Iron-Deficiency Anemia

Vitamin B12 Deficiency Anemia

Iron-Deficiency Anemia | Johns Hopkins Medicine

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Vitamin B12 deficiency anemia is a condition in which your body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin B12.

This vitamin is needed to make red blood cells, which carry oxygen to all parts of your body. Without enough red blood cells, your tissues and organs don’t get enough oxygen.

Without enough oxygen, your body can’t work as well.

Folic acid, also called folate, is another B vitamin. Anemias caused by a lack of vitamin B12 or a lack of folate are 2 types of megaloblastic anemia.

With these types of anemia, the red blood cells don’t develop normally. They are very large. And they are shaped an oval, not round healthy red blood cells. This causes the bone marrow to make fewer red blood cells.

In some cases the red blood cells die sooner than normal.

What causes vitamin B12 deficiency anemia?

Vitamin B12 deficiency anemia is more common in people whose families come from northern Europe. It is caused by one of the following:

  • Lack of intrinsic factor. Intrinsic factor is a protein made in the stomach. It is needed to absorb vitamin B12. This type of B12 deficiency anemia is called pernicious anemia.
  • Surgery that removes or bypasses the end of the small intestine. This part of the small intestine is where vitamin B12 is absorbed.

The inability to make intrinsic factor may be caused by several things, such as:

  • Chronic gastritis
  • Surgery to remove all or part of the stomach (gastrectomy)
  • An autoimmune condition, where the body attacks its own tissues

Other types of megaloblastic anemia may be linked with type 1 diabetes, thyroid disease, and a family history of the disease.

The inability to make intrinsic factor may be the result of several factors, such as chronic gastritis, gastrectomy (removal of all or part of the stomach), or an autoimmune condition (the body attacks its own tissues). Other types of megaloblastic anemia may be associated with type 1 diabetes, thyroid disease, and a family history of the disease.

Who is at risk for vitamin B12 deficiency anemia?

Risk factors for vitamin B12 deficiency anemia include:

  • A family history of the disease
  • Having part or all of your stomach or intestine removed
  • Autoimmune diseases, including type 1 diabetes
  • Crohn's disease
  • HIV
  • Some medicines
  • Strict vegetarian diets
  • Being an older adult

What are the symptoms of vitamin B12 deficiency anemia?

Each person’s symptoms may vary. Symptoms may include:

  • Weak muscles
  • Numb or tingling feeling in hands and feet
  • Trouble walking
  • Nausea
  • Decreased appetite
  • Weight loss
  • Irritability
  • Lack of energy or tiring easily (fatigue)
  • Diarrhea
  • Smooth and tender tongue
  • Fast heart rate

The symptoms of megaloblastic anemia may look other blood conditions or health problems. Always see your healthcare provider for a diagnosis.

How is vitamin B12 deficiency anemia diagnosed?

This type of anemia is usually found during a medical exam through a routine blood test. Your healthcare provider will take your medical history and give you a physical exam.

Your provider may give you additional blood tests. You may also have other evaluation procedures, such as a bone marrow biopsy.

How is vitamin B12 deficiency anemia treated?

Your healthcare provider will figure out the best treatment for you :

  • How old you are
  • Your overall health and medical history
  • How sick you are
  • How well you handle certain medicines, treatments, or therapies
  • If your condition is expected to get worse
  • Your opinion or preference

Vitamin B12 deficiency anemia and folate deficiency anemia often occur together and can be hard to tell apart. Treatment may include vitamin B12 shots (injections) and folic acid pills.

Foods that are rich in folic acid include the following:

  • Orange juice
  • Oranges
  • Romaine lettuce
  • Spinach
  • Liver
  • Rice
  • Barley
  • Sprouts
  • Wheat germ
  • Soy beans
  • Green, leafy vegetables
  • Beans
  • Peanuts
  • Broccoli
  • Asparagus
  • Peas
  • Lentils
  • Chickpeas (garbanzo beans)

Foods that are rich in both folic acid and vitamin B12 include the following:

  • Eggs
  • Meat
  • Poultry
  • Milk
  • Shellfish
  • Fortified cereals

Taking folic acid by mouth is more effective than eating foods rich in folic acid. Vitamin B12 is not as well absorbed by mouth as per injection.

Living with vitamin B12 deficiency anemia

Depending on the cause of your vitamin B12 deficiency, you may need to take vitamin B12 supplements for the rest of your life. These may be pills or shots. This may seem difficult. But it will let you live a normal life without symptoms.

