Gastrointestinal complaints can include loss of appetite, heartburn, nausea, painful swallowing, and constipation. Menstrual disturbances are also very common with iron deficiency anemias. Your periods can become heavy, irregular or stop altogether.

Rarely you can experience bizarre food cravings for substances such as ice, clay or cornstarch.

In severe anemia (hemoglobin less than 70 grams per litre of blood) the inside of the lower eyelid is a pearly white colour and there is no colour in the creases in the palm of the hand. The hair and nails are brittle, the tongue smooth, the nails spoon shaped and the corners of the mouth cracked.

Reasons For Iron Deficiency

Anemia due to low iron can result from any or all of the following factors that cause either not enough iron to go into your body or too much iron to leave your body.

1. What you eat is low in iron.

2. You have problems absorbing iron from your food.. Causes of poor absorption include dietary factors, poor digestion, chronic diarrhea, malabsorption syndrome and following a partial or complete gastrectomy.

3. You lose too much blood.

Women are particularly vulnerable to increased blood loss, because they bleed every month at their period. In addition to losing about one-tenth of a cup of blood per period, they lose anywhere from one-half to one cup of blood at childbirth. If they are having heavy periods, the blood loss can be as high as a half cup per period. Women can also become anemic around menopause if they have repeated heavy or prolonged periods.

Blood loss can also come from the stomach or intestines, as for example with bleeding ulcers or bleeding hemorrhoids. This bleeding can either be obvious (vomiting blood or passing black, tarry stools) or hidden (only found on microscopic examination of the stool).

The blood loss from all these causes can add up, and produce an iron deficiency that develops slowly over months or years.

Alternatively, anemia can quickly develop if you lose a lot of blood over a short period of time.

Not All Anemias Are Caused By Low Iron

Not all anemias are caused by low iron. Low hemoglobin levels can be caused by a lack of certain vitamins such as B-12 or folic acid. Deficiencies of B6 or zinc can also lead to an anemia which mimics iron deficiency anemia.

Afro-Americans normally have a hemoglobin which is 100 grams lower than Caucasians, and thus may be needlessly treated for anemia.

Inherited abnormalities of the hemoglobin molecule itself can also cause anemia. Sickle cell anemia, which occurs mainly among African Americans, may produce different kinds of anemia including iron deficiency anemia. Thalassemia minor causes anemia and is due to a defect in making hemoglobin. It was originally thought to be present mainly in Mediterranean people, but can occur in any race.

The Normal "anemia" Of Pregnancy

In medical school, I was taught that pregnant women have increased iron requirements and should be taking iron supplements throughout their pregnancy.

In a well-nourished pregnant woman, there will normally be a doubling of her blood volume, resulting in a low hemoglobin, and a low blood iron. The blood iron binding capacity will normally rise during pregnancy. It now appears that these blood changes are a natural part of normal pregnancy and do not have to be treated.

In fact, the larger circulating blood volume may enable women to better withstand blood loss during childbirth.