Iron deficiency anemia is a common nutrient deficiency, affecting 30% of the population worldwide. Iron is important for making red blood cells that help carry oxygen to body tissues. Reasons for iron deficiency can include restrictive diets, heavy menstruation, malabsorption, and other health issues. Iron supplements may be helpful in supporting iron levels, particularly among women.
This article explores the role iron supplements can play in supporting iron levels, as well as signs that iron pills may be effective.
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Why Patients Are Given Iron Supplements
Patients are often given iron supplements to help address low iron levels. Without enough iron, the body may not produce enough healthy red blood cells, which can affect oxygen delivery to tissues. Iron supplements can help support iron stores, promote red blood cell production, and may help alleviate symptoms associated with low iron levels, thereby supporting overall health and well-being.
Conditions Supported by Iron Supplements
Iron supplements may help support iron levels in the following conditions:
- Iron deficiency with or without anemia
- Nutritional deficiency
- Malabsorption
- Blood loss
- Increased need for iron, such as during pregnancy
- Chronic inflammation
Common Causes of Iron Deficiency
Numerous factors can contribute to iron deficiency, including:
- Low dietary iron intake
- Chronic bleeding
- Heavy or long-lasting menstruation in women
- Gastrointestinal (GI) issues
- Celiac disease
- Crohn's disease
- Gastric surgeries
- Gastritis
- Underlying malignancy
- Chronic kidney disease
- Hemodialysis
- Small intestinal bacterial overgrowth (SIBO)
- Whipple disease
- Pregnancy
- Colon, small bowel, stomach, or esophageal cancers
- Esophageal varices caused by cirrhosis
- Gastrointestinal bleeding linked to long-term use of ibuprofen, aspirin, or blood-thinning medicines
- Peptic ulcer disease
- Excessive use of antacids or tetracycline (an antibiotic)
- Bone marrow disorders
- Autoimmune disorders
Individuals at a greater risk of iron-deficiency anemia include older adults, strict vegetarian dieters, babies, young children, and teenagers.
Benefits of Iron Supplements
Iron supplements can be important for people with iron deficiency or its risk factors because iron plays a key role in red blood cell production and oxygen transport throughout body tissues. In people with iron deficiency, iron supplementation may help restore normal blood cell functioning and reduce symptoms of low iron.
Signs Iron Pills May Be Working in Your Patients
There are several signs that may indicate iron pills are working in patients, including:
Improvement in Symptoms
Iron supplements may be effective if people experience fewer or no symptoms of iron deficiency. Increasing iron in the body can support hemoglobin levels, promote red blood cell formation, and enhance oxygenation, which may contribute to:
- Reduced fatigue
- More energy
- Improved mood and concentration
- Less weakness
- Reduced shortness of breath
- Improvements in pica (ice cravings resulting from iron deficiency)
- Lower heart rate
- Fewer heart palpitations
- Less dizziness
- Fewer headaches
- Warmer hands and feet
- Less hair loss
- Stronger nails
- Reduced lightheadedness
- Improvement in pale skin
- Reduced tongue soreness or inflammation
- Fewer or no mouth ulcers
- Fewer uncontrolled leg movements during sleep
Patients may also have a lower risk of infection as their iron levels reach normal values.
Physical Changes
Physical changes that may indicate iron supplements are working include healthier hair, skin, and nails. Patients might experience enhanced stamina, strength, and overall physical performance. They may notice improved skin tone, feel better overall, have more energy, and achieve a better quality of life.
Objective Lab Results
Objective lab results can also indicate that iron pills are working. Labs that evaluate iron levels include hemoglobin, hematocrit, iron, and ferritin levels. Signs iron pills are working may include normalization of hematocrit and hemoglobin and increased ferritin and iron.
Signs Iron Pills May Not Be Working
Signs that iron pills may NOT be working include:
Persistent or Worsening Symptoms
If an individual’s iron-deficiency anemia symptoms persist or worsen, iron supplements might not be working well enough to support iron levels. Signs iron deficiency isn’t improving may include:
- Continued fatigue
- Weakness
- Shortness of breath
- Pale skin
- Irregular heartbeats
- Difficulty concentrating
- Cravings for ice
- Dizziness
- Cold hands and feet
- Thinning hair
- Headache
- Lightheadedness
- Weak nails
- Sore or inflamed tongue
- Mouth ulcers
Patients might also have restless legs or a persistent urge to move their legs while sleeping.