If your deficiency is due to a restrictive diet, you may want to work with a nutritionist. He or she can help ensure that you get enough vitamin B12 and other vitamins. Tell your healthcare provider about any symptoms and follow your treatment plan.

Key points about vitamin B12 deficiency anemia

  • With this condition, your body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin B
  • It is one of several types of megaloblastic anemia.
  • Without enough red blood cells, your tissues and organs don’t get enough oxygen. Without enough oxygen, your body can’t work as well.
  • Symptoms include weak muscles, numbness, trouble walking, nausea, weight loss, irritability, fatigue, and increased heart rate.
  • Treatment may include vitamin B12 supplements. It is also important to eat a well-balanced diet.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.


Iron Deficiency and Anemia – Signs and Therapeutic Options

Iron-Deficiency Anemia | Johns Hopkins Medicine

GlobalRPh student writer

Iron is an essential mineral. Be it forming and oxygenating blood cells and hemoglobin, maintaining the immune system, or contributing to cognitive function, the human body needs iron. This said, iron deficiency is the most common nutritional deficiency in the world. Almost 2 billion people are iron-deficient, according to the stats.

What Is Iron Deficiency

Not having enough iron in the body is known as iron deficiency or sideropenia. Total body iron of an adult is about 4 g and about 70 percent of it is found in hemoglobin and myoglobin.

Hemoglobin is the oxygen carrier in red blood cells (RBC) whereas myoglobin is that of muscles. Without sufficient iron, the body can’t make red blood cells. The result: tiredness and lack of energy.

Plus, it can lead to many health problems, including iron deficiency anemia.

Signs of Iron Deficiency

The signs and symptoms of iron deficiency vary, depending on its severity, as well as a person’s age and health status. In some cases, it is also possible to be iron deficient and have no symptoms. Common signs include:

  • Fatigue: One of the most common symptoms of an iron deficit. This is because less oxygen reaches muscles and tissues, depriving them of energy. Also, the heart tries to pump more oxygenated blood around the body, which can drain a person’s energy.
  • Pale skin: Hemoglobin gives blood its color and, thus, the skin its rosy hue. Low iron may be to blame if the gums, inside of lips and bottom eyelids are pale.
  • Shortness of Breath: Low hemoglobin levels translate into poor oxygen transportation to muscles and tissues and heightened breathing rate. Blame it on iron deficiency, if you feel air while doing easy daily tasks.
  • Restless leg syndrome: Approximately 15% of people with restless leg syndrome may have iron deficiency, says John Hopkins Medicine.
  • Frequent headaches: Lack of iron can cause the brain arteries to swell, which then translates into headaches, says the National Headache Foundation. This is because the body prioritizes getting more oxygen to the brain.
  • Anxiety (for no reason): A lack of oxygen revs up heartbeat and sympathetic nervous system. The result: fight-or-flight mode even when one has every reason to feel ‘Zen’.
  • Hair loss: Losing around 100 hairs on a good day is normal. Having iron deficiency inhibits hemoglobin production, which is essential for hair growth. The result: excessive thinning of hair.
  • Underactive thyroid gland: Iron is essential for thyroid function, says the National Academy of Hypothyroidism. Iron-deficient people experience low energy levels and sudden weight gain because of an underactive thyroid gland.
  • Inflamed tongue(Glossitis): Low iron levels significantly reduce myoglobin, an iron-containing protein in muscle. As a result, iron-deficient people complain of swelling, sores or strangely smooth tongue.

Causes of Iron deficiency

People can have low iron levels for several reasons:

  • Iron malabsorption: Age and medications can interrupt the body’s ability to absorb ion even after consuming iron-rich foods. Medical conditions such as inflammatory bowel disease (IBD) or surgical procedures can also contribute to iron deficiency and anemia.
  • Blood loss: Chronic blood loss can cause one to lose more red blood cells and iron. Blood loss can be a result of,
  1. Internal bleeding from ulcers, colon cancer and bleeding disorders such as von Willebrand disease and polycythemia vera.
  2. Long-term use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
  3. Heavy menstrual periods
  4. Frequent blood tests or donations
  5. Urinary tract bleeding
  • Inadequate dietary intake: Poorly balanced vegetarian or vegan diet and chronic fad dieting can create an imbalance in iron levels in the body. Infants, adolescent girls, pregnant women, and lactating mothers need more iron than others. Consuming iron-fortified formulas and iron-rich foods ensure they get enough iron for bodily functions.
  • Exercise: athletes are more prone to iron deficiency anemia because regular workout increases the iron requirement of the body. For instance, hard exercises promote red blood cell production, while the iron is lost through sweat and urine. Mechanical hemolysis (destruction of red blood cells from physical shear) and exercise-induced gastrointestinal bleeding also contribute to iron deficiency in endurance athletes. Furthermore, a high-carb low-fat diet can increase the risk of iron deficiency.

