Clinical features

Development of iron deficiency anaemia symptoms depend on how quickly the anaemia develops. In chronic, slow blood loss, patients often tolerate extremely low haemoglobin concentrations and may have very few symptoms (1).

Most patients complain of tiredness, breathlessness after exertion (2).

Other less common symptoms include:

• headache
• tinnitus
• taste disturbances
• mental changes, such as pica
• sore tongue (1,3)

Additionally, iron deficiency may be associated with the following signs:

• glossitis
• angular stomatitis - painful cracks at the angle of the mouth
• nail changes - spoon-nails (koilonychias); brittle longitudinal ridges occur in 10% of patients (1)
• dysphagia due to pharyngeal webs - Plummer-Vinson syndrome - usually seen in elderly or middle-aged women
• thin, fragile scalp hair
• modest splenomegaly - in a small number of patients (1,3)
• achlorhydria

Symptoms such as angina, marked ankle oedema, or dyspnoea at rest is not typically seen (in haemoglobin concentrations of more than 7 g/dL) unless there is additional cardiorespiratory pathology (2).

Reference:

• (1) Provan D. (2010). Iron deficiency anaemia. ABC of clinical haematology
• (2) Todd T, Caroe T. Newly diagnosed iron deficiency anaemia in a premenopausal woman. BMJ. 2007;334(7587):259
• (3) Cox, T.M. (2003) Iron metabolism and its disorders. In: Warrell, D.A., Cox, T.M., Firth, J.D. and Benz, E.J.Jr (Eds.) Oxford textbook of medicine. 4th edn. Oxford: Oxford University Press. Section 22.5.4