Side Effects or Adverse Reactions
Side effects and reactions iron supplements may cause in some individuals include:
- Nausea
- Constipation
- Stomach pain, cramps, or discomfort
- Heartburn
- Diarrhea
- Dark stools
- Reduced appetite
Side effects associated with taking iron supplements are typically temporary, fading away as a patient’s body gets used to taking iron pills.
Some individuals may also have allergic reactions or an intolerance to some types of iron supplements.
Lab Results Indicating Lack of Improvement
Lab test results that indicate a lack of improvement of iron-deficiency anemia may include persistent low levels of hemoglobin, red blood cells, serum iron, ferritin, transferrin, mean corpuscular volume (MCV), and hematocrit. Other tests, including fecal occult blood and calprotectin stool testing, may indicate ongoing malabsorption or chronic gastrointestinal bleeding.
When to See a Doctor
Patients should see their doctor if they experience:
Severe or Persistent Symptoms
People with persistent symptoms, particularly those that are severe, should have a medical evaluation to determine the underlying cause and how to best address it. Providers may need to alter treatment plans if patients don’t respond to iron supplementation.
However, it might take 1-4 weeks after an individual begins treatment until they begin feeling better.
Concerns About Iron Supplementation
Individuals using iron supplements should see their healthcare provider if they have bothersome effects, allergic reactions, or other adverse reactions. Taking iron supplements with meals may help reduce their side effects.
However, iron pills often work best on an empty stomach or with vitamin C to support absorption.
Individuals should avoid taking iron supplements with caffeine, antacids, milk, or calcium supplements because doing so could reduce iron absorption within the body.
It’s important for healthcare providers to discuss alternative forms of iron supplements or treatments whenever necessary to minimize medical concerns.
Regular Monitoring and Follow-Up
Frequent follow-up appointments allow providers to track progress related to iron supplementation. There is a need for ongoing lab testing to ensure that taking iron pills is safe and effective while avoiding complications.
Lab Tests to Monitor Iron Supplementation
Lab tests to consider to monitor iron supplementation effectiveness in patients with iron deficiency include:
Complete Blood Count (CBC)
CBC lab tests include:
- Red blood cell count
- Hematocrit
- Hemoglobin
- Mean corpuscular volume (MCV)
- Mean corpuscular hemoglobin (MCH)
- Mean corpuscular hemoglobin concentration (MCHC)
- Red cell distribution width (RDW)
CBC labs allow healthcare providers to track improvements after beginning iron supplementation.
Iron Studies
Specific iron tests to consider for potentially anemic patients include:
- Serum iron
- Ferritin
- Transferrin
- Transferrin saturation (% sat)
- Total iron-binding capacity (TIBC)
- Unsaturated iron binding capacity (UIBC)
These lab tests provide a comprehensive understanding of iron status and its absorption within the body. Certain levels will be high or low based on the type of anemia present.
Additional Lab Tests
Other lab tests that evaluate if iron pills are working or screen for underlying medical conditions include:
- Vitamin B12 tests
- Folate tests
- Inflammation markers
- Occult blood
- Calprotectin
- Comprehensive stool analysis
- Blood tests that measure immune and genetic markers common in IBS, Crohn's disease, and Celiac disease
- SIBO breath test
- Comprehensive hormone panel identifying hormone imbalances contributing to heavy menstrual bleeding in women
- Gastrointestinal imaging
- Serum hCG to rule out pregnancy
- Comprehensive Helicobacter pylori stool test to screen for H. pylori infection
Imaging and endoscopic procedures can help diagnose Celiac disease, hypochlorhydria, IBD, and more.
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Key Takeaways
- Low-iron diets, malabsorption issues, blood loss, and underlying health problems can contribute to iron deficiency.
- Fatigue, dizziness, paleness, difficulty concentrating, and other signs of iron deficiency anemia often subside within 1-4 weeks after taking iron supplements — if supplementation is effective.
- Lab testing is an objective way to assess the effectiveness of iron supplements or determine the underlying cause of iron deficiency.
- Medical supervision and regular lab testing are crucial when taking iron supplements to support patient health outcomes.
- Patients should seek medical advice for concerns pertaining to iron supplementation, particularly if they experience consistent symptoms, worsening symptoms, or severe side effects.
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