Other causes include obesity, gut infections, urinary tract bleeding, kidney failure, and congestive heart failure.

The Risk Factors

Some iron deficiency risk factors can be managed, while other factors may be beyond control. For example, age, gender, and health status. Also, iron deficiency is much more prevalent in the populations of developing nations, with women and children having an increased risk of developing anemia.

At-Risk Groups

  • Pregnant women: Blood volume increases by 30 to 50 percent during pregnancy. This, in turn, increases fetus’ iron demand to produce red blood cells (especially during the third trimester). Women who don’t have enough iron stores can develop iron deficiency anemia. This can be further aggravated with other factors twin pregnancy, low iron diet, repeated pregnancies or adolescent pregnancy.
  • Women with heavy periods: Due to excessive blood loss and increased blood supply demands, this category of women is the most affected ones – with a global prevalence of approximately 42%.
  • Adolescent girls: Their often poor or restricted diets – combined with puberty changes – put these girls in the high-risk groups.
  • Young children: Toddlers and preschoolers have the highest prevalence of iron deficiency anemia – a whopping 47%, says World Health Organization (WHO). Young children often receive a good supply of cow’s milk, yet it is not sufficient to meet the daily iron requirements. Moreover, cow’s milk can decrease iron absorption and can irritate the intestinal lining.
  • People who have gone Surgeries: Surgical procedures can also increase a person’s risk of becoming iron-deficient and anemic.
  • Malnourished people: People living in developing nations are another group susceptible to iron deficiency. Incidences of malnutrition and immunodeficiency worsen the situation.
  • Frequent blood donors: Studies show that serum ferritin levels of regular blood donors than non donors. Ferritin is an iron-containing protein that is used as a marker to test the iron reserves of the human body.

How Much Iron Is Needed

The recommended daily intake (RDI) isn’t one-size-fits-all, especially for children and women. Adult women between the ages of 19 and 50 require 18 mg of iron a day, with men in that age requiring 20 mg.

For pregnant women, the RDI bumps up to 27 mg whereas lactating mothers require only 9 mg. Plus, the heaviness of the period could alter the iron requirements in women. However, after women stop menstruating, the number goes down considerably to 8 mg per day.

Since non-heme has a low absorption rate, the RDI for vegans and vegetarians is 1.8X that of meat-eaters.

How To Get More Iron

Of the several nutrients, the human body can’t make six groups essential nutrients on its own. These nutrients (vitamins, minerals, protein, fat, carbohydrate, and water) must come from food.

Food has two types of iron – heme (found in animal products) and non-heme (found in plants). Heme iron is easier to absorb- about 30 percent of what one consumes whereas the human body can absorb only 2 to 10 percent of the non-heme iron.

Some of the best heme iron foods are:

  • Liver (chicken and beef)
  • Oysters, clams, and mussels
  • Red meat (Lean Beef and lamb)
  • Chicken and Turkey
  • Tuna and Canned Sardines

Moving onto the best non-heme foods, we have

  • Legumes (beans, lentils, and peas)
  • Nuts and Seeds (Pumpkin, Flaxseeds, cashews and macadamia nuts)
  • Leafy Greens (spinach, kale, swiss chard, collard)
  • Whole-grain and enriched bread
  • Corn syrup and Maple syrup

Fill the plates with these iron-rich foods to reduce the risk of iron deficiency and anemia.

Iron Regulation

The human body maintains appropriate levels of iron for vital functions, even if the iron consumption rate doesn’t always exactly match with iron loss. Thanks to ferritin, a protein that can store 4500 iron (III) ions per protein molecule.

Ferritin stores extra iron (mostly in the liver) and uses it during times when dietary intake is inadequate. Thus, it acts as a ‘buffer’ against iron deficiency and iron overload. Poor dietary intake and diseases can affect the body’s iron regulation.

