Iron & Anemia: Reading Your Complete Blood Count

The Most Common Deficiency Nobody Talks About Properly

India is the anemia capital of the world. The statistics should alarm every Indian:

• 52% of women aged 15-49 are anemic
• 25% of men are anemic (not as "normal" as people think)
• 67% of children under 5 are anemic
• 57% of pregnant women are anemic — putting babies at risk

You might think your fatigue is normal — everyone's tired, right? But if you can't climb a flight of stairs without your heart pounding, if your nails are thin and curved, if the inside of your lower eyelids is pale pink instead of healthy red — that's not normal stress. That's your body struggling to carry oxygen because there isn't enough hemoglobin.

This is India's silent crisis, where exhaustion has been normalized.

India: The Anemia Capital of the World

Statistics that should alarm every Indian:

• 52% of women aged 15-49 are anemic
• 25% of men are anemic (not as "normal" as people think)
• 67% of children under 5 are anemic
• 57% of pregnant women are anemic — putting babies at risk

More than half of India's women are walking around with insufficient oxygen-carrying capacity in their blood. They're tired. They're breathless. They're being told it's "just stress."

Understanding Your Blood Count (CBC)

The Complete Blood Count (CBC) is the most common blood test performed. Yet most people have no idea how to read it. Here are the key values:

Hemoglobin (Hb)

The oxygen-carrying protein in red blood cells. This is the number that defines anemia.

Category	Men	Women (non-pregnant)	Pregnant Women
Normal	13.5-17.5 g/dL	12.0-15.5 g/dL	11.0-14.0 g/dL
Mild Anemia	11-13.4 g/dL	10-11.9 g/dL	10-10.9 g/dL
Moderate Anemia	8-10.9 g/dL	8-9.9 g/dL	7-9.9 g/dL
Severe Anemia	Below 8 g/dL	Below 8 g/dL	Below 7 g/dL

Red Blood Cell (RBC) Count

The number of red cells in the blood. Can be normal even when hemoglobin is low (if cells are small and pale).

MCV (Mean Corpuscular Volume)

The average size of red blood cells. This indicates what type of anemia is present:

• Low MCV (microcytic): Small cells — usually iron deficiency or thalassemia
• Normal MCV (normocytic): Normal-sized cells — chronic disease, acute blood loss, or early deficiency
• High MCV (macrocytic): Large cells — B12 or folate deficiency

MCH and MCHC

How much hemoglobin is in each cell. Low in iron deficiency (cells are pale).

RDW (Red Cell Distribution Width)

How much variation in size among red cells. High RDW suggests the body is making new cells of different sizes — often seen in iron deficiency with recent iron replacement.

The Iron Story: More Than Just Hemoglobin

Here's what most people don't understand: by the time hemoglobin drops, iron stores have been depleted for months or years. Hemoglobin is the last thing to fall.

The stages of iron depletion:

Stage 1: Iron Store Depletion

The body's iron storage (ferritin) drops. Hemoglobin is still normal. No symptoms yet. This would only be detected by testing ferritin.

Stage 2: Iron Deficiency Without Anemia

Ferritin is low. The body is struggling to maintain hemoglobin. There might be tiredness, brain fog, shortness of breath. But hemoglobin is still "normal" — so the report says "fine."

Stage 3: Iron Deficiency Anemia

Now hemoglobin drops. Officially anemic. This is when most people get diagnosed — when the barn door is wide open and the horse has left.

The Tests That Tell the Full Story

Test	What It Measures	Optimal Range
Ferritin	Iron stores	50-150 ng/mL (30+ is often called "normal" but 50+ is optimal)
Serum Iron	Iron in blood	60-170 mcg/dL
TIBC	Total iron binding capacity	250-370 mcg/dL (high in iron deficiency)
Transferrin Saturation	% of transferrin loaded with iron	20-50% (low in iron deficiency)

A typical iron deficiency pattern: Low ferritin, low serum iron, high TIBC, low transferrin saturation, low MCV, low hemoglobin.

Why Are So Many Indians Iron Deficient?

Diet

The vegetarian diet common in India is low in heme iron (the easily absorbed form from meat). Plant iron (non-heme) is poorly absorbed — often only 5-10% compared to 25-30% from meat.

Additionally:

• Phytates in grains and legumes block iron absorption
• Tannins in tea and coffee block iron absorption
• Calcium (dairy) blocks iron absorption when consumed together

Chronic Blood Loss

In women, heavy menstrual periods are a major cause. A woman who loses clots, bleeds through pads, or has periods lasting more than 7 days is likely losing more iron than she's absorbing.

In both sexes:

• Hemorrhoids (piles) — extremely common in India
• Chronic gastritis and ulcers
• Hookworm and other parasitic infections (still prevalent in rural areas)
• Colorectal cancer (rare but important to rule out in unexplained anemia)

Increased Needs

Pregnancy, breastfeeding, growth spurts in adolescence — all dramatically increase iron requirements.

Malabsorption

Celiac disease, H. pylori infection, gastric surgery, chronic antacid use — all impair iron absorption.

The Tea Trap: India's Hidden Iron Blocker

Consider the chai habit that's worsening the anemia crisis.

Tannins in tea bind to iron and prevent its absorption. A cup of tea with or immediately after a meal can reduce iron absorption by up to 60%.

Now think about the typical Indian meal pattern:

• Breakfast with chai
• Post-lunch chai
• Evening chai
• After-dinner chai

Iron absorption is being actively sabotaged with every meal.

