Iron Deficiency Anemia - Symptoms and Signs

Symptoms and Signs

Iron-deficiency anemia is characterized by the sign of pallor (reduced oxyhemoglobin in skin or mucous membranes), and the symptoms of fatigue, lightheadedness, and weakness. None of the symptoms (or any of the others below) are sensitive or specific. Pallor of mucous membranes (primarily the conjunctiva) in children is the sign of anemia with best correlation to the actual disease, but in a large study was found to be only 28% sensitive and 87% specific (with high predictive value) in distinguishing children with anemia and 49% sensitive and 79% specific in distinguishing severe anemia (Hb < 7.0 g/dl). Thus, this sign is reasonably predictive when present, but not helpful when absent, as only one-third to one-half of children who are anemic (depending on severity) will show pallor. Iron-deficiency must be diagnosed by laboratory testing.

Because iron deficiency tends to develop slowly, adaptation occurs and the disease often goes unrecognized for some time. In severe cases, dyspnea (trouble breathing) can occur. Unusual obsessive food cravings, known as pica, may develop. Pagophagia or pica for ice has been suggested to be specific, but is actually neither a specific or sensitive symptom, and is not helpful in diagnosis. When present, it may (or may not) disappear with correction of iron-deficiency anemia.

Other symptoms and signs of iron-deficiency anemia include:

• Anxiety often resulting in OCD-type compulsions and obsessions
• Irritability or a low feeling
• Angina
• Constipation
• Sleepiness
• Tinnitus
• Mouth ulcers
• Palpitations
• Hair loss
• Fainting or feeling faint
• Depression
• Breathlessness
• Twitching muscles
• Pale yellow skin
• Tingling, numbness, or burning sensations
• Missed menstrual cycle
• Heavy menstrual period
• Slow social development
• Glossitis (inflammation or infection of the tongue)
• Angular cheilitis (inflammatory lesions at the mouth's corners)
• Koilonychia (spoon-shaped nails) or nails that are weak or brittle
• Poor appetite
• Pruritus (itchiness)
• Dysphagia due to formation of esophageal webs (Plummer-Vinson syndrome)
• Insomnia
• Restless legs syndrome