Over time, this results in the depletion of iron stores in the body. Most common effects include:

  • Iron depletion: It occurs when the hemoglobin levels are normal but a small amount of stored iron. It usually has no obvious signs and symptoms.
  • Iron deficiency: Both iron and hemoglobin levels drop below normal. Iron-deficient people may experience some symptoms, including fatigue, dizziness, and poor appetite.
  • Iron deficiency anemia: It is characterized by a lower-than-normal RBC count and insufficient hemoglobin levels. Symptoms include fatigue, shortness of breath, lightheadedness, and palpitations. Cognition impairment and immunodeficiency diseases are also common in anemic patients.

How Iron Deficiency Is Diagnosed

Doctors diagnose iron deficiency with blood tests.

  • Complete blood count (CBC): It determines red blood cells (RBCs), white blood cells (WBCs), hemoglobin, hematocrit, and platelets. The CBC also helps to diagnose iron deficiency anemia. Smaller RBCs and low hematocrit and hemoglobin levels are characteristics of iron deficiency anemia.
  • Transferrin test: It measures transferrin (iron transporting protein) levels in the blood. Under normal conditions, transferrin is one-third saturated with iron and two-thirds is held in reserve.
  • TIBC (total iron-binding capacity): It measures the total amount of iron that can be bound by circulatory proteins. Since transferrin is the primary iron-binding protein, the TIBC test is an alternative to measure transferrin availability.
  • Serum iron and ferritin levels: These are indicators of the amount of iron available in the blood and body.
  • Fecal occult blood test (FOBT): Iron deficiency due to gastrointestinal bleeding may show a positive FOBT.

Iron Deficiency: Therapeutic Options

Iron deficiency treatment is a two-step approach: first, finding and treating the underlying cause and then bringing back iron levels back to normal. Finding the type of deficiency and what is causing it is important in older patients. Because the risk of developing colorectal cancer and gastrointestinal bleeding gets higher with age.

Stats show that about 60% of iron deficient adults may have gastrointestinal disorders leading to heavy blood loss. Next comes oral iron supplementation using iron salts and/or iron-rich foods. The choice of the supplement depends on the severity of iron deficiency, recovery period, and the health profile of the patient.

The non-prescription iron supplements come with two forms of iron: ferrous and ferric. Ferrous iron salts (ferrous sulfate, ferrous gluconate, and ferrous fumarate) are faster absorbing forms. Generally, they are administered with ascorbic acid to boost bioavailability. Taking iron supplements with orange and grapefruit juice is also recommended to improve absorption.

Eating iron-rich foods also helps to restore iron levels in the body.

Additional notes

Self-diagnosis and self-medication are not recommended. Taking iron supplements when tired or light-headed will not help unless iron deficiency anemia is confirmed.

Fatigue, paleness, and palpitations can be symptomatic of other health conditions, not just iron deficiency or anemia. Some of them could be an early sign of chronic diseases.

Don’t overdo iron supplements. They may interfere with the absorption of other minerals, including copper and zinc.

Nausea, constipation, diarrhea and black stools are the common side effects associated with oral iron replacement therapy.

Iron overdose can be fatal.


Adolescent female blood donors at risk for iron deficiency and associated anemia

Iron-Deficiency Anemia | Johns Hopkins Medicine

Female adolescent blood donors are more ly to have low iron stores and iron deficiency anemia than adult female blood donors and nondonors, which could have significant negative consequences on their developing brains, a new study led by Johns Hopkins researchers suggests. these findings, the authors propose a variety of measures that could help this vulnerable population.

Each year, an estimated 6.8 million people in the U.S. donate blood, according to the American Red Cross, which coordinates blood drives across the country. Adolescents are increasingly contributing to the donor pool due to blood drives at high schools. In 2015, adolescents ages 16-18 contributed approximately 1.5 million blood donations.

Although blood donation is largely a safe procedure, adolescents are at a higher risk for acute, adverse donation-related problems, such as injuries from fainting during donation, explains study leaders Eshan Patel, M.P.H.

, a biostatistician in the Department of Pathology at the Johns Hopkins University School of Medicine, and Aaron Tobian, M.D., Ph.D.

, professor of pathology, medicine, oncology and epidemiology at the Johns Hopkins University School of Medicine and director of transfusion medicine at The Johns Hopkins Hospital.

Additionally, they add, blood donation may also increase the risk of iron deficiency, as each whole blood donation removes about 200-250 milligrams of iron from the blood donor.

