Severe fatigue, lack of energy, weakness, headaches, dizziness, pale skin… Does this sound familiar? One possible cause may be iron deficiency, when the body’s iron stores are significantly reduced, and in more serious cases it can lead to anemia, a condition characterized by low hemoglobin levels.
How common are iron deficiency and anemia, what is the role of iron in our body, who is most at risk, and what is important to know about anemia during pregnancy? These and other important questions are addressed by Dr. Nellija Seimuškina, gynecologist, reproductive specialist, and infertility treatment expert at “Northway” Clinic.
How common are iron deficiency and anemia?
Anemia affects approximately 1.62 billion people worldwide — about 24.8% of the global population (McLean et al., 2009). Anemia is suspected when hemoglobin (Hb) levels fall below 120 g/L in women and below 130 g/L in men, and the most common cause is iron deficiency. Among all mineral deficiencies, iron deficiency is the most common. It is estimated that even in developed countries, around 30–40% of preschool children and pregnant women suffer from iron deficiency (World Health Organization, 2008). Thus, it is a global issue requiring increased attention.
Possible consequences of iron deficiency
- In adults: significantly reduced work productivity and overall quality of life;
- In pregnant women: increased risk of childbirth complications, preterm birth, and low birth weight;
- In children: impaired physical and cognitive development and more frequent illness.
To avoid iron deficiency and prevent anemia, especially for people in risk groups, it is important to ensure adequate intake of iron-rich foods and, if necessary (after consulting a doctor), use iron supplements. Regular health check-ups, including ferritin, iron, and hemoglobin testing, are also an essential part of prevention.
The role of iron in the body
Iron in the human body is found in hemoglobin, in many proteins and enzymes, in storage organs (liver, spleen, bone marrow), and in immune system cells.
- Iron is involved in the production of red blood cells and hemoglobin;
- It is important for immune system function;
- It supports muscle function, connective tissue formation, normal growth and development, and hormone production;
- It ensures oxygen transport to tissues and removal of carbon dioxide. Iron deficiency can disrupt oxygen exchange, leading to fatigue and, in severe cases, anemia;
- Iron is important for DNA integrity. Enzymes involved in DNA synthesis and repair depend on sufficient iron. Iron deficiency disrupts cell growth and division.
How does iron deficiency manifest?
Most common symptoms include:
- persistent fatigue
- weakness
- reduced physical endurance
- shortness of breath
- restless legs syndrome
- headaches and dizziness
- in rare cases, pica (craving non-food items such as chalk, ice, or soil)
Risk groups
People most at risk of iron deficiency include:
- individuals with heart failure or ischemic heart disease
- people with an unbalanced diet, including vegetarians, vegans, and raw foodists
- pregnant women, new mothers, and women with heavy menstrual bleeding
- premature babies or infants with low birth weight
- patients with conditions causing blood loss or malabsorption (e.g., gastrointestinal bleeding)
- elderly people with chronic diseases or inflammation, including those with B12 or folate deficiency or kidney disease
- blood donors, due to frequent loss of iron through blood donation
Diagnosis
Iron deficiency anemia is not a separate disease but usually a consequence of other health issues, so the underlying cause must be identified.
- Determine the cause of anemia and perform additional tests if necessary (e.g., colonoscopy or gastroscopy);
- In unexplained iron deficiency cases, test for celiac disease;
- Preoperative optimization is important to detect and treat iron deficiency before surgery, especially when significant blood loss is expected. Diagnostics include complete blood count, iron studies (ferritin, CRP), kidney function tests, and comparison with previous results.
Diagnostic approach
Recommended evaluation includes:
- Complete blood count and serum ferritin – key diagnostic markers for iron deficiency anemia
- Serum iron is NOT suitable for diagnosis because it fluctuates throughout the day and decreases during inflammation
- Ferritin interpretation: in elderly patients or those with inflammation, iron deficiency may exist even with ferritin levels up to 60–100 µg/L
- C-reactive protein (CRP): helps detect inflammation that may mask iron deficiency
- Hematologist consultation if diagnosis is unclear
- Absorption disorders: inflammation, medications, dietary factors (e.g., calcium or phytates), and gastrointestinal diseases may impair iron absorption
Anemia during pregnancy – why is it dangerous?
Anemia in pregnancy is defined as hemoglobin levels below:
- First trimester: Hb < 110 g/L
- Second and third trimester: Hb < 105 g/L
- Postpartum: Hb < 100 g/L
Symptoms of anemia during pregnancy
Symptoms are often non-specific unless anemia is severe. The most common include:
- pale skin
- weakness
- headaches
- palpitations
- dizziness
- shortness of breath
- irritability
Iron deficiency may also affect body regulation, causing increased sensitivity to cold.
Even when hemoglobin levels are normal, iron deficiency can still cause symptoms such as fatigue, hair loss, and cognitive difficulties (poor concentration, irritability).
A rare symptom is pica (craving non-food substances).
How to prevent anemia?
Recommendations:
- Complete blood count (CBC):
- at the start of prenatal care
- repeated at 28 weeks of pregnancy
- Dietary recommendations:
- consume iron-rich foods (lean meat, leafy greens, legumes, fish)
- include vitamin C-rich foods to improve iron absorption (citrus fruits, peppers)
- limit tea, coffee, and calcium-rich foods during meals
- avoid taking iron supplements at the same time as medications that reduce stomach acidity (separate by a few hours)
Iron depletion before anemia develops
Iron stores decrease before hemoglobin levels drop, meaning symptoms can appear even before anemia is detected. Early diagnosis through ferritin testing is essential.
Diagnostic criteria:
- Ferritin < 15 µg/L → iron deficiency diagnosed
- Ferritin < 30 µg/L in pregnancy → treatment should be started (recommendation level 2A)
Ferritin is the most useful marker for assessing iron deficiency. Early treatment based on ferritin levels can prevent anemia progression and improve pregnancy outcomes.
Remember – only regular ferritin monitoring, prevention of iron deficiency, and timely treatment can effectively reduce its negative effects.
All necessary tests, including iron level assessments during pregnancy and postpartum, can be conveniently done at “Northway: Clinic. Appointments: +371 26407723 or +371 28664723, Email: info@northwayklinika.lv.
