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 (1,2)

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)
• 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. Snook J, Bhala N, Beales ILP, et al. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut. 2021 Nov;70(11):2030-51.
2. Bermejo F, García-López S. A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases. World J Gastroenterol. 2009 Oct 07;15(37):4638-43