Because adolescents typically have lower blood volumes, when donating the same amount of blood, they have a relatively higher proportional loss of hemoglobin — the iron-containing protein in blood cells that transports oxygen — and consequently more iron during donation than adults.

Females are even more at risk of iron deficiency than males due to blood loss during menstruation every month.

Numerous studies have shown that younger age, female sex and increased frequency of blood donation are all associated with lower serum ferritin levels (a surrogate for total body iron levels) in blood donor populations.

However, note Patel and Tobian, no study using nationally representative data has compared the prevalence of iron deficiency and associated anemia between blood donor and nondonor populations, specifically adolescents.

Toward this end, the researchers analyzed data from the National Health and Nutrition Examination Survey, a long-running study designed to assess the health and nutritional status of adults and children in the U.S.

both physical exams and interviews conducted by the Centers for Disease Control and Prevention.

From 1999 to 2010, this study included collections of blood samples as well as questions about blood donation history in the past 12 months.

The researchers found 9,647 female participants 16-49 years old who had provided both samples and blood donor history information. There were 2,419 adolescents ages 16-19 in this group.

They report in the journal Transfusion on Feb. 19 that about 10.7 percent of the adolescents had donated blood within the past 12 months, compared with about 6.4 percent of the adults. Mean serum ferritin levels were significantly lower among blood donors than among nondonors in both the adolescent (21.2 vs. 31.4 nanograms per milliliter) and the adult (26.2 vs. 43.

7 nanograms per milliliter) populations. The prevalence of iron deficiency anemia was 9.5 percent among adolescent donors and 7.9 percent among adult donors — both low numbers, but still significantly higher than that of nondonors in both age groups, which was 6.1 percent. Besides, 22.6 percent of adolescent donors and 18.3 percent of adult donors had absent iron stores.

Collectively, the authors say, these findings highlight the vulnerability of adolescent blood donors to associated iron deficiency.

Patel and Tobian note that some federal policies and regulations are already in place to protect donors in general from iron deficiency due to this altruistic act, such as hemoglobin screening, a minimum weight to donate and an eight-week interval between donations for repeat whole blood donation. However, more protections are necessary for adolescent donors — for example, suggesting oral iron supplementation, increasing the minimum time interval between donations or donating other blood products such as platelets or plasma rather than whole blood could help mitigate iron loss.

“We're not saying that eligible donors shouldn't donate. There are already issues with the lack of blood supply,” Tobian says. “However, new regulations or accreditation standards could help make blood donation even safer for young donors.”

Story Source:

Materials provided by Johns Hopkins Medicine. Note: Content may be edited for style and length.

Journal Reference:

  1. Eshan U. Patel, Jodie L. White, Evan M. Bloch, Mary K. Grabowski, Eric A. Gehrie, Parvez M. Lokhandwala, Patricia A. R. Brunker, Ruchika Goel, Beth H. Shaz, Paul M. Ness, Aaron A. R. Tobian. Association of blood donation with iron deficiency among adolescent and adult females in the United States: a nationally representative study. Transfusion, 2019; DOI: 10.1111/trf.15179


Iron-Deficiency Anemia

Iron-Deficiency Anemia | Johns Hopkins Medicine

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The most common cause of anemia worldwide is iron deficiency. Iron is needed to form hemoglobin, part of red blood cells that carry oxygen and remove carbon dioxide (a waste product) from the body. Iron is mostly stored in the body in the hemoglobin. About one-third of iron is also stored as ferritin and hemosiderin in the bone marrow, spleen, and liver.

What causes iron-deficiency anemia?

Iron-deficiency anemia may be caused by the following:

  • Diets low in iron. Iron is obtained from foods in our diet; however, only 1 mg of iron is absorbed for every 10 to 20 mg of iron ingested. A person unable to have a balanced iron-rich diet may suffer from some degree of iron-deficiency anemia.

  • Body changes. An increased iron requirement and increased red blood cell production is required when the body is going through changes, such as growth spurts in children and adolescents, or during pregnancy and lactation.

  • Gastrointestinal tract abnormalities. Malabsorption of iron is common after some forms of gastrointestinal surgeries. Most of the iron taken in by foods is absorbed in the upper small intestine.

    Any abnormalities in the gastrointestinal (GI) tract could alter iron absorption and result in iron-deficiency anemia. Surgery or medications that stop stomach acid production will also decrease iron absorption.


  • Blood loss. Loss of blood can cause a decrease of iron and result in iron-deficiency anemia. Sources of blood loss may include GI bleeding, menstrual bleeding, or injury.

What are the symptoms of iron-deficiency anemia?

The following are the most common symptoms of iron-deficiency anemia. However, each individual may experience symptoms differently. Symptoms may include:

  • Abnormal paleness or lack of color of the skin

  • Irritability

  • Lack of energy or tiring easily (fatigue)

  • Increased heart rate (tachycardia)

  • Sore or swollen tongue

  • Enlarged spleen

  • A desire to eat peculiar substances such as dirt or ice (a condition called pica)

The symptoms of iron-deficiency anemia may resemble other blood conditions or medical problems. Always consult your doctor for a diagnosis.

How is iron-deficiency anemia diagnosed?

Iron-deficiency anemia may be suspected from general findings on a complete medical history and physical examination, such as complaints of tiring easily, abnormal paleness or lack of color of the skin, or a fast heartbeat (tachycardia).

Iron-deficiency anemia is usually discovered during a medical examination through a blood test that measures the amount of hemoglobin (number of red blood cells) present, and the amount of iron in the blood.

In addition to a complete medical history and physical examination, diagnostic procedures for iron-deficiency anemia may include the following:

  • Additional blood tests for iron

  • Bone marrow aspiration and/or biopsy. A procedure that involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells. This test is usually not necessary. 

  • Upper and/or lower endoscopy. These tests may help rule out a source of blood loss.  

Treatment for iron-deficiency anemia

Specific treatment for iron-deficiency anemia will be determined by your doctor :

  • Your age, overall health, and medical history

  • Extent of the anemia

  • Cause of the anemia

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the anemia

  • Your opinion or preference

Treatment may include:

  • Iron-rich diet. Eating a diet with iron-rich foods can help treat iron-deficiency anemia. Good sources of iron include the following:

    • Meats, such as beef, pork, lamb, liver, and other organ meats

    • Poultry, such as chicken, duck, turkey, (especially dark meat), liver

    • Fish, such as shellfish, including clams, mussels, and oysters, sardines, anchovies

    • Leafy greens of the cabbage family, such as broccoli, kale, turnip greens, and collards

    • Legumes, such as lima beans and green peas; dry beans and peas, such as pinto beans, black-eyed peas, and canned baked beans

    • Yeast-leavened whole-wheat bread and rolls

    • Iron-enriched white bread, pasta, rice, and cereals

  • Iron supplements. Iron supplements can be taken over several months to increase iron levels in the blood. Iron supplements can cause irritation of the stomach and discoloration of bowel movements.

    They should be taken on an empty stomach, or with orange juice, to increase absorption. They are much more effective than dietary interventions alone. In cases of malabsorption or intolerance, IV iron may be needed.

  • Evaluation for a source of blood loss. This may include upper endoscopy or colonoscopy. 

How does the body process iron?

Iron is present in many foods and absorbed into the body through the stomach. During this process of absorption, oxygen combines with iron and is transported into the plasma portion of blood by binding to transferrin. From there, iron and transferrin are used in the production of hemoglobin, stored in the liver, spleen, and bone marrow, and utilized as needed by all body cells.

The following is a list of foods that are good sources of iron. Always consult your doctor regarding the recommended daily iron requirements for your particular situation.

Iron-Rich FoodsQuantityApproximate Iron
(milligrams) Oysters Beef liver Prune juice Clams Walnuts Ground beef Chickpeas Bran flakes Pork roast Cashew nuts Shrimp Raisins Sardines Spinach Lima beans Kidney beans Turkey, dark meat Prunes

Roast beef

Green peas Peanuts Potato Sweet potato Green beans Egg
3 ounces 13.2
3 ounces 7.5
1/2 cup 5.2
2 ounces 4.2
1/2 cup 3.75
3 ounces 3.0
1/2 cup 3.0
1/2 cup 2.8
3 ounces 2.7
1/2 cup 2.65
3 ounces 2.6
1/2 cup 2.55
3 ounces 2.5
1/2 cup 2.4
1/2 cup 2.3
1/2 cup 2.2
3 ounces 2.0
1/2 cup 1.9
3 ounces 1.8
1/2 cup 1.5
1/2 cup 1.5
1 1.1
1/2 cup 1.0
1/2 cup 1.0
1 1.0