Most common cause is excessive blood loss such as heavy or prolonged menstrual cycles, or slow bleed in the gastrointestinal tract.  In addition to common symptoms of being tired and fatigues, lack of energy, etc., some patients also develop habit of eating/chewing ice.  In medical terms, it is called Pagophagia (a subtype of Pica).  The treatment is obviously iron therapy, in the form of iron pills, but if patient for some reason is not able to tolerate oral iron, due to side effects or absorption, then we treat with intravenous iron, which also produces quick response.

At the same time, it is also important to correct the cause of bleeding.  In our practice, we see most patients with iron deficiency are young females whom have heavy menstrual periods.  While we treat their anemia, they also work with their GYN physician to investigate and treat heavy menstrual blood loss.  In difficult cases sometimes, I also try to intervene; interestingly I have seen some success with DDAVP therapy, an agent approved for other bleeding disorders such as Von –Willebrands disease, etc.  Ease of administration and quick response, if achieved, is very gratifying for young professional females, who while working, also have to struggle with symptoms of anemia, which obviously can affect their full potential at work.

For middle age and elderly patients, we advise them to have colonoscopy, if indicated EGD (upper endoscopy) to rule out any slow bleeding, occult ulcer or lesion.