Other Signs and Symptoms of Iron Deficiency

Iron deficiency has multiple symptoms that may be observed on their own, or in combination with other symptoms. 

Fatigue is often associated with iron deficiency,1 especially in otherwise healthy individuals.2 Fatigue is more extreme than general tiredness, and it can be defined as long-term mental and/or physical exhaustion that occurs without any great physical exertion.3 Patients may describe fatigue as feeling “exhausted”, “listless”, “washed out” or “cranky” and may also associate it with diminished performance at work or increased difficulty in performing routine daily tasks.4

One challenge in identifying the symptoms of iron deficiency anaemia, including fatigue, is that they may start gradually,5 meaning that the patient may not initially recognise the symptom and may have accepted it as part of their life. The patient may also blame their symptoms on age or another co-morbidity or condition.

In addition to fatigue, a number of other symptoms can occur in iron deficiency.

  • Pallor: The patient may look pale as a result of reduced haemoglobin in the blood.6 This may be noticed most easily on their face, nails, inner mouth and lining of the eyes. The lining of the eyes should be a rich red colour, as a pale peach or white colour could be an indication of anaemia.6
  • Shortness of breath (dyspnoea) and heart palpitations7,8: The patient’s resting heart and breathing rates may be increased in the body’s attempt to increase distribution of  oxygen around the body. 
  • Sore tongue or dry mouth9,10: Long term iron deficiency can cause atrophy of the tongue’s surface and difficulty swallowing (dysphagia).
  • Cracks at the corners of the mouth (angular cheilitis/ stomatitis)9: Iron deficiency can also cause the appearance of sore, red, flaky cracks at one or both sides of the mouth.
  • Mouth ulcers11: Mouth ulcers can occur for a variety of reasons, including stress and mechanical damage, but iron deficiency is another reason.
  • Cold intolerance12: If the patient complains of feeling the cold easily, this could be a symptom of iron deficiency.
  • Craving to eat non-food items13,14: Pica, or cravings to eat ice or non-food items such as clay, dirt, ash, and starch could be a sign of iron deficiency. Pica can cause dental injury.15
  • Restless leg syndrome (RLS)16,17: Restless leg syndrome is a disturbing need to move the legs when resting, for example when the patient is in bed. This distressing feeling often goes away once the legs have been moved. Restless leg syndrome may occur without iron deficiency, however up to 25-30% people who are iron deficient may experience RLS.18
  • Hair loss19,20:  If a patient realises that they have been losing more hair than normal, it could be caused by iron deficiency. Increasing their iron levels could stop or reduce this extra hair loss.  
  • Brittle21 or spoon-shaped nails21: Nails that chip and crack easily or that are dipped in the middle and raised at the edges, to give a rounded appearance like a spoon, may be a result of  iron deficiency.
  • Headache22 Headaches can occur for many reasons, however they could be a sign of iron deficiency as has been suggested for menstrual headaches.22
  • Increased susceptibility to infections23: Iron is needed by the body to maintain a healthy immune system, therefore iron deficiency increases the patient’s risk of infections.
  • Dizziness24, irritability 25 and loss of concentration26: If the patient seems  irritable or loses concentration quickly, or tells you that they often feel dizzy, they could be iron deficient.

It is important to note that although iron deficiency is the most common cause of anaemia,27 vitamin B12 and/or folate deficiencies can lead to similar symptoms. Fatigue can also be a symptom of many conditions.28–30

Blood tests can help to confirm a diagnosis of iron deficiency with or without anaemia. The underlying cause of iron deficiency should also be investigated.