Table of Contents
Anaemia Explained: Iron Deficiency vs Megaloblastic
Anaemia is a condition in which the number of red blood cells or the amount of haemoglobin in the blood is lower than normal. Haemoglobin is the part of red blood cells that carries oxygen to all parts of the body. When the level of haemoglobin goes down, the body does not get enough oxygen, and this is the reason why a person feels weak and tired.
There are many types of anaemia, but the two most common ones are Iron Deficiency Anaemia and Megaloblastic Anaemia.
Iron Deficiency Anaemia happens when the body does not have enough iron. Iron is very important for making haemoglobin. If iron is low, haemoglobin cannot be made properly, and this leads to small and pale red blood cells.
Megaloblastic Anaemia happens when the body does not have enough vitamin B12 or folic acid. These vitamins are needed for red blood cell formation. If they are missing, the body produces abnormally large red blood cells that do not work well.
How Common is Anaemia in India
Anaemia is very common in India, especially among women and children. According to national health surveys, more than half of women between 15 and 49 years of age are anaemic, and almost two out of three children under five years also have anaemia.
This is a big public health problem because it affects energy, growth, and overall health. Pregnancy makes the risk even higher since the body needs more iron and vitamins during that time.
So, it is not just an individual problem but a community concern, and this is the reason the government runs programmes like Anaemia Mukt Bharat to reduce its burden.
⚠ Disclaimer
The content provided in this blog is for educational and informational purposes only. It should not be taken as medical advice. Always consult a licensed healthcare professional before starting, changing, or stopping any medication. Treatment decisions should be based on a doctor’s evaluation of your individual health status and medical history.
Iron Deficiency Anaemia – Causes and Risk
Iron Deficiency Anaemia (IDA) is the most common type of anaemia. It happens when the body does not have enough iron to make haemoglobin. Without enough iron, red blood cells become small and pale, and they cannot carry oxygen properly.
Causes of Iron Deficiency
- Blood loss – heavy menstrual bleeding, stomach ulcers, piles, or internal bleeding
- Pregnancy – higher demand for iron for both mother and baby
- Poor diet – low intake of iron-rich foods like green leafy vegetables, pulses, and meat
- Poor absorption – conditions like celiac disease, chronic diarrhoea, or after stomach surgery
- Worm infestation – hookworm or other intestinal worms
Risk Groups
Some people are at higher risk of IDA, such as:
- Women of reproductive age due to monthly blood loss
- Pregnant women because of extra iron needs
- Young children whose bodies are growing fast
- Adolescents especially girls, because of growth spurt and menstrual loss
- Elderly people with poor diet or hidden bleeding
This is why iron deficiency is not just about poor food intake but also about lifestyle, health conditions, and special stages of life like pregnancy and growth.
Symptoms and Red Flags of Iron Deficiency Anaemia
The symptoms of Iron Deficiency Anaemia are often slow to appear, but they affect daily life. Since haemoglobin carries oxygen, when it is low, the whole body feels the effect.
Common Symptoms
- Tiredness and weakness – feeling exhausted even after light work
- Pale skin – especially on the face, nails, and inside of the eyelids
- Shortness of breath – getting breathless while climbing stairs or walking fast
- Dizziness or headache – due to low oxygen supply to the brain
- Cold hands and feet – poor circulation because of low haemoglobin
Red Flags to Watch For
- Pica – craving for non-food items like clay, ice, or chalk
- Brittle nails and hair loss
- Glossitis – tongue becomes red, sore, or swollen
- Fast heartbeat or chest discomfort in severe cases
These signs should not be ignored. If anaemia becomes severe, it can affect heart health and overall quality of life.
Tests and Diagnosis of Iron Deficiency Anaemia
To confirm Iron Deficiency Anaemia, doctors suggest a few important tests. These tests help find out if the anaemia is truly because of low iron or due to some other cause.
Main Tests
- Complete Blood Count (CBC) – shows low haemoglobin and low MCV (red blood cells are smaller than normal).
- Serum Ferritin Test – measures iron stores in the body. In IDA, ferritin is low.
- Serum Iron and TIBC (Total Iron Binding Capacity) – in IDA, serum iron is low and TIBC is high.
- Transferrin Saturation – usually low in iron deficiency.
Other Checks
- Doctors may also check for sources of blood loss, such as stomach ulcers, piles, or heavy menstrual bleeding.
- In some cases, stool tests are done to look for worm infestation or hidden bleeding in the intestines.
These tests help confirm that the cause of anaemia is iron deficiency and not another type like B12 or folate deficiency.
Treatment and Dosing of Iron Deficiency Anaemia
The main goal of treatment is to increase haemoglobin and restore iron stores in the body. This is usually done with iron supplements and dietary changes.
Iron Tablets
- Doctors commonly prescribe iron tablets or syrups.
- A usual dose is 60 to 120 mg of elemental iron per day (the exact dose depends on the patient’s condition).
- It is best to take iron on an empty stomach with a glass of water or orange juice, since vitamin C improves absorption.
- Avoid tea, coffee, and milk around the time of taking iron, as they reduce absorption.
Side Effects
- Some people may get constipation, nausea, or stomach upset.
- If this happens, doctors may suggest taking the tablet after food or using alternate-day dosing to reduce side effects.
How Long to Continue
- It usually takes 3 to 6 months of treatment to fully correct anaemia and rebuild iron stores.
- Blood tests are done regularly to check improvement.
Other Treatments
- In very severe cases, or if tablets are not tolerated, doctors may give iron injections or IV iron.
- Treating the underlying cause (like heavy bleeding or worm infestation) is also very important.
This is why self-medication should be avoided. Always follow the doctor’s advice on the right dose and duration.
Diet Plan for Iron Deficiency Anaemia
Along with medicines, a proper diet plays an important role in treating and preventing Iron Deficiency Anaemia. The food we eat decides how much iron the body can absorb.
Iron-Rich Foods
- Animal sources (heme iron, better absorbed): liver, red meat, chicken, fish, eggs
- Plant sources (non-heme iron): spinach, drumstick leaves, rajma, chana, jaggery, garden cress seeds (halim), sesame seeds, bajra
How to Improve Absorption
- Eat vitamin C rich foods like amla, oranges, lemon, tomatoes, or guava along with iron-rich foods.
- Cooking in iron utensils can slightly increase iron content in food.
Foods to Avoid with Iron
- Tea, coffee, and colas reduce iron absorption.
- Milk and calcium-rich foods should not be taken at the same time as iron tablets.
This is why a balanced plate in India should include dal, green leafy vegetables, seasonal fruits, and some vitamin C source to improve iron absorption naturally.
Megaloblastic Anaemia (Vitamin B12/Folate Deficiency)
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua.
Causes of Megaloblastic Anaemia
Megaloblastic Anaemia happens when the body does not have enough vitamin B12 or folic acid. These vitamins are important for the production and proper growth of red blood cells. Without them, the body makes abnormally large red blood cells that do not function well.
Common Causes
- Poor diet – very common in strict vegetarians or people who eat very little animal food, since vitamin B12 is mainly found in animal products
- Pregnancy – the need for folic acid increases during pregnancy
- Poor absorption – conditions like pernicious anaemia, gastric surgery, or intestinal diseases reduce absorption of B12 and folate
- Medicines – some drugs like methotrexate, phenytoin, or long-term use of metformin and proton pump inhibitors can reduce vitamin B12 or folate levels
- Alcoholism – heavy alcohol use can interfere with folate absorption
So, it is not just about what you eat but also how your body absorbs these vitamins and if there are other health conditions or medicines that disturb the process.
Symptoms of Megaloblastic Anaemia
The symptoms of Megaloblastic Anaemia are quite similar to iron deficiency, but there are some special signs that make it different.
Common Symptoms
- Tiredness and weakness – feeling exhausted most of the time
- Pale or yellowish skin
- Shortness of breath even with mild activity
- Sore or red tongue (glossitis)
- Loss of appetite and weight loss
Special Symptoms with Vitamin B12 Deficiency
- Numbness and tingling in hands and feet
- Difficulty in walking or balance problems
- Memory issues or confusion in severe cases
- Mood changes like irritability or depression
These neurological symptoms are mainly linked with vitamin B12 deficiency, not folate deficiency. This is why it is very important to find the exact cause before starting treatment.
Lab Pattern and Diagnosis of Megaloblastic Anaemia
Doctors use blood tests to confirm Megaloblastic Anaemia and to find out whether it is due to vitamin B12 or folic acid deficiency.
Blood Test Findings
- CBC (Complete Blood Count): shows low haemoglobin and high MCV (red blood cells are larger than normal).
- Peripheral smear: red blood cells appear oval and large, with changes in white blood cells as well.
- Serum Vitamin B12 level: low in vitamin B12 deficiency.
- Serum Folate level: low in folate deficiency.
Additional Tests
- Methylmalonic acid (MMA): increased in vitamin B12 deficiency.
- Homocysteine level: raised in both vitamin B12 and folate deficiency.
These tests help doctors to separate B12 deficiency from folate deficiency. This is important because the treatment is different, and giving folic acid alone in a B12 deficient patient can make nerve problems worse.
Treatment of Megaloblastic Anaemia
The main aim of treatment is to replace the missing vitamin, either vitamin B12 or folic acid, and to correct the red blood cell production.
Vitamin B12 Treatment
- Injections (IM): commonly given when absorption is poor or deficiency is severe.
- Oral tablets: can be used if the cause is dietary and absorption is normal.
- Regular treatment is needed in chronic conditions like pernicious anaemia.
Folic Acid Treatment
- Folic acid tablets are prescribed daily for deficiency.
- In pregnancy, folic acid is given to prevent anaemia and also to reduce the risk of birth defects.
Important Point
- Always check vitamin B12 level before starting folic acid alone. If folic acid is given without B12 in a B12 deficient patient, it can improve blood counts but make nerve damage worse.
With proper treatment, symptoms improve quickly and blood counts usually return to normal within a few weeks.
B12 Sources for Vegetarians (India)
Finding B12 vegetarian sources in India can be slightly challenging since Vitamin B12 is naturally found in animal-based foods. However, vegetarians can still meet their requirements through smart dietary choices and fortified options.
- Dairy Products – Milk, paneer, cheese, and curd are natural sources of Vitamin B12. Including a daily glass of milk or a bowl of curd can support B12 intake.
- Paneer & Curd – Fresh paneer and homemade curd are popular in Indian diets and provide moderate amounts of Vitamin B12 while also supporting gut health.
- Fortified Foods – In India, many brands offer fortified breakfast cereals, plant-based milks (soy, almond, oat), and nutritional yeast that are enriched with Vitamin B12. Always check the food label for fortification details.
- Supplements (if needed) – For strict vegetarians or those with low B12 levels, supplements may be required. It is best to consult a healthcare professional before starting Vitamin B12 tablets or injections.
You May Also Like
-
Tuberculosis Explained: Symptoms, Diagnosis, Treatment & Global Efforts to End TB
-
Anaemia Explained: Iron Deficiency vs Megaloblastic – Causes, Symptoms, and Treatment
-
Alcoholic Liver Disease (AALD): Symptoms, Stages, Diagnosis and Recovery
-
Peptic Ulcer Disease (PUD): Symptoms, Causes, Tests, Treatment & Diet
IDA vs Megaloblastic
| Feature | Iron Deficiency Anemia (IDA) | Megaloblastic Anemia |
|---|---|---|
Cause | Lack of iron due to poor intake, chronic blood loss, malabsorption | Deficiency of Vitamin B12 and/or Folate |
MCV (Mean Corpuscular Volume) | Low → Microcytic (<80 fL) | High → Macrocytic (>100 fL) |
Ferritin | Low (reflects depleted iron stores) | Usually normal or high |
B12/Folate levels | Normal | Low (B12 and/or Folate) |
Key Symptoms | Fatigue, pallor, pica (craving for clay/ice), brittle nails | Fatigue, glossitis, neurological signs (numbness, tingling, memory loss) |
First-line Treatment | Oral or IV iron supplementation, plus treating underlying cause | Vitamin B12 injections or Folate tablets (depending on deficiency) |
Anaemia in Pregnancy & National Guidance (India)
In India, anaemia in pregnancy is a major public health challenge, with iron deficiency being the leading cause. To tackle this, the Government of India has rolled out specific national guidelines under the Anemia Mukt Bharat (AMB) strategy, focusing on prevention, early detection, and timely treatment.
Key National Guidelines
- Daily IFA Tablets in Pregnancy & Lactation
- Pregnant women: 1 tablet of IFA (100 mg elemental iron + 500 mcg folic acid) daily, starting in the second trimester and continuing for at least 180 days during pregnancy and 180 days postpartum.
- Therapeutic dose: For women diagnosed with moderate anaemia, 2 IFA tablets daily under supervision.
- Weekly IFA for Adolescents
- 6–19 years: Weekly supplementation with IFA tablets to build iron stores before pregnancy.
- Deworming
- Albendazole 400 mg single dose in the 2nd trimester (after the first trimester), especially in high-burden areas.
- Testing & Screening
- Universal haemoglobin testing during ANC visits using digital hemoglobinometers.
- Classification of anaemia (mild, moderate, severe) guides treatment.
- Fortified Foods
- Use of iron-fortified wheat flour, rice, and double-fortified salt under government schemes.
- Behavior Change Communication (BCC)
- Promoting dietary diversification (green leafy vegetables, pulses, meat, jaggery).
- Avoid tea/coffee with meals as they hinder iron absorption.
- Addressing Non-Nutritional Causes
Malaria, hemoglobinopathies (e.g., thalassemia), and chronic diseases are also considered during diagnosis and management.
When to See a Doctor (and What to Ask)
Anaemia may sometimes be managed with diet and supplements, but there are situations where you must see a doctor promptly. Early medical care can prevent complications, especially in pregnancy and in cases of severe anaemia.
When to See a Doctor for Anaemia
Seek medical help if you notice:
- Severe fatigue or weakness interfering with daily activities
- Shortness of breath even at rest or with minimal exertion
- Chest pain, palpitations, or dizziness
- Very low haemoglobin levels detected on blood test
- Pregnancy or lactation, where anaemia increases maternal and foetal risks
- Persistent or heavy bleeding (menstrual, gastrointestinal, or other sources)
- Neurological symptoms such as numbness, tingling, or difficulty concentrating
Questions to Ask Your Doctor About Anaemia
To get the best care, prepare a checklist of questions:
- What type of anaemia do I have?
- What treatment duration is needed?
- Which side-effects should I watch out for with iron/folate therapy?
- How often should I get follow-up blood tests?
- Do I need dietary changes or specific foods to improve haemoglobin?
- Could my anaemia be due to a non-nutritional cause (like chronic disease, bone marrow issue, or hereditary condition)?
FAQs - Anaemia
Ferritin normal range is about 30–300 ng/mL for men and 15–150 ng/mL for women.
On average, haemoglobin rises by 1–2 g/dL every 2–3 weeks with proper iron therapy.
Yes, alternate-day dosing often improves absorption and reduces stomach side effects.
No, avoid tea/coffee within 1–2 hours of taking iron as they reduce absorption.
Vegetarian B12 sources in India include milk, curd, paneer, fortified cereals, and supplements.
Yes, anaemia can lead to headaches, hair loss, fatigue, and palpitations.
Conclusion
Raising anemia awareness is important because many people ignore early signs like fatigue or weakness until the condition becomes severe. With timely diagnosis, most forms of anemia can be managed effectively through the right anemia treatment options, whether it is iron supplements, dietary changes, or advanced therapies. Early medical consultation not only prevents complications but also improves overall quality of life. If you notice persistent symptoms, don’t delay—getting tested and starting treatment early can make a big difference in recovery.
1 thought on “Anaemia Explained: Iron Deficiency vs Megaloblastic – Causes, Symptoms, and Treatment”