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Iron deficiency anemia

Last reviewed: 10 Jun 2025
Last updated: 29 Apr 2025

Summary

Definition

History and exam

Key diagnostic factors

  • fatigue
  • dyspnea on exertion
  • pica
  • restless legs syndrome
  • nail changes
  • dysphagia
Full details

Other diagnostic factors

  • impaired muscular performance
  • glossitis and angular stomatitis
  • dyspepsia
  • pallor
  • hair loss
  • rectal lesion on examination
  • growth impairment
  • cognitive and behavioral impairment
  • heart failure
  • recurrent infections
Full details

Risk factors

  • pregnancy
  • vegetarian and vegan diet
  • menorrhagia
  • hookworm infestation
  • chronic kidney disease
  • celiac disease
  • gastrectomy/achlorhydria
  • nonsteroidal anti-inflammatory drugs (NSAID) use
  • chronic heart failure
  • preterm or low birth weight
  • infant feeding with cows' milk
  • black women and Mexican women
  • low socioeconomic status
  • obesity
  • Helicobacter pylori infection
Full details

Diagnostic tests

1st tests to order

  • hemoglobin and hematocrit
  • platelet count
  • MCV
  • MCH
  • MCHC
  • red cell distribution width
  • peripheral blood smear
  • reticulocyte count
  • serum iron
  • total iron-binding capacity
  • transferrin saturation
  • serum ferritin
  • celiac serology
  • urinalysis
  • Helicobacter pylori testing
Full details

Tests to consider

  • hemoglobin electrophoresis
  • urease breath test
  • autoimmune gastritis testing
  • upper gastrointestinal endoscopy (esophagogastroduodenoscopy)
  • small-bowel biopsy
  • lower gastrointestinal endoscopy (colonoscopy)
  • CT colonography
  • transferrin receptor-ferritin index
  • bone marrow biopsy
  • monitored trial of iron
  • fecal occult blood tests
Full details

Emerging tests

  • urinary hepcidin
  • percentage of hypochromic erythrocytes
  • reticulocyte hemoglobin content
  • erythrocyte protoporphyrin

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Atul Mehta, MD

Consultant Haematologist

Lysosomal Storage Disorders Unit

Department of Haematology

Royal Free Hospital

London

UK

利益声明

AM declares that he has no competing interests.

鸣谢

Dr Atul Mehta would like to gratefully acknowledge Dr Martina Murphy, Dr Marc Zumberg, and Dr Rebecca Fischer Connor, previous contributors to this topic.

利益声明

MZ declares that he is medical director for NCF Diagnostics and DNA Technologies, and a consultant for Alexion Pharmaceuticals. MM and RFC declare that they have no competing interests.

同行评议者

Carlos Aravena, MD

Internal Medicine Instructor

Member of Evidence Based Medicine Unit

Catholic University of Chile

Santiago

Chile

利益声明

CA declares that he has no competing interests.

Jim Murray, MBBS

Consultant Haematologist

Clinical Haematology

University Hospital Birmingham NHS Trust

Birmingham

UK

利益声明

JM declares that he has no competing interests.

Ajay Kumar, MD, FACP

Medical Director

Blood Management

Cleveland Clinic

Cleveland

OH

利益声明

AK has received a fee for speaking about perioperative blood management from Ortho-Biotech, and has also received reimbursement from medscape.com for the education webcast of the same presentation.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

US Preventive Services Task Force. Iron deficiency and iron deficiency anemia during pregnancy: screening and supplementation. Aug 2024 [internet publication].全文

Pavord S, Daru J, Prasannan N, et al. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol. 2020 Mar;188(6):819-30.全文  摘要

Snook J, Bhala N, Beales ILP, et al. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut. 2021 Nov;70(11):2030-51.全文  摘要

US Preventive Services Task Force. Iron deficiency anemia in young children: screening. Sep 2015 [internet publication].全文

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Iron deficiency anemia images
  • 鉴别诊断

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    • Disorders of globin synthesis (thalassemias, hemoglobin E, hemoglobin C, unstable hemoglobins)
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  • 指南

    • Guideline for the laboratory diagnosis of iron deficiency in adults (excluding pregnancy) and children
    • Guidelines for the management of iron deficiency anaemia in adults
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  • 患者教育信息

    Anemia, iron deficiency

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