Groups at risk and causes of iron deficiency

Groups at risk of iron deficiency

Iron deficiency and iron deficiency anaemia (IDA) can occur at all stages of life, being most prevalent among at-risk groups due to physiological, nutritional or social factors:

  • premature or low birth-weight babies, toddlers and preschool children
  • adolescents
  • menstruating women
  • pregnant and breastfeeding women
  • endurance athletes
  • regular blood donors
  • refugees and recent migrants from economically poor countries
  • some indigenous populations
  • hospitalised and institutionalised patients, including elderly people in aged-care facilities
  • restrictive diets, e.g. vegetarians and vegans. 

Patients with preoperative anaemia may have worse health outcomes with surgery. It’s important to assess baseline haemoglobin, iron status and bleeding risk assessment in any patient requiring surgery that may result in significant blood loss.

Causes of iron deficiency

Iron deficiency results when iron demands or losses exceed iron absorption and is often multifactorial. Factors contributing to negative iron balance include:

Increased iron requirements
  • growing infants, children and adolescents
  • menstruating women
  • pregnancy
  • lactation
  • multiparity
  • parturition/childbirth
Increased iron loss

Gastrointestinal blood loss

  • medication-related, e.g. aspirin, NSAIDs
  • malignancy, e.g. colon, gastric
  • peptic ulcer
  • inflammatory bowel disease
  • infection, e.g. intestinal parasites
  • angioectaisa (angiodysplasia)


Non-gastrointestinal blood loss

  • heavy menstrual bleeding
  • blood donation
  • post-op patients with significant blood loss
  • haematuria
  • intravascular haemolysis: haemoglobinuria
  • extreme physical exercise (endurance athletes)
Decreased iron intake
  • low socioeconomic status
  • vegetarian or vegan diets
  • lack of balanced diet or poor oral intake
  • excessive alcohol intake
  • older age
Decreased iron absorption
  • dietary factors
  • chronic renal failure
  • medications that decrease gastric acidity or bind iron
  • malabsorption resulting from:
  • disease, e.g. Coeliac disease, H. pylori colonisation
  • surgery, e.g. gastrectomy or intestinal bypass
  • inflammation, e.g. chronic gastritis
  • genetic - iron refractory iron-deficiency anaemia