Iron can be supplemented orally or by intravenous injection. Simple inexpensive iron preparations are adequate. File photograph used for representational purposes only
Iron is quantitatively the most important element in all living organisms because of its role in oxygen transport and storage by haemoglobin; in energy metabolism and in cellular growth and proliferation. A normal adult male has 50 mg/kg of iron, while females have 40 mg/kg: and most of this iron is in haemoglobin which is essential to carry oxygen from the lungs to the tissues.
The main source of iron is in the food we eat, with males requiring 10 mg of iron daily in the diet of which only 1 mg is absorbed, while females need double the amount to compensate for menstrual blood loss. Non-vegetarian sources of iron are better absorbed, but a diet which contains millets, unpolished rice, milk or curd, pulses and leafy vegetable can provide adequate iron. However, this needs to be supplemented in pregnancy.
Iron deficiency
When the body’s iron is depleted, there is a fall in haemoglobin (Hb), and the red cells become smaller (MCV: normal 80-100). The following tests can help differentiate iron deficiency from thalassemia carrier state, since MCV is low in both these conditions: serum ferritin and Haemoglobin HPLC (variant). The normal serum ferritin is 24-336 nanograms per millilitre for adult males and 24-307 nanograms per millilitre for females. A fall in Hb results in weakness, shortness of breath and palpitations on walking. In children who are chronically deficient in iron, growth can be retarded.
The main causes of iron deficiency are the following:
Nutritional: Inadequate intake of iron in the diet (in rare cases failure to absorb oral iron).
Blood loss: In females who have heavy periods, iron can be depleted. Gastrointestinal blood loss can also cause iron deficiency and older patients must be evaluated for malignancy of the stomach or colon.
Once the diagnosis has been confirmed and the cause established, the cause must then be treated, and iron replacement therapy started. Iron can be supplemented orally or by intravenous injection. Simple inexpensive iron preparations are adequate: adult patients are started on one tablet of oral iron (60mg elemental iron) taken after meals and this is increased to two after a week and then three after another week. This low dose start and ramp up allows the patient to tolerate the iron, and is also beneficial for iron absorption. Iron replacement should continue for at least three months to build up iron stores in the body. Some patients develop nausea, vomiting or constipation with oral iron and for these patients, the iron is given intravenously. Patients usually start feeling better and the Hb begins to rise one month after starting treatment.
A public health problem
In India, iron deficiency was recognised as a public health problem in children and in women who are pregnant or lactating. Therefore, the government of India started the National Nutritional Evaluation Programme (NNAEP) in which iron supplements were provided to children and pregnant and lactating women. This programme was funded by UNICEF but an evaluation of this programme by the Indian Council of Medical Research (ICMR) showed poor compliance by the beneficiaries.
Iron deficiency in the population is a serious problem that can affect the growth and development of children and people’s general health, with studies showing a significant reduction of the work output in populations that are iron deficient. In the West, most infant formulas and breakfast cereals are supplemented with iron.
Iron overload
The body does not have a mechanism to excrete increased iron: the maximum daily excretion of iron is only one mg. One blood transfusion loads the patient with about 200 mg of iron, so children with thalassemia who need regular blood transfusions require treatment to remove the excess iron which can damage the liver, heart and the endocrine system. This is done with medicines called chelators, which can be given subcutaneously with a small pump (desferal) or orally, deferoxamine. The body’s iron stores are monitored by checking serum ferritin every six months and with a T2* MRI once a year. In rare patients, there is a genetic condition which results in increased body iron stores: this is known as haemochromatosis.
This article was first published in The Hindu’s e-book Care and Cure
(Dr. Mammen Chandy is a senior consultant, physician, and haematologist, Naruvi Hospitals, Vellore. mammenchandy@gmail.com; Dr. Mathumithra T. is a consultant haematologist, Naruvi Hospitals, Vellore. mathumithra.t@naruvihospitals.com)
Published – January 15, 2026 03:00 pm IST