Iron Deficiency Anaemia: The Fatigue We Normalize

“I’m just tired.”

A 21-year-old college student keeps cancelling plans.

She sleeps for eight hours but wakes up exhausted. Her hair seems thinner than before, her nails break easily, and climbing a single flight of stairs leaves her breathless. Friends tell her she is overthinking. Family members say she is lazy or stressed. She starts believing them.

She is not lazy. She is iron deficient.

Approximately one in three women of reproductive age (15-49 years) worldwide is affected by iron deficiency anaemia, representing a major global health challenge. (1)

A photo of a young woman looking exhausted

What Is Iron Deficiency Anaemia?

Iron deficiency anaemia occurs when the body does not have enough iron to produce adequate haemoglobin. Haemoglobin is the oxygen-carrying protein in red blood cells. Without sufficient haemoglobin, oxygen delivery to tissues drops, and the body is forced to function in a constant low-energy state.

This is not a rare disorder. It is one of the most common nutritional deficiencies globally. It affects children, adolescents, adults, and older people, but the burden is especially high among women of reproductive age due to menstrual blood loss.

Calling it “low blood” oversimplifies the problem. This condition affects the brain, muscles, immune system, heart, and overall quality of life.

Why Iron Deficiency Is So Common and So Missed

Iron deficiency often develops slowly. The body adapts. Symptoms creep in quietly rather than appearing suddenly. Because there is no dramatic pain or visible illness, people learn to tolerate feeling unwell.

Fatigue becomes normalised. Breathlessness is blamed on poor fitness. Hair fall is blamed on stress. Poor concentration is blamed on phone usage. This slow progression is exactly why iron deficiency anaemia is frequently ignored.

Another major reason it is missed is inadequate testing. Many people only get haemoglobin checked. By the time haemoglobin drops, iron stores have often been depleted for months or even years.

Common Symptoms People Should Not Ignore

Iron deficiency anaemia does not look the same in everyone, but common warning signs include:

• Persistent fatigue that does not improve with rest

• Pale skin, lips, or inner eyelids

• Hair thinning and increased hair fall

• Brittle or spoon-shaped nails

• Dizziness or frequent headaches

• Shortness of breath with minimal exertion

• Palpitations or rapid heartbeat

• Poor concentration and memory issues

• Cold hands and feet

These symptoms are not signs of weakness or poor motivation. They are physiological consequences of inadequate oxygen delivery.

Understanding the Blood Tests That Matter

Haemoglobin alone does not tell the full story. Iron deficiency develops in stages, and early stages can be missed if only haemoglobin is measured.

A proper evaluation may include:

• Haemoglobin to assess anaemia

• Serum ferritin to assess iron stores

• Serum iron to measure circulating iron

• Total iron binding capacity to understand iron transport

Low ferritin is a key marker. Even if haemoglobin appears borderline normal, low ferritin means iron stores are depleted and symptoms are real.

Ignoring low ferritin because haemoglobin is “not too bad” delays recovery and prolongs symptoms.

Blood sample collection for testing

Diet, Absorption, and Why Food Alone Is Often Not Enough

Iron intake comes from dietary sources such as green leafy vegetables, legumes, nuts, seeds, meat, and eggs. Vitamin C improves iron absorption, while substances like tea and coffee reduce it.

However, diet alone may not correct deficiency in many cases, especially when:

• Menstrual blood loss is heavy or prolonged

• Iron intake has been low for years

• Gastrointestinal absorption is impaired

• Requirements are increased during adolescence or pregnancy

Iron supplements are not a failure or a shortcut. They are a medical treatment. When prescribed appropriately and taken correctly, they are safe and effective.

Long-Term Consequences of Untreated Iron Deficiency

Untreated iron deficiency anaemia affects far more than energy levels. Long-term consequences can include:

• Reduced academic and work performance

• Impaired cognitive function

• Weakened immunity and frequent infections

• Worsening anxiety or low mood

• Increased risk during pregnancy for both mother and baby

• Delayed growth and development in adolescents

This condition quietly erodes productivity, confidence, and physical resilience.

Common Myths That Need Correction

Myth: Eating healthy prevents anaemia.

Reality: Absorption issues and chronic blood loss still matter.

Myth: Iron tablets are dangerous.

Reality: They are safe when taken under medical supervision.

Myth: Feeling tired all the time is normal.

Reality: Chronic fatigue is a symptom, not a lifestyle choice.

What Action Actually Looks Like

If iron deficiency anaemia is suspected, guessing is not enough.

Practical steps include:

1. Getting proper blood tests, not assumptions

2. Discussing iron studies, not just haemoglobin

3. Following treatment consistently for the full duration

4. Identifying and addressing the underlying cause

   
   

With timely diagnosis and adherence to treatment, full recovery is achievable. Constant tiredness is not a personality trait. Hair fall is not just cosmetic. Dizziness is not something to push through.

Iron deficiency anaemia is common, real, and treatable. Normalising depletion does not make someone resilient. It makes them unwell.

If this feels familiar, the next step is not self-blame. It is proper evaluation and care.

References

1. World Health Organization.Iron Deficiency Anaemia: Assessment, Prevention and Control.Geneva: World Health Organization.

2. Camaschella C.Iron-deficiency anemia. New England Journal of Medicine. 2015;372:1832–1843.

3. Cappellini MD, Musallam KM, Taher AT.Iron deficiency anaemia revisited.Journal of Internal Medicine. 2020;287(2):153–170.

4. Centers for Disease Control and Prevention.Iron Deficiency Anemia.CDC.

5. National Institutes of Health, Office of Dietary Supplements.Iron: Fact Sheet for Health Professionals.NIH.

6. Pasricha S-R, Flecknoe-Brown SC, Allen KJ, et al.Diagnosis and management of iron deficiency anaemia: a clinical update.Medical Journal of Australia. 2010.

Assessed and Endorsed by the MedReport Medical Review Board