Iron deficiency


Appropriate Tests


Review clinical findings, Full blood count, Blood film; see Anaemia - hypochromic, microcytic.

Iron deficiency can be present before the development of anaemia; Red cell count and Blood film are more sensitive indicators than Hb.

Ferritin provides the most sensitive measure of iron stores; low Ferritin is diagnostic of Iron deficiency, however normal levels may occur when iron deficiency is associated with inflammation or neoplasia.

A more specific test for iron deficiency is the ratio of plasma Soluble transferrin receptor to serum Ferritin.

See Table 3.

Alternatively, a trial of oral iron therapy offers a more practical approach.

Chronic blood loss, especially

This is the most common cause of iron deficiency anaemia and may be occult; uterine and gastrointestinal blood loss, in particular, should be considered.


See under Vaginal bleeding

Gastrointestinal malignancy


Parasitic infection, especially

  • Hookworm infection

See Worm infection

Intravascular haemolysis, eg, mechanical heart valves


Increased iron requirements, especially








Malabsorption, especially


  • Coeliac disease


  • Post-gastrectomy


Dietary deficiency

An uncommon cause in developed countries, but may be seen in the elderly and may be a contributing factor in pregnancy, debilitating illness and alcoholism.

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