Iron deficiency anemia is a type of anemia caused by a lack of iron in the body. Without the iron it needs, the body is unable to function normally. Patients may suffer symptoms like weakness, shortness of breath, and cold hands and feet.

Doctors typically prescribe oral iron supplements to treat iron deficiency anemia, but in some cases, a more direct approach is needed. Injectable iron replacement products like Injectafer go directly into the bloodstream, and can help replenish iron levels more quickly than oral iron supplements.

Injectafer can cause side effects in some people, however, including severe hypophosphatemia (HPP), in which the body becomes dangerously deficient in phosphate.

How Many People Suffer from Anemia?

The Centers for Disease Control and Prevention (CDC) states that in 2014, about 188,000 people went to the emergency room and were diagnosed with anemia. In 2015, over 5,000 people died of the condition. In a 2016 study, researchers found that between 2003 and 2012, about 5.6 percent of the U.S. population had anemia, and about 1.5 percent had moderate-severe anemia. Certain groups were at a higher risk:

  • Pregnant women
  • Elderly people
  • Women of reproductive age
  • Non-Hispanic blacks
  • Hispanics

Rates among men increased with age, while women either 40-49 years or 80-85 years were most at risk. The scientists also found that anemia is a “growing problem,” noting that prevalence nearly doubled from 2003-2004 to 2011-2012.

What is Anemia?

Anemia is a condition in which the body lacks oxygen-rich blood. There are not enough healthy red blood cells to take the oxygen where it needs to go, so patients feel tired and dizzy, and may suffer from headaches or shortness of breath.

Red blood cells contain a protein called “hemoglobin.” When you breathe in oxygen, it comes into your lungs, then attaches to the hemoglobin in your blood. As the blood circulates throughout the body, it carries the oxygen (secured by hemoglobin) to the tissues and organs that need it. One hemoglobin protein carries four oxygen molecules, dropping it off to various cells that then use it for repair, maintenance, and other normal physiological activities.

If a doctor suspects that a patient has anemia, he or she will conduct a blood test and measure hemoglobin levels. The following measurements indicate low hemoglobin:

  • In men: less than 13.5 g/dL
  • In women: less than 12 g/dL
  • In children: varies with age

If levels are low, it’s most likely that the person has anemia, especially if the symptoms match, too.

What is Iron-Deficiency Anemia?

There are several different things that can cause anemia, including the following:

  • Severe blood loss
  • Chronic inflammation
  • A diet lacking B vitamins
  • Blood disorders like sickle cell anemia
  • Bone marrow problems
  • Cancer
  • Some autoimmune diseases (including hemolytic anemia, where the immune system mistakenly attacks the red blood cells)
  • Severe high blood pressure
  • Spleen enlargement
  • Thyroid disorders
  • Other medical conditions (like liver disease)

The most common cause in the United States, however, is an iron deficiency. If a person doesn’t have enough iron in the body, she can’t make enough hemoglobin, because iron is necessary for manufacturing hemoglobin.

What causes a person to be short on iron? There are many possibilities:

  • Inability to absorb it well (possible after gastric bypass surgery, or in patients with inflammatory bowel diseases)
  • Pregnancy (during pregnancy, the body requires more iron)
  • Vegetarian or vegan diet (meat is a rich source of iron—vegans and vegetarians must eat carefully to ensure they get enough iron from other sources)
  • Blood loss (during heavy menstruation, or after an accident or injury)
  • Donating blood too often
  • Medications that interfere with iron absorption (antacids, drugs to treat acid reflux)
  • Malnutrition (anorexic, or suffering from another eating disorder)
  • Stomach or intestinal bleeding (from an ulcer, cancer, or taking too many non-steroidal anti-inflammatory drugs)
  • Chronic kidney disease
  • Infections

What are the Symptoms of Iron-Deficiency Anemia?

At mild levels, iron deficiency anemia may cause no symptoms. But at moderate and severe levels, symptoms usually include:

  • Fatigue
  • Weakness
  • Pale skin or yellowish skin
  • Fast or irregular heartbeat
  • Chest pain
  • Shortness of breath
  • Headaches
  • Dizziness or lightheadedness
  • Cold hands and feet
  • Pounding or “whooshing” sound in the ears
  • Difficulty concentrating
  • Sexual dysfunction

If the condition continues untreated, complications can develop, including:

  • Heart problems (irregular heartbeat, enlarged heart, heart failure)
  • Pregnancy problems (premature birth, low birth weight)
  • Growth problems in children (delayed growth and development)

How is Iron Deficiency Anemia Diagnosed?

To diagnose the condition, a doctor conducts a thorough medical exam, looks at the patient’s health history, and runs blood tests to measure the following:

  • Hemoglobin levels
  • Ferritin (this is a protein in the body that stores iron—if levels are low, it means iron levels are likely low, too)
  • What red blood cells look like (small, pale red blood cells indicate iron deficiency anemia)
  • Hematocrit levels (how much of the blood volume is made up of red blood cells)

If, after looking at these tests, the doctor believes the patient has iron deficiency anemia, he or she may conduct more tests to determine the cause. Does the patient have an ulcer? Is she bleeding internally? Is she suffering from excess menstrual bleeding? Tests may include endoscopy, colonoscopy, or ultrasound. These, together with the blood test, help create a final diagnosis.

How is Iron Deficiency Anemia Treated?

Treatment depends on the cause, but since an iron deficiency is usually to blame, doctors will recommend some form of iron replacement. Usually that involves iron pills or iron supplements delivered over a period of many weeks—often many months, as it can take time to restore iron reserves to normal. The doctor determines the dose based on the individual.

Though oral iron supplements are an effective treatment for iron deficiency anemia, they don’t work for everyone. Sometimes:

  • The individual can’t tolerate the pills—because of a digestive problem, he or she can’t absorb the iron needed, or struggles too much with side effects like constipation
  • The iron pills don’t work for some other reason
  • The individual has kidney disease

When the anemia is severe, the patient may need a faster remedy than pills can provide. In these and other situations, doctors may recommend iron injections instead.

Not All Iron Injections are the Same

Iron injections may be administered through the muscle or intravenously (IV). Often the ones that are administered intravenously are called iron “infusions.” Iron injections take less time to administer, but they can cause side effects, including pain, bruising, and skin discoloration around the injection site. Iron infusions are delivered through a drip IV, and can take 30 minutes or more.

Like oral iron pills, iron infusions can have side effects, too. Patients may experience headaches, joint pain, or a mild metallic taste in the mouth. These are not serious and will pass, but some iron infusions can have a more serious side effect known as hypophosphatemia (HPP). Injectafer, more than other brands of iron infusions, has been found in studies to increase the risk of HPP and severe HPP.

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