Sometimes, people withiron deficiency anemiadon’t respond to treatment with iron supplementation and may go months to years with little to no improvement in anemia. This can happen if the dose is too low or may be due to factors such as missed doses or poor timing of doses.
However, if there aren’t improvements even after making adjustments to the dosage and/or taking the supplement as directed, it may mean that the body isn’t absorbing iron properly or that the anemia is actually due tothalassemia, an inherited blood disorder.
This article explores the reasons why iron supplements may not be working and why thalassemia often gets mislabeled as aniron deficiency.
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Why Iron Supplements May Not Work
Reasons for a lack of response to iron therapy may include:
Iron Absorption Test
For an iron absorption test, your iron levels are checked after fasting (having nothing to eat or drink) for a period of time. You are then given a dose of iron, and the iron level test is repeated. If your body is able to absorb iron, your iron level will increase dramatically. If there is little to no improvement, your healthcare provider may recommend iron infusions, or intravenous iron that’s given through a vein.
Thalassemia Trait
Thalassemia is a condition in which the body makes lesshemoglobin, a protein that’s an important part of red blood cells. This results in red blood cells being destroyed, which is known as hemolytic anemia.
This condition means the body lacks enough red blood cells to carry enough oxygen to tissues throughout the body. As a result, you may often feel weak or tired.
People who are carriers of thalassemia, also called thalassemia trait, might be mislabeled as having iron deficiency anemia.There are two major types of thalassemia: alpha and beta.
Alpha globin and beta globin are the building blocks of hemoglobin. Those with alpha thalassemia don’t make enough alpha globin and those with beta thalassemia don’t make enough beta globin.
Why Thalassemia Trait Gets Mislabeled as Iron Deficiency Anemia
The lab values are very similar in iron deficiency and thalassemia trait. On first glance of thecomplete blood count(CBC), hemoglobin will be low. This points toanemiaand the fact that the corpuscular volume (MCV), or size of the red blood cells, is low. The large majority of people with these changes on CBC have iron deficiency anemia.
Distinguishing Iron Deficiency Anemia From Thalassemia Trait
The first difference is in the red blood cell count (labeled RBC). In iron deficiency, this value is low because the bone marrow is unable to manufacture red blood cells. In thalassemia trait, RBC is normal to elevated.A normal ferritin level can rule out iron deficiency.
A more specific test, sometimes called hemoglobin electrophoresis or hemoglobinopathy evaluation, measures the different types of hemoglobin in our blood. In an adult, there should be hemoglobin A and A2. People with beta thalassemia trait will have elevation in hemoglobin A2 and/or F (fetal).
There is no simple test for alpha thalassemia trait. Usually, the healthcare provider rules out iron deficiency and beta thalassemia trait. Once these two diagnoses are ruled out, alpha thalassemia trait is the presumptive diagnosis.
Find Out if You Have Thalassemia Trait
If you and your partner both have the same thalassemia trait (both alpha or both beta), you have a 1 in 4 (25%) of having a child with thalassemia disease. Thalassemia disease can range from moderate to severe anemia, requiring monthly blood transfusions.
Summary
Thalassemia, an inherited condition that results in anemia, is sometimes mislabeled as iron deficiency anemia. A thalassemia diagnosis may be delayed until after the anemia doesn’t respond to treatment with iron supplements.
Other reasons that iron supplementation may not improve anemia can be related to issues with absorption, not taking it as directed, or needing a higher dose.
4 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Jimenez K, Kulnigg-Dabsch S, Gasche C.Management of iron deficiency anemia.Gastroenterol Hepatol (N Y). 2015;11(4):241–250.Centers for Disease Control and Prevention.What is thalassemia?Baird DC, Batten SH, Sparks SK.Alpha- and beta-thalassemia: rapid evidence review.Am Fam Physician. 2022;105(3):272-280.Fibach E, Rachmilewitz EA.Pathophysiology and treatment of patients with beta-thalassemia - an update.F1000Res. 2017;6:2156. doi:10.12688/f1000research.12688.1.
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Jimenez K, Kulnigg-Dabsch S, Gasche C.Management of iron deficiency anemia.Gastroenterol Hepatol (N Y). 2015;11(4):241–250.Centers for Disease Control and Prevention.What is thalassemia?Baird DC, Batten SH, Sparks SK.Alpha- and beta-thalassemia: rapid evidence review.Am Fam Physician. 2022;105(3):272-280.Fibach E, Rachmilewitz EA.Pathophysiology and treatment of patients with beta-thalassemia - an update.F1000Res. 2017;6:2156. doi:10.12688/f1000research.12688.1.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Jimenez K, Kulnigg-Dabsch S, Gasche C.Management of iron deficiency anemia.Gastroenterol Hepatol (N Y). 2015;11(4):241–250.Centers for Disease Control and Prevention.What is thalassemia?Baird DC, Batten SH, Sparks SK.Alpha- and beta-thalassemia: rapid evidence review.Am Fam Physician. 2022;105(3):272-280.Fibach E, Rachmilewitz EA.Pathophysiology and treatment of patients with beta-thalassemia - an update.F1000Res. 2017;6:2156. doi:10.12688/f1000research.12688.1.
Jimenez K, Kulnigg-Dabsch S, Gasche C.Management of iron deficiency anemia.Gastroenterol Hepatol (N Y). 2015;11(4):241–250.
Centers for Disease Control and Prevention.What is thalassemia?
Baird DC, Batten SH, Sparks SK.Alpha- and beta-thalassemia: rapid evidence review.Am Fam Physician. 2022;105(3):272-280.
Fibach E, Rachmilewitz EA.Pathophysiology and treatment of patients with beta-thalassemia - an update.F1000Res. 2017;6:2156. doi:10.12688/f1000research.12688.1.
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