Iron is needed to make haemoglobin, the part of red blood cells that carries oxygen around the body. When iron runs low, you can feel tired, flat and short of breath.
Why iron runs low
Think of your iron stores as a water tank. You use iron every day, so the tank needs topping up from food, and it shouldn’t have any leaks. Most people become low in iron for one of three reasons.
Losing blood
This is the most common cause in Australia.
- Heavy periods are the main cause in women of child-bearing age.
- Slow bleeding from the stomach or bowel, from ulcers, polyps or long-term use of anti-inflammatory medicines such as ibuprofen, can go unnoticed.
Not getting enough in food
- Vegetarian and vegan diets. Iron from plants is harder to absorb than iron from meat.
- Restricted eating, which is common in some athletes and in people with less access to a varied diet.
- Pregnancy and growth spurts, when the body needs more.
Not absorbing it
- Coeliac disease damages the lining of the gut where iron is absorbed.
- Weight-loss surgery can reduce how much iron is taken up.
- Tea and coffee with meals block iron absorption.
Low iron and anaemia
Low iron happens in stages:
- Iron deficiency without anaemia. Your stores are low, but you still make enough red blood cells. You might feel flat, have restless legs or notice thinning hair, while a standard blood count still looks normal.
- Iron deficiency anaemia. Your stores are empty and you can no longer make enough red blood cells. You may feel very tired and breathless, notice a racing heart, or crave ice.
Understanding your blood tests
- Ferritin shows your iron stores. A level below about 30 usually means low iron. Ferritin can read higher during illness or inflammation, so we look at it alongside your other results.
- Transferrin saturation shows how much iron is being delivered to your cells. A low level means your cells are short of iron.
- Haemoglobin shows whether you have anaemia.
Treatment
We will also look for, and treat, the reason your iron is low.
Iron tablets
Tablets suit most people. Taking iron every second day is often just as effective and causes fewer side effects such as constipation. Take it with vitamin C, such as a glass of orange juice, and away from tea, coffee and dairy.
Iron infusions
If tablets haven’t worked, you can’t tolerate them, or your levels need to rise quickly, your GP may suggest an iron infusion into a vein.
- Infusions are given by our nurses in the nurses’ treatment room.
- Allow about 90 minutes for your visit. The drip itself usually runs for 15 to 30 minutes, and we check on you before, during and afterwards.
- Many people feel more energy over the following weeks, though it varies.
Infusions are generally safe, but there are risks to discuss with your GP first. Iron can leak into the skin around the drip and leave a brown stain, which may be permanent. Rarely, a serious allergic reaction can happen, even if you have had iron infusions safely before.
Your GP will recommend the type of iron replacement that suits you. Iron infusion fees, including the iron itself, are listed on our fees page.
Helpful resources
- Healthdirect: symptoms and when to see your GP.
- BloodSafe eLearning Australia: a clear iron deficiency fact sheet for patients.
- Jean Hailes for Women’s Health: help with heavy periods and iron.
- Gastroenterological Society of Australia (GESA): information on gut causes such as coeliac disease and inflammatory bowel disease.