Iron-deficiency anaemia
Also called: iron deficiency anemia, IDA, low iron, khoon ki kami, low haemoglobin due to iron deficiency
Iron-deficiency anaemia is low haemoglobin (the part of red blood cells that carries oxygen) caused by too little iron. It is the most common type of anaemia worldwide and is very common in Pakistani women and children. It is treatable, but the cause must also be found.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Anaemia means the blood has fewer red blood cells, or less haemoglobin, than normal. Haemoglobin is the protein inside red blood cells that carries oxygen to every organ. The body needs iron to make haemoglobin. When iron runs short, the red cells become small and pale and cannot carry enough oxygen. This is iron-deficiency anaemia. Iron deficiency is the most common nutritional deficiency in the world and the leading cause of anaemia.
Iron can run low for three main reasons: the body loses blood, it cannot absorb enough iron from food, or it does not get enough iron in the first place. Heavy periods are the most common cause in women of child-bearing age. Pregnancy, infancy and the teenage years raise the body's need for iron. In older adults and in men, slow bleeding from the stomach or bowel is the most common cause, so the source of bleeding must always be looked for. In countries like Pakistan, poor diet, hookworm and other parasites, repeated pregnancies and infections all add to the problem.
The condition often develops slowly, so many people have no symptoms at first. It is confirmed with simple blood tests. Treatment has two parts: replacing iron (usually with tablets, sometimes by injection into a vein) and treating whatever caused the iron loss. With the right care, most people recover fully.
In Pakistan: what studies show
Pakistan's National Nutrition Survey 2018 found anaemia in 53.7% of young children and 41.7% of women aged 15-49, and iron-deficiency anaemia in 28.6% of young children and 18.2% of women. Only around 30% of mothers took iron tablets for at least 90 days in pregnancy.
- In the 2018 National Nutrition Survey, more than half (53.7%) of Pakistani children aged 6 to 59 months had anaemia, and 5.7% had severe anaemia.[1] (national survey, data April 2018 - January 2019)
- Iron-deficiency anaemia in Pakistani children under five fell from 33.4% in the 2011 national nutrition survey to 28.6% in the 2018 survey, but still affects more than one in four.[2] (national survey, data 2011 and 2018 (two national nutrition surveys))
- In the 2018 survey, 41.7% of women aged 15 to 49 had anaemia, a little more often in rural areas (44.3%) than in cities (40.2%).[1] (national survey, data April 2018 - January 2019)
- Iron-deficiency anaemia in women aged 15 to 49 dropped only slightly, from 19.9% in 2011 to 18.2% in the 2018 national survey.[2] (national survey, data 2011 and 2018 (two national nutrition surveys))
- Among the provinces, Sindh had the most iron-deficiency anaemia in women in 2018, affecting about a quarter (23.8%) of women aged 15 to 49.[1] (national survey, data April 2018 - January 2019)
- In the 2018 survey, more than half (54.7%) of adolescent girls in Pakistan had anaemia.[1] (national survey, data April 2018 - January 2019)
- A review that pooled sixteen Pakistani studies of pregnant women found that 70.4% of pregnant women had anaemia.[3] (systematic review/meta-analysis, data studies published 1 Jan 2007 - Dec 2021 (data collection years not stated))
- In the 2017-2018 Pakistan Demographic and Health Survey, only around 30% of women said they took iron tablets for at least 90 days in their last pregnancy.[4] (national survey, data 2017-2018)
What we do not know yet: Studies pooled in the review found anaemia in far more pregnant women than the 2018 national survey did, so the true level in pregnancy is uncertain; the survey report's text and summary table also give slightly different overall figures for women. We could not open WHO country estimates for Pakistan or a current Pakistan clinical guideline on anaemia, and no national data newer than 2018-2019 were found.