Symptoms That Go Beyond "Just Tired"

Iron deficiency affects every system in the body. Here's what to watch for:

Classic Symptoms

• Fatigue, weakness, lack of energy
• Shortness of breath, especially on exertion
• Pale skin, pale nail beds, pale inner eyelids
• Dizziness, lightheadedness when standing
• Cold hands and feet
• Rapid or irregular heartbeat

Symptoms People Don't Know Are Related

• Pica — craving ice, clay, starch, or other non-food items
• Restless leg syndrome — urge to move legs, especially at night
• Brittle, spoon-shaped nails (koilonychia)
• Hair loss
• Mouth sores, cracked corners of mouth
• Difficulty swallowing (rare, from esophageal webs)
• Poor concentration, decreased work productivity
• Weakened immunity, frequent infections

Treatment: More Than Just Taking Iron Pills

Oral Iron

Most people with iron deficiency anemia can be treated with oral iron supplements.

Common forms:

• Ferrous sulfate — most common, cheapest, but can cause stomach upset
• Ferrous gluconate — gentler on the stomach, less iron per tablet
• Ferrous fumarate — higher iron content
• Carbonyl iron — slower release, may cause less GI issues

How to take oral iron properly:

• Take on empty stomach if tolerated (absorbs better)
• If stomach upset, take with a small amount of food (but not dairy)
• Take with Vitamin C (orange juice, lemon) — dramatically improves absorption
• Don't take with tea, coffee, dairy, or antacids
• Expect black stools — this is normal
• Expect some constipation — increase fiber and water

Duration: Continue for 3-6 months after hemoglobin normalizes to replenish stores.

IV Iron

Sometimes oral iron isn't enough:

• Severe anemia requiring rapid correction
• Intolerance to oral iron (severe GI symptoms)
• Malabsorption conditions
• Ongoing blood loss that oral iron can't keep up with
• Pregnancy when oral iron isn't raising levels fast enough

IV iron (ferric carboxymaltose, iron sucrose) can replenish stores in 1-2 infusions. It's safe and effective when indicated.

Blood Transfusion

Reserved for severe, symptomatic anemia (typically hemoglobin below 7 g/dL with symptoms) or in emergencies. Transfusion is not a treatment for iron deficiency — it's a rescue measure.

Not All Anemia Is Iron Deficiency

A critical point: don't assume all anemia is iron deficiency. Other causes include:

B12/Folate Deficiency

Causes macrocytic anemia (large red cells). Common in vegetarians (B12) and can be masked by folic acid supplementation.

Chronic Disease

Inflammation, infections, kidney disease, cancer — all can cause "anemia of chronic disease." The body has iron but can't use it properly.

Thalassemia

Extremely common in India. A genetic condition causing microcytic anemia. Often mistaken for iron deficiency — but giving iron to a thalassemia patient is dangerous (they already have excess iron).

Hemolysis

Conditions where red blood cells are destroyed faster than they're made. Causes anemia with high reticulocyte count (new cells being produced rapidly).

Special Considerations

Women with Heavy Periods

If you soak through a pad or tampon every hour, pass clots larger than a quarter, or bleed for more than 7 days — you're losing too much iron. Treatment includes addressing the underlying cause (fibroids, hormonal issues) and iron supplementation.

Pregnancy

Iron requirements triple during pregnancy. The developing baby and placenta need iron. Expanded blood volume needs more hemoglobin. Maternal anemia increases risk of preterm birth, low birth weight, and maternal death. Every pregnant woman should be screened and supplemented.

Athletes

"Sports anemia" and exercise-induced hemolysis are real. Runners in particular can destroy red cells through foot strike. Athletes often need iron supplementation, especially women athletes.

Blood Donors

Each blood donation removes about 250 mg of iron. Regular donors (especially women) should be monitored for iron status.

Food Sources of Iron

Heme Iron (Better Absorbed)

• Liver, organ meats — highest sources
• Red meat (mutton, beef)
• Poultry
• Fish, shellfish

Non-Heme Iron (Plant-Based)

• Legumes (rajma, chana, lentils)
• Dark leafy greens (spinach, methi, amaranth)
• Nuts and seeds (pumpkin seeds, sesame)
• Fortified cereals
• Jaggery (gur)
• Dried fruits (apricots, raisins)

Monitoring Treatment

If being treated for iron deficiency:

• Recheck hemoglobin in 4-8 weeks — it should start rising within 2-3 weeks
• Recheck ferritin in 3 months — it takes longer to replenish stores
• Continue iron for 3-6 months after hemoglobin normalizes to fill stores
• If hemoglobin doesn't rise despite treatment, investigate why (malabsorption, ongoing loss, wrong diagnosis)

The Recovery Story

Three months after treatment — IV iron infusions and thorough investigation — Preethi's hemoglobin is 12.5 g/dL. She can climb stairs. She can exercise. She can think clearly.

Investigation revealed she had heavy periods (which she'd never mentioned because she thought they were "normal for women") and celiac disease (undiagnosed, causing malabsorption).

"I didn't realize how bad I felt," she says. "Because I'd felt that way for so long, it became my normal."

This is the pattern across India. Women especially — accepting exhaustion as their baseline. Never questioning whether feeling half-alive is actually living.

Don't let iron deficiency steal your energy, your clarity, your capacity for life. It's one of the most treatable conditions in medicine. We just need to look for it.

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