Symptoms

Mild iron deficiency anemia may not cause noticeable symptoms. If anemia is severe, symptoms may include:

• Weakness, fatigue, or lack of stamina.
• Shortness of breath during exercise.
• Headache.
• Trouble concentrating.
• Irritability.
• Dizziness.
• Pale skin.
• Craving substances that are not food (pica). In particular, a craving for ice can be a sign of iron deficiency anemia.

Other signs may include:

• Rapid heartbeat.
• Brittle fingernails and toenails.
• Cracked lips.
• Smooth, sore tongue.
• Muscle pain during exercise.
• Trouble swallowing.

Babies and small children with iron deficiency anemia may not grow as expected and may have delays in skills such as walking and talking. Children may be irritable and have a short attention span. These problems usually go away when the deficiency is treated. If it is not treated, mental and behavior problems may be permanent.

Exams and Tests

If your doctor suspects iron deficiency anemia, he or she will do a physical exam and ask about your symptoms and your medical history. Your doctor will want to know about:

• Any medicines that you are taking.
• Your eating habits.
• Any current or past conditions or diseases that you or a close family member has had.
• Your history of pregnancy, menstruation, or other sources of bleeding.

Your doctor will recommend tests to check for low iron levels and anemia. Possible tests include:

• A complete blood count (CBC), to look at the shape, color, number, and size of your blood cells.
• Iron tests, which measure the amount of iron in your blood, to help determine the type and severity of anemia.
• Reticulocyte count, to help determine the cause of anemia. Reticulocytes are immature red blood cells produced by bone marrow and released into the bloodstream. Levels of reticulocytes are lower in iron deficiency anemia.
• A ferritin level test, which reflects how much iron may be stored in the body. Abnormally low ferritin levels may point to iron deficiency anemia. This is one of the first tests to be abnormal when you have iron deficiency.

If your doctor suspects that bleeding in your stomach or intestines is causing your anemia, you will have tests to determine the cause of the bleeding. These may include:

• A fecal occult blood test (FOBT), which looks for blood in stool samples.
• A colonoscopy. This test inspects the entire large intestine (colon) using a long, flexible, lighted viewing scope to look for polyps or other sources of bleeding.
• An upper gastrointestinal (GI) endoscopy. This test, which uses a thin, flexible, lighted viewing instrument, can help identify stomach ulcers or other causes of irritation or bleeding.
• Video capsule endoscopy. For this test, you swallow a capsule that contains a tiny camera. As the capsule travels through your system, the camera takes pictures of your small intestine that can show where bleeding is occurring.
• X-ray tests such as an upper GI series or barium enema.

If blood tests don't find the problem, you may need a test called a bone marrow aspiration. Bone marrow aspiration removes a small amount of bone marrow fluid through a needle inserted into the bone. Because iron is stored in the bone marrow, this test can provide a good idea of how much iron is in the body. But bone marrow aspirations are not done very often.