Pakistan studies cited
- Ministry of National Health Services, Regulations and Coordination; Aga Khan University; UNICEF Pakistan National Nutrition Survey 2018: Key Findings Report. Government of Pakistan / UNICEF Pakistan 2018. Open source
- Habib A, Kureishy S, Soofi S, et al. Prevalence and Risk Factors for Iron Deficiency Anemia among Children under Five and Women of Reproductive Age in Pakistan: Findings from the National Nutrition Survey 2018. Nutrients 2023;15(15):3361. doi:10.3390/nu15153361. Open source
- Mahar B, Shah T, Shaikh K, et al. Uncovering the hidden health burden: a systematic review and meta-analysis of iron deficiency anemia among adolescents, and pregnant women in Pakistan. Journal of Health, Population and Nutrition 2024;43(1). doi:10.1186/s41043-024-00643-y. Open source
- Ali SA, Ali SA, Razzaq S, et al. Predictors of iron consumption for at least 90 days during pregnancy: Findings from National Demographic Health Survey, Pakistan (2017-2018). BMC Pregnancy and Childbirth 2021;21(1). doi:10.1186/s12884-021-03825-2. PMID 33941108. Open source
Symptoms
- Tiredness and weakness, especially on exertion
- Shortness of breath when walking or climbing stairs
- Pale skin, pale inner eyelids, pale nail beds or gums
- Headaches, dizziness or feeling light-headed when standing up
- Fast or pounding heartbeat (palpitations)
- Poor concentration and difficulty paying attention
- Sore, smooth or inflamed tongue and cracks at the corners of the mouth
- Craving ice, clay or other non-food items (pica)
- Brittle or spoon-shaped nails and hair loss
- Restless legs at night and cold hands and feet
Causes and risk factors
Causes
- Blood loss: heavy or frequent periods, bleeding from stomach ulcers, piles, bowel polyps or bowel cancer, and bleeding caused by long-term use of painkillers (NSAIDs), aspirin or blood thinners
- Poor absorption of iron: coeliac disease, inflammatory bowel disease (Crohn's disease), stomach surgery or long-term stomach inflammation, and infection with Helicobacter pylori (a stomach bacterium)
- Not enough iron in the diet, for example a diet with little meat, fish, pulses or green vegetables
- Extra need for iron: pregnancy, breastfeeding, infancy and the growth spurt of the teenage years
- Parasites such as hookworm, which cause slow bleeding in the gut, and infections such as malaria
- Babies who are not breastfed and are given cow's milk early, which is low in iron
What makes it more likely
- Being a woman of child-bearing age, especially with heavy periods
- Pregnancy, recent childbirth, or pregnancies close together (less than two years apart)
- Being a child under two years old or a teenager
- A diet low in iron-rich foods, or strict vegetarian eating without planning
- Poverty, food insecurity, no formal education and living in a rural area
- Poor sanitation and worm infections
- Repeated diarrhoea, fever or other infections in young children
- Long-term use of NSAID painkillers, aspirin, blood thinners or antacids
- Chronic conditions such as kidney disease, heart failure and inflammatory bowel disease
Complications
Untreated iron-deficiency anaemia makes the heart work harder to move oxygen around the body. This can cause a fast heartbeat, heart murmurs and, in severe cases, heart failure. In children it can slow physical growth and harm brain development, attention and school performance. In pregnancy it is linked with premature birth, low birth weight and a higher risk of the mother dying. Iron deficiency also lowers resistance to infections and can cause restless legs, depression and headaches. People with the condition have longer hospital stays and more problems after operations. Rarely, long-standing deficiency causes a web of tissue in the food pipe that makes swallowing difficult.
When to see a doctor
- Black, tarry stools or blood in the stool
- Vomiting blood or material that looks like coffee grounds
- Chest pain, severe breathlessness, fainting or a very fast heartbeat (go to the emergency department)
- Unexplained anaemia in a man, a woman past the menopause, or anyone over 60, because bowel cancer must be ruled out
- Anaemia with weight loss, loss of appetite, difficulty swallowing or a change in bowel habit
- Anaemia in pregnancy, or very heavy periods that soak through pads every hour
- Blood in the urine
Diagnosis
Your doctor will ask about your diet, periods, pregnancies, bowel habit, painkiller use and any bleeding, and will examine you for pallor and other signs. The first test is a full blood count (FBC). In iron deficiency the haemoglobin is low and the red cells are smaller and paler than normal. A serum ferritin test (ferritin is the protein that stores iron) is the best single test, because a low ferritin confirms that iron stores are empty. Ferritin can be falsely normal during infection, inflammation, liver disease or kidney disease, so your doctor may add iron studies such as transferrin saturation.
Finding the cause is just as important as finding the anaemia. Tests may include a coeliac blood test, a urine test for blood, a stool test for blood or worms, and a haemoglobin electrophoresis test if thalassaemia is possible. Men, women past the menopause and anyone with bowel symptoms are usually referred for endoscopy (a camera test of the stomach and bowel) to look for a source of bleeding. Women with heavy periods and no bowel symptoms usually do not need these camera tests. In children, doctors look especially at feeding, growth and worm infection.
Treatment
- Confirm iron deficiency with blood tests before starting treatment, and start looking for the cause at the same time.
- Begin oral iron tablets or syrup (ferrous salts are the usual first choice). Your doctor decides the dose. Taking the tablets away from tea, coffee, milk and calcium helps absorption; vitamin C may help a little.
- Expect side effects such as nausea, constipation and dark stools. If they are troublesome, tell your doctor; a lower dose, a different iron preparation or taking it less often can be tried rather than stopping.
- Have a repeat blood test after about a month to check the haemoglobin is rising. If it is not, the doctor checks whether the tablets are being taken, whether iron is being absorbed, or whether bleeding is continuing.
- Continue iron for around three months after the haemoglobin returns to normal so that the body's iron stores are refilled.
- Iron given into a vein (intravenous iron) is used when tablets are not tolerated or not absorbed, when blood loss is ongoing, when there is kidney disease, heart failure or inflammatory bowel disease, or when iron is needed quickly, for example late in pregnancy or before surgery.
- Treat the cause: heavy periods, ulcers, worms, coeliac disease or Helicobacter pylori. A blood transfusion is only for severe anaemia with symptoms that cannot wait.
