What Are the Three Stages of Iron Deficiency?

There are three stages of iron deficiency: Iron depletion occurs when the body’s stored iron runs low, but blood levels still look normal. A eritropoiese deficiente em ferro (o processo pelo qual os glóbulos vermelhos são produzidos na medula óssea) ocorre quando não há ferro suficiente para produzir glóbulos vermelhos saudáveis, mesmo que a hemoglobina ainda esteja dentro dos limites. Iron deficiency anemia occurs when hemoglobin drops and symptoms like tiredness, weakness, or pale skin appear.

Stage One: Iron Depletion

Your body begins using up its stored iron (mainly ferritin) to keep making red blood cells. At this point, blood levels still look normal, but iron reserves are shrinking. This is the easiest stage to treat with diet or supplements. If missed, iron levels will keep dropping. Catching it now can prevent anemia later.

Key lab markers: The main early sign of iron deficiency is low serum ferritin, often below 20 nanograms per milliliter of blood (ng/mL). As stores decline further, serum iron and transferrin saturation may also start to decrease, although these can still appear normal early on.

Sintomas:Most people feel fine, but some may notice mild fatigue, lower energy during exercise, or difficulty focusing.

Stage Two: Iron Deficiency

At this stage, your iron stores are gone, and there isn’t enough iron to make healthy red blood cells. Red blood cells are made, but they’re smaller and carry less oxygen.

During this stage, your body is no longer keeping up with iron needs. If not treated, it will progress to full-blown anemia. Early treatment can still restore healthy iron levels before symptoms get worse.

Key lab markers: Hemoglobin is often still normal, but transferrin saturation drops below 16%, and serum iron is low. Ferritin is already low, showing iron stores are gone.

Some people may start to feel:

• Fadiga
• Fraqueza
• Tontura
• Tontura
• Problemas de concentração

Stage Three: Iron Deficiency Anemia

By this point, your body doesn’t have enough iron to make the hemoglobin it needs. Red blood cells become small and pale, and there aren’t enough of them to carry oxygen properly. This is when full anemia sets in.

This stage can seriously affect your energy, focus, and heart health. It often requires iron supplements or medical treatment to reverse. If left untreated, it can lead to long-term health problems.

Key lab markers: Hemoglobin and hematocrit are low. Red blood cells are smaller and paler than normal (low MCV and MCH). A saturação de ferritina, ferro sérico e transferrina é muito baixa, e o RDW costuma ser alto, mostrando tamanhos celulares irregulares, o que acompanha a deficiência de ferro.

Os sintomas comuns incluem:

• Unhas quebradiças
• Desire to eat ice, dirt, or non-food things (pica)
• Feeling lightheaded when you stand up
• Pale skin color
• Falta de ar
• Sore or inflamed tongue
• Úlceras na boca
• Uncontrolled movement of legs during sleep (restless leg syndrome)
• Perda de cabelo

What Causes Iron Deficiency?

Iron deficiency can happen when you don’t get enough iron, your body can’t absorb it properly, or you lose too much blood. Certain life stages, health conditions, and diet choices can all increase your risk.

Common causes of iron deficiency include:

• Not eating enough iron-rich foods, especially in vegetarian or vegan diets
• Má absorção due to conditions like Crohn’s disease, celiac disease, or after weight loss surgery
• Increased iron needs during pregnancy, growth spurts, or intense athletic training
• Perda de sangue from heavy periods, ulcers, hemorrhoids, surgery, injury, or bleeding from colon cancer
• Certos alimentos (like grains and legumes high in phytic acid) that reduce iron absorption
• Doenças crônicas such as kidney disease or cancer, which affect red blood cell production

Some people may have enough iron in the body, but other health problems prevent it from being used properly. Identifying the cause is key to treating and preventing iron deficiency effectively.

When Does It Become Dangerous?

Extreme iron deficiency anemia can cause tachycardia or rapid heart rate. It can also cause low blood pressure. In children, extreme iron deficiency may contribute to learning and concentration problems.

Pregnant women who have an iron deficiency can have low energy. They also have an increased risk of low birth weight babies and premature birth.

Diagnosing Low Iron Levels

Healthcare providers usually start with a complete blood count (CBC) to check your red blood cells. While this test can suggest iron deficiency, more tests are needed to confirm it and find out what’s causing it.

Common blood tests include:

• Serum ferritin: Shows your iron stores
• Serum iron: Measures the amount of iron in your blood
• Transferrin and transferrin saturation:Mostre quão bem o ferro está sendo transportado

Se esses testes sugerirem deficiência de ferro, seu médico poderá procurar sangramento interno, especialmente no estômago ou intestinos.

Isso pode incluir um exame de fezes para sangue oculto ou procedimentos como colonoscopia ou endoscopia para verificar úlceras, pólipos ou outros problemas.

Em casos raros em que a causa não é clara, pode ser realizada uma biópsia da medula óssea. No entanto, isso geralmente só é necessário se outros testes não derem respostas.

Os exames físicos são menos úteis porque sintomas como pele pálida ou fadiga geralmente aparecem tarde. É por isso que os exames de sangue são tão importantes para detectar precocemente a deficiência de ferro.

Como é tratada a deficiência de ferro?

O tratamento da deficiência de ferro depende do estágio e da causa subjacente. É importante corrigir a causa e restaurar os níveis de ferro.

Para o estágio um (esgotamento de ferro), o tratamento pode incluir:

• Comer mais alimentos ricos em ferro, como carne vermelha, folhas verdes e cereais fortificados
• Tomar suplementos de ferro em baixas doses, se necessário

For stage two (iron deficiency), treatment may involve:

• Higher-dose oral iron supplements
• Checking for absorption problems or hidden blood loss
• Using iron infusions (IV) if oral supplements aren’t tolerated

For stage three (iron deficiency anemia), treatment may involve:

• High-dose iron supplements or IV iron
• Treating the cause of blood loss, such as ulcers or heavy periods
• Blood transfusions in severe cases

Most people start to feel better within weeks. Blood tests are usually repeated after about a month to check progress. Even after symptoms improve, iron treatment often continues for a few more months to fully restore iron stores.

How Much Iron Do You Need to Stay Healthy?

Most people can avoid iron deficiency by eating the right foods. How much iron you need each day depends on your age and life stage:

The Best Iron Sources for Your Body

The best way to maintain healthy iron levels is to get enough iron through your diet. Boas fontes incluem:

• Carne e aves
• Feijão e leguminosas
• Fish like tuna and shellfish like oysters
• Nozes e vegetais verde-escuros
• Suco de tomate e batatas

Se você come ferro vegetal (como feijão ou espinafre), combine-o com alimentos ricos em vitamina C – como suco de laranja ou pimentão – para ajudar seu corpo a absorver melhor o ferro.

Algumas pessoas podem precisar de ferro extra se o seu corpo não o absorver bem ou se perderem sangue com frequência. Nestes casos, os profissionais de saúde podem sugerir injeções de ferro.

A maioria dos adultos obtém ferro suficiente dos alimentos e não precisa de suplementos, a menos que seja recomendado por um fornecedor. Indivíduos grávidas ou com grande perda de sangue podem necessitar de ferro extra. Se você toma suplementos, discuta a dose correta de ferro com seu médico.

Suplementos de ferro podem causar prisão de ventre ou dor de estômago. Muito ferro pode ser prejudicial, especialmente para pessoas com uma doença chamada hemocromatose, em que o corpo armazena muito ferro. Mantenha sempre os suplementos de ferro fora do alcance das crianças, pois podem ser perigosos.