daily dosing, because a dose raises a hormone that blocks absorption for the following 24 hours. It also causes fewer stomach effects, which is why people stay on it.American Journal of Hematology Auerbach, 2016
Intravenous iron
Corrects stores in one or two visits. It is for people who cannot absorb or cannot tolerate oral iron, or who need correcting quickly, and it is a hospital day case rather than a first step.American Journal of Hematology Auerbach, 2016
Haemoglobin rises within 2 to 4 weeks of effective treatment and normalises by 8 weeks. Refilling the stores takes another 3 months after that, so treatment continues for 3 months beyond the point at which you feel better.American Journal of Hematology Auerbach, 2016
Energy and concentration often improve before the numbers do, and hair shedding is the slowest to recover because the hair cycle is long. Expect 3 to 6 months before the shedding settles, and do not judge it earlier.New England Journal of Medicine Camaschella, 2015
Take oral iron on alternate days, with vitamin C, on an empty stomach, and at least 2 hours away from tea, coffee, milk and calcium. Those four rules roughly double what you absorb from the same tablet and they cost nothing.American Journal of Hematology Auerbach, 2016
Ask for the ferritin number rather than whether it was normal. Many laboratory ranges start at 10 or 15 micrograms per litre, and a level under 30 is treated as deficiency, so a result inside the printed range can still be the answer.Gut Snook, 2021
Do not cut gluten out before you are tested. Coeliac testing only works while you are still eating it, and stopping first means the test has to be repeated after 6 weeks of eating it again.Gut Snook, 2021
Do not buy a general vitamin panel to investigate tiredness. Ferritin, a full blood count, thyroid and vitamin D answer most of it, and the wider panels add markers nobody acts on.New England Journal of Medicine Camaschella, 2015
Do not buy an iron infusion as a first step. Oral iron corrects most deficiency at a fraction of the cost, and an infusion is for people who cannot absorb or cannot tolerate it. Saying so costs us the larger fee.American Journal of Hematology Auerbach, 2016
Step 1
Ferritin with a full blood count, thyroid and vitamin D in one draw. Results in a day or two with the numbers, not a normal or abnormal.
Step 2
Periods, diet, coeliac disease, or a gut source. In a man or a woman past the menopause that question is answered before treatment is called finished.
Step 3
Alternate day oral iron with the absorption rules, and a repeat ferritin at 3 months to prove the stores have actually refilled.
Ask before you book if you are not sure this is the right appointment.
Below 30 micrograms per litre indicates iron deficiency in most people, and that is well inside many printed laboratory ranges. Ask for the number. Ferritin also rises with inflammation, so a normal reading with a raised inflammatory marker is checked further rather than accepted.
Yes, and it is the commonest version of it. Stores fall first and the blood count is the last thing to change, so tiredness, breathlessness on stairs and hair shedding can all be present while haemoglobin is still normal.
On alternate days rather than daily, with vitamin C, on an empty stomach, and at least 2 hours away from tea, coffee and calcium. Alternate day dosing is absorbed better and upsets fewer stomachs, which is the reason most people give up on it.
Energy often improves within 2 to 4 weeks. Haemoglobin normalises by about 8 weeks and the stores take a further 3 months, so treatment continues past the point you feel well. Hair shedding is the slowest and takes 3 to 6 months.
The Core panel, which includes ferritin, a full blood count, thyroid and vitamin D, is £350 and a doctor reads it with you and writes the plan. A 30 minute appointment to look for the cause is £150 and the 3 month recheck by telephone is £59.
Yes, and in a man it is treated as a warning rather than a nutritional problem. Iron deficiency anaemia in a man, or in a woman past the menopause, is investigated for a gut source of bleeding urgently, and we arrange that rather than only replacing the iron.
No. Coeliac disease is part of the work up and the blood test for it only works while you are still eating gluten. Cutting it out before testing means eating it again for 6 weeks and starting over.
This page is general information about a condition and it is not a diagnosis. Treatment depends on what a doctor finds when they examine you, and no outcome is guaranteed. If you are severely unwell, or if any of the warnings at the top of this page apply to you, go to your nearest emergency department or call 999.
American Journal of Hematology
How we diagnose and treat iron deficiency anaemiaAuerbach, 2016
Gut, British Society of Gastroenterology
Guidelines for the management of iron deficiency anaemia in adultsSnook, 2021
New England Journal of Medicine
Iron deficiency anaemiaCamaschella, 2015
NICE
NICE
Thyroid disease, assessment and managementNG145, 2019
NICE
Heavy menstrual bleeding, assessment and managementNG88, 2021
Royal College of Obstetricians and Gynaecologists
Heavy menstrual bleeding, patient and clinical informationRCOG guidance, 2022
World Health Organization
Haemoglobin concentrations for the diagnosis of anaemia and assessment of severityWHO/NMH/NHD/MNM/11.1, 2011
Written by the clinical team at The Wellness. Awaiting clinical sign off.
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