Medicines in Pakistan
Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Oral iron salts | first choice for most people; tablets or syrup taken by mouth, continued for months to refill iron stores | Ferrous sulfate (9 brands), Elemental Iron (26 brands), Iron (40 brands), Iron polymaltose complex (108 brands), Polysaccharide iron complex (23 brands), Iron protein succinylate (28 brands) |
| Oral iron with folic acid | often used in pregnancy and where folate deficiency is also likely; your doctor decides which combination suits you | Ferrous sulfate + Folic acid (21 brands), Elemental iron + Folic acid (12 brands), Iron + Folic acid (11 brands), Iron polymaltose complex + Folic acid (79 brands), Iron protein succinylate + Folic acid (5 brands) |
| Intravenous iron | given by drip in a clinic or hospital when oral iron fails, is not tolerated or is not absorbed, or when iron must be replaced quickly | Iron sucrose (8 brands), Ferric carboxymaltose (2 brands) |
| Vitamin C | sometimes taken with iron tablets to help absorption; the evidence that it helps is limited | Ascorbic acid (64 brands) |
Also used (not yet in our price list): Ferrous fumarate, Ferrous gluconate, Iron dextran injection, Ferric derisomaltose injection
Self-care and prevention
Self-care
- Eat iron-rich foods every day: red meat, liver, chicken, fish, lentils (daal), chickpeas, beans, eggs, spinach and other green leafy vegetables, and fortified cereals.
- Add a source of vitamin C to meals, such as oranges, guava, tomatoes or lemon, to help your body absorb iron from plant foods.
- Avoid tea, coffee and milk for an hour or two around iron tablets and iron-rich meals, because they block iron absorption.
- Take calcium supplements or antacids at a different time of day from iron tablets.
- Take iron exactly as your doctor advised and do not stop early, even when you feel better.
- Expect dark stools on iron; this is harmless. Drink plenty of water and eat fibre to limit constipation.
- Diet alone is rarely enough to correct established anaemia; it supports treatment but does not replace it.
- Keep follow-up blood test appointments so your doctor can confirm the anaemia has gone and does not return.
Prevention
- Eat a varied diet with iron-rich foods and vitamin C sources at every stage of life, especially for girls, women and young children.
- Breastfeed babies and avoid giving cow's milk before the age advised by your doctor; introduce iron-rich weaning foods from six months.
- Space pregnancies at least two years apart and attend antenatal care, where iron and folic acid supplements are usually advised.
- Treat worm infections and malaria promptly; wash hands and use clean water and toilets.
- Seek treatment for heavy periods rather than putting up with them.
- Avoid long-term use of painkillers such as NSAIDs or aspirin without medical advice.
Common questions
How long do I need to take iron tablets?
Usually for several months. The haemoglobin often improves within about a month, but the body's iron stores take longer to refill. Doctors normally continue iron for about three months after the blood count is back to normal. Stopping early is a common reason the anaemia comes back.
Can I fix iron-deficiency anaemia with food alone?
Diet is important for preventing iron deficiency and supporting treatment, but on its own it is usually not enough to correct anaemia once it has developed. Iron tablets or injections are normally needed, together with treatment of the cause.
Why does my doctor want a camera test of my bowel for anaemia?
In men, women past the menopause and anyone over 60, slow bleeding from the stomach or bowel is the most likely cause of iron deficiency. This can come from ulcers, polyps or cancer, so an endoscopy or colonoscopy is advised to find and treat the source. Women with heavy periods and no bowel symptoms usually do not need it.
Is iron-deficiency anaemia the same as thalassaemia?
No. Both cause small red blood cells, but thalassaemia is an inherited condition and the body's iron stores are usually normal or high. Giving iron to someone with thalassaemia who is not iron deficient can be harmful. A ferritin test and a haemoglobin electrophoresis test tell the two apart, and both conditions are common in Pakistan.
Are iron injections better than tablets?
Not for most people. Tablets work well and are safer and cheaper. Intravenous iron is reserved for people who cannot tolerate or absorb tablets, who are still losing blood, or who need iron quickly. It is given in a clinic or hospital where any reaction can be treated.
Sources
- WHO fact sheet. Anaemia (2025).
- WHO Regional Office for the Eastern Mediterranean. Anaemia (2026).
- NHS Remedy BNSSG referral pathways. Anaemia (Iron Deficiency) (2025).
- NHS Scotland Right Decisions. Iron deficiency anaemia | Right Decisions (2026).
- StatPearls (NCBI Bookshelf). Iron-Deficiency Anemia - StatPearls - NCBI Bookshelf (2026).
- MedlinePlus. Iron deficiency anemia: MedlinePlus Medical Encyclopedia (2025).
- Nutrients (peer-reviewed, Aga Khan University / Government of Pakistan). Prevalence and Risk Factors for Iron Deficiency Anemia among Children under Five and Women of Reproductive Age in Pakistan: Findings from the National Nutrition Survey 2018 (2023).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.