Iron deficiency anemia – demystifying a common, treatable and preventable public health problem

Over 830,000 Canadians have iron deficiency anemia (IDA),¹ the most common cause of anemia.²    

“Iron deficiency anemia is a global health issue with significant effects on quality of life and productivity,” notes Dr. Wendy Lim, hematologist and professor in the Department of Medicine at McMaster University and director of its Division of Hematology and Thromboembolism.

Commonly characterized by loss of cognitive function³ and feelings of fatigue or lack of energy,⁴ untreated IDA can lead to hospitalization, blood transfusions, and even death.¹ 

Associated with adverse outcomes during pregnancy for maternal and fetal health; motor and behavioural developmental delays in infants and toddlers; and reduced exercise capacity and functional status in heart failure patients, the consequences of unaddressed IDA are significant.¹ 

Diagnosis of the condition is relatively simple, requiring a complete blood count which measures hemoglobin and a ferritin level to measure iron levels and stores.⁵ 

Although IDA is one of the most common blood disorders seen by hematologists in Canada like Dr. Lim, it remains a largely underrecognized and undertreated disease.¹ 

“Before you can treat a condition, you need to recognize it as a problem,” notes Dr. Lim. 

Canadians at risk

Not all populations are affected equally. Menstruating women and girls, pