Anaemia (Iron Deficient Anaemia)

Anaemia is a condition in which the number of red blood cells (RBC) or the haemoglobin concentration within the RBC is lower than normal depriving the body of oxygen.

Oxygen fuels our cells and helps provide the basic building blocks that our bodies need to survive.  Oxygen helps organisms grow, reproduce, and turn food into energy. We get the oxygen we need by breathing air into our lungs. Oxygen gives our cells the ability to break down food in order to get the energy we need to survive.  Everyday functions of the body like digesting your food, moving your muscles or even just thinking, need oxygen.  When these processes happen, a gas called carbon dioxide is produced as a waste product. The job of your lungs is to provide your body with oxygen and to get rid of the waste gas, carbon dioxide.  Permanent brain damage begins after only 4 minutes without oxygen, and death can occur as soon as 4 to 6 minutes later.

There are many forms of anaemia, each with its own cause. Anaemia can be temporary or long term and can range from mild to severe. In most cases, anaemia has more than one cause.

Iron-deficiency anaemia (IDA) is the most common type of anaemia. It occurs when your body doesn't have enough iron. Potential causes include not eating enough iron-rich foods, blood loss due to menstruation, and an inability to absorb iron.

Who can be affected?

  • Women: Blood loss during menstruation and childbirth can lead to anaemia.  This is especially true if you have heavy periods or fibroids.
  • Children ages 1 – 2 – the body needs more iron during growth spurts.
  • Infants – Infants may get less iron when weaned from breast milk. Breast milk contains Lactoferrin, a major iron-binding protein, to facilitate iron absorption.
  • People over 65 – are more likely to have iron-poor diets and certain chronic diseases.
  • People on blood thinners and proton pump inhibitors (to reduce gastric acid).

Signs and symptoms

IDA can be so mild that it goes unnoticed. But as the body becomes more deficient in iron and anaemia worsens, the signs and symptoms intensify.  IDA signs and symptoms may include:

Other symptoms include:

  • Extreme fatigue
  • Cold hands and feet
  • Swollen tongue with teeth ridges
  • Unusual cravings called pica for non-nutritive substances, such as ice, dirt or starch
  • Ringing in the ears
  • Poor appetite, especially in infants and children
  • Heavy periods
  • Insomnia
  • Depression and Anxiety
  • Pale skin
  • Brittle nails and vertical ridges
  • Hair loss

Blood tests and what they mean:

Red Blood Cells (ideal range 3.8 – 4.8)

RBC's carry oxygen around the body. Lower levels can be seen in pregnancy, bleeding, malnutrition, anaemia, kidney disease and other conditions.  If too low, the body does not get the oxygen it needs.  Elevated levels can increase the risk of clumping together and may block tiny blood vessels.  

Haemoglobin (range female 12-15 male 13-17)

An iron-rich protein found in RBCs that carries oxygen from the lungs to the body tissues.  Low levels can suggest anaemia, bleeding, lack of nutrients, or other conditions – leading to weakness and fatigue.  Dehydration can cause a temporary increase.  The levels usually correlate with RBC levels.

Haematocrit – HCT (range 0.36 – 0.46)

This is a measure of the percentage of blood that is composed of red blood cells.  It becomes too high with dehydration and other conditions.  Low levels occur with anaemia, bleeding and other conditions.

MCV (range 84 – 96fL)

MCV measures the size of the average red blood cell and can indicate anaemia and certain vitamin deficiencies.

MCH (range 27 – 32)

MCH measures the amount of oxygen-carrying haemoglobin in an average red blood cell.  This is a specific test for anaemia.

MCHC – Mean Cell Haemoglobin Concentration (range 31.5 – 34.5)

MCHC measures the average concentration of haemoglobin in RBCs.  The most common cause of low MCHC is lack of iron in the diet. High levels can indicate a B12 or Folate deficiency.

Total Iron (range 9 – 30)

Iron is required to build haemoglobin, which carries oxygen throughout the body.  Low iron levels can lead to anaemia, affecting oxygen and energy levels.  Too much iron can cause damage to the liver, heart and pancreas.

Transferrin (range 2.0 – 3.6)

Transferrin’s are glycoproteins that transports iron through the blood to various tissues such as the liver, spleen, and bone marrow.  High transferrin means the liver is producing more of the protein to use all the iron available in the body. Low transferrin level means the body is absorbing more iron then needed.

TIBC (range 53 – 95)

Total Iron Binding Capacity measure the capacity of the transferrin to bind iron.  TIBC is not an exact measure as not all the iron is bound by transferrin.  All the iron not bound to protein is removed and the serum iron is measured. 

Transferrin Saturation (range 19 – 43)

A more sensitive screening test for iron deficiency than serum iron or TIBC.   This measures the value of serum iron divided by the total iron-binding capacity of the available transferrin, the main protein that binds iron in the blood, this value tells how much serum iron is bound. 

The classic pattern of iron deficiency shows a decreased serum iron and an increased TIBC. A % transferrin saturation of 20 – 35% is optimal and 15% or below is a classic finding in iron deficiency anaemia.  It is calculated by

% Transferrin saturation = (Serum iron x 100) / TIBC

Serum Vitamin B12 (range 187 – 883)

Vitamin B12 is important for energy, sleep and the nervous system.  B12 works synergistically with folate to make Red Blood Cells and provokes the release of the sleep hormone melatonin.   Most vitamins are made by plants and animals but only microorganisms - yeasts, moulds, algae and bacteria – can make B12.  Symptoms may begin to appear when levels drop below 400.

Serum Folate (range 3 – 17)

Folate is the naturally occurring vitamin while Folic Acid is manmade.  Folate works with B12 to make Red Blood Cells.  Optimum level is 15 and symptoms can appear below 10.  Folate can deplete quite quickly as the body can only store enough for one – two months. 

Serum Ferritin (range 30 – 200) - this is a really important biomarker.

Ferritin is the main storage form of iron in the body.  In most cases decreased the serum ferritin level will occur before changes in serum iron, development of anaemia, or changes in RBC morphology.  The body will do whatever it takes to keep the serum levels of iron at an optimal level.  Ferritin is the most sensitive test to detect iron deficiency.  Symptoms can begin to be experience when levels drop below 100. 

Dietary Iron

There are two types of dietary iron: heme iron and non-heme iron.

  • Heme iron is only found in animal foods e.g. meat, poultry and fish and is bound to the oxygen-binding proteins haemoglobin and myoglobin. The absorption rate is 35% and is the most efficiently absorbed form of iron.
  • Non Heme iron - Food contains more nonheme iron and, thus, it makes the larger contribution to the body's iron pool despite its lower absorption rate of 2% to 20%. Absorption of nonheme iron is markedly influenced by the levels of iron stores and the inclusion of vitamin C.

Hepcidin - iron regulating hormone

Hepcidin is an iron-regulating peptide hormone that's produced in your liver. It works to control the delivery of iron to your blood from food through the lining of the intestines. It is the master regulator in iron metabolism and the balance between iron storage and absorption better known as iron homeostasis.

When hepcidin levels are high, it reduces intestinal iron absorption and red blood cell production. Low hepcidin levels stimulates iron absorption, iron supply to bone marrow and promotes haemoglobin and red blood cell production.

Hepcidin is at its lowest first thing in the morning creating an opportunity to increase absorption from food and supplements.  Exercise can increase hepcidin levels reducing the absorption of iron for up to three hours.

Iron supplementation can be difficult for your body to tolerate for different reasons but there are solutions and iron levels can be restored.  If you are suffering from any of the above symptoms or your blood count is indicating that you have anaemia book a consultation and together we will figure our the root cause.



 This blog is not intended to take the place of medical advice. Please seek assistance for any medical concerns.