Persistent fatigue, unexplained dizziness and a constant feeling of weakness are symptoms many people tend to dismiss as stress, lack of sleep or a hectic lifestyle. However, when these symptoms continue despite adequate rest, an underlying nutritional deficiency could be worth investigating. Iron deficiency is one common cause, particularly when it progresses to iron deficiency anaemia.
Neurologist Dr Priyanka Sehrawat has highlighted the importance of looking at blood indicators when symptoms such as fatigue and dizziness persist. While these symptoms can have many possible causes, blood tests can help doctors determine whether inadequate iron stores or reduced oxygen-carrying capacity could be contributing to them.
What is iron deficiency
Iron is an essential mineral required for several functions in the body. One of its most important roles is helping produce haemoglobin, the protein in red blood cells that carries oxygen throughout the body.
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When iron stores become depleted, the body may initially compensate, and haemoglobin can remain within the normal range. With more significant or prolonged deficiency, haemoglobin production may fall, resulting in iron deficiency anaemia.
Because oxygen delivery is affected, a person may experience tiredness, reduced exercise tolerance, weakness, headaches, dizziness or difficulty concentrating.
Four blood indicators doctors may check
1. Ferritin
Ferritin is a protein that stores iron, making serum ferritin an important marker of the body's iron reserves. Low ferritin can indicate depleted iron stores, even before significant anaemia develops.
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However, ferritin can rise in response to inflammation, infection and certain other conditions. This means the result should be interpreted alongside symptoms and other laboratory findings rather than in isolation.
2. Haemoglobin
A haemoglobin test is commonly included in a complete blood count (CBC). It measures the amount of haemoglobin in the blood.
Low haemoglobin can indicate anaemia, although anaemia has numerous possible causes. Iron deficiency is one of them, but vitamin B12 or folate deficiency, blood loss, chronic disease and other conditions can also cause anaemia.
This is why a low haemoglobin result should prompt further evaluation rather than automatically being attributed to iron deficiency.
3. Mean corpuscular volume (MCV)
MCV measures the average size of red blood cells and is another component of a CBC.
In established iron deficiency anaemia, red blood cells may become smaller than usual, a pattern known as microcytosis. A low MCV can therefore provide an important clue when doctors are investigating anaemia.
However, low MCV is not exclusive to iron deficiency. Other conditions, including certain inherited blood disorders, can also cause small red blood cells.
4. Transferrin saturation
Transferrin saturation (TSAT) provides information about how much iron is available for transport in the bloodstream. It is generally interpreted together with serum iron, transferrin or total iron-binding capacity and ferritin.
A low TSAT can support the possibility that insufficient iron is available to tissues for normal use. Looking at multiple indicators can give clinicians a clearer picture than relying on a single measurement.
Why fatigue and dizziness should not be ignored
Iron deficiency can develop gradually, so symptoms may initially be subtle. A person may notice that climbing stairs feels more difficult, workouts become harder, concentration declines or everyday activities leave them unusually exhausted.
Some people may also experience headaches, pale skin, shortness of breath during exertion, a fast heartbeat, cold hands and feet or unusual cravings such as eating ice.
Dizziness, however, has many possible causes. Dehydration, low blood pressure, blood sugar changes, medication effects, inner-ear disorders, heart conditions and neurological problems can also contribute. Persistent or recurrent dizziness therefore deserves proper medical assessment.
Who may be at higher risk
Iron deficiency can occur in anyone, but certain groups have a greater risk. These include people with heavy menstrual bleeding, pregnant individuals, people who consume insufficient dietary iron, frequent blood donors and individuals with gastrointestinal blood loss or conditions that interfere with nutrient absorption.
In children and adolescents, increased nutritional requirements can also contribute to deficiency.
Importantly, unexplained iron deficiency especially in adult men or postmenopausal women may require investigation for a source of blood loss rather than simply treating the low iron level.
Should you take iron supplements
Iron supplements should not automatically be taken whenever fatigue occurs. Excess iron can be harmful, and fatigue has many potential causes.
A healthcare professional can determine whether testing is appropriate and identify the reason for deficiency if it is present. Depending on the situation, treatment may involve dietary changes, oral iron supplementation or, in selected cases, intravenous iron.
If fatigue or dizziness is persistent, recurrent or interfering with daily life, speak with a healthcare professional about whether a CBC and iron studies are appropriate.
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