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Month: February 2018

Iron Deficiency Signs and Symptoms -Part IV

Iron Deficiency Signs and Symptoms -Part IV

Symptoms of Iron Deficiency Anemia:

Iron is essential for oxygen carrying capacity.  Iron deficiency and anemia decreases oxygen delivery to all major organs of the body. Most especially the brain, heart and muscles.   Iron deficiency manifests with easily identified symptoms and conditions.  Here is a quick overview followed by a more detailed description.


common symptoms of iron deficiency anemia

Mental Fatigue and Cognitive Impairment.

Iron is an essential cofactor for neurotransmitter and myelin synthesis.  Brain neuronal cells require iron for DNA synthesis, mitochondrial respiration, and other vital processes.  As with each of these conditions, iron deficiency anemia reduces tissue oxygenation.  The brain is vitally dependent on O2 and glucose.

Pale (pallid) or Yellow (sallow) Skin.

Here is a comparison of a well perfused (red blooded) iron sufficient hand with an anemic iron deficient hand.  This is simply a visual sign of arterial oxygenation saturation.  Well oxygenated and perfused blood is red.   Technically, we can measure arterial pO2, pCO2 and pH.   The pO2 is the partial pressure of oxygen.

Pulling the lower eyelid revealing the conjunctival inner surface.  This reveals a lack of normal capillary perfusion.  While I was an Emergency Physician we also used another rapid test.  Pressing a fingernail watching for rapid reperfusion or capillary refilling.

anemia with (pallid) poor conjunctival perfusion pallor of anemia compared to normally perfused hand

Unexplained Fatigue or Lack of Energy

physical and mental fatigue

Heart Failure in Susceptible Individuals with Heart Disease

In individuals with a weak or failing heart, iron deficiency anemia stresses heart function.  Diminished oxygen saturation requires more rapid blood flow to keep up with oxygen requirements.  This increases heart rate.  We call this tachycardia.  This tachycardia in turn stresses an already weakened heart.   The heart is, after all, a large muscular organ.  Lack of oxygen leads to myoglobin deficit.   It is a circular set of reactions as seen in figure 5

iron and heart failure
figure 5

Pagophagia – Craving for Ice or Clay

This is an interesting phenomenon.  And it is not well scientifically explained.  It is possible this increase in alertness is a response to the fatigue of iron deficiency anemia.

pica or pagopahgia is a symptom or iron deficiency

Sore or smooth tongue and cheilitis

A smooth tongue.  The “angles” of the mouth show signs of angular cheilitis.  This appears to be an inflammatory condition.  In the past I thought this was a vitamin deficiency.

glossitis (re tongue) and angular cheilitis are symptoms of iron deficiency

Brittle nails or hair loss

Another interesting phenomenon  indicating the need for iron in hard connective tissue synthesis.  A poorly explained phenomenon.  We think this may be related to injury to the nail plate – the origin of nail growth.  Somehow this may be more susceptible to damage or injury with iron deficiency anemia.

brittle nails are a symptom of iron deficiency

Restless Legs Syndrome

Restless legs is an annoying condition that disturbs healthy and regenerative sleep.  It is nearly synonymous with “periodic limb movement.”  This is an important  observation during a thorough sleep study.  Iron deficiency as a cause is becoming more recognized.  Iron infusions are quite dramatic in their ability to completely resolve this condition.   In the past we have treated this condition with Mirapex, a dopamine agonist, more commonly used to treat Parkinson’s Disease.

restless leg syndrome at night (periodic limb movement)

Additional Symptoms:

Here are further manifestations mostly related to more rapid arterial blood flow in response to diminished oxygen availability:

  • Shortness of breath or chest pain, especially with activity (dyspnea)
  • Unexplained generalized weakness (asthenia)
  • Rapid heartbeat (tachycardia)
  • Pounding or “whooshing” in the ears (pulsatile tinnitis)
  • Headache, especially with activity (exertional headache)

So let’s move on to the final episode: treatment of iron deficiency and anemia.

Previous Pages

 Part I, Part II, Part III


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