You have anemia

Anemia affects a lot of people. One-quarter of the world’s population have anemia. More than 3 million Americans have anemia. The most common form of anemia is iron deficiency anemia. This is anemia caused by lack of enough iron.

Iron deficiency anemia is bad. It can reduce your quality of life and cause premature death.

What is anemia?

The World Health Organization defines anemia as hemoglobin below 13.0 g/dL in male adults, below 12.0 g/dL in non-pregnant female adults, and below 11.0 g/dL in pregnant women.

What is iron deficiency anemia?

Iron deficiency is suggested by low mean corpuscular volume (MCV), wide red cell distribution width (RDW), transferrin saturation less than 20% or a ferritin level lower than 30 ng/mL.

What causes iron deficiency anemia?

Iron deficiency anemia can be due to poor iron intake, poor absorption of iron, increased demand for iron, gastrointestinal loss, gynecologic loss and others.

Lack of iron consumption
  • Vegetarian diet. Click HERE for foods high in iron.
Poor iron absorption
  • Celiac disease.
  • Surgery such as gastric resection, gastric bypass, and duodenal resection.
  • Autoimmune gastritis.
  • Helicobacter pylori gastritis.
  • Crohn’s disease affecting the small intestine.
Not enough iron due to increased need
  • Pregnancy.
  • Lactation.
  • Use of erythropoiesis stimulating agents.
Gastrointestinal Loss
  • Malignancy like stomach cancer, colon cancer.
  • Peptic ulcer disease like gastric ulcer and duodenal ulcer.
  • Variceal bleeding.
  • Esophagitis.
  • Mallory-Weiss tear.
  • Angiodysplasia and vascular ectasia.
  • Dieulafoy lesions.
  • Cameron lesions.
  • Meckel diverticulum.
  • Infectious colitis.
  • Inflammatory bowel disease (ulcerative colitis and crohn’s disease).
  • Diverticular disease like diverticular bleeding and diverticulitis.
  • Anal fissure.
  • Rectal ulcers.
  • Hemorrhoids.


Gynecologic Loss
  • Menorrhagia (heavy menses).
  • Uterine cancer.


Other causes
  • Blood loss from trauma, surgery, childbirth.
  • Blood donation.
  • Medications such as non-steroidal anti inflammatory drugs.
  • Parasites such as hookworm and tapeworm.
  •  Idiopathic pulmonary hemosiderosis.
  • Hereditary hemorrhagic telangiectasia.


Why you should see a gastroenterologist for iron deficiency anemia

  • If you are older than 50 years or a post-menopausal woman, iron deficiency anemia is often due to gastrointestinal loss.
  • Gastroenterologists are trained to perform various endoscopic procedures.  They can identify bleeding lesions within the gastrointestinal tract and control them. A gastroenterologist is also trained to take endoscopic biopsies if necessary and remove lesions within the gastrointestinal tract.
  • If you see a gastroenterologist, you are likely to get an upper endoscopy and a colonoscopy. An upper endoscopy is also called esophagogastroduodenoscopy (EGD). If EGD and colonoscopy are negative, you may also get a capsule endoscopy. Also, you may need a push enteroscopy or balloon enteroscopy.  There are other tests that may be necessary for iron deficiency anemia such as nuclear bleeding scan, arteriography, or meckel’s scan. If no bleeding source is found, you may need a bone marrow biopsy.

Treatment for iron deficiency anemia 

  • Blood transfusion if necessary.
  • Iron supplementation (oral or intravenous).
  • Identify the cause of iron deficiency anemia.
  • Stop further loss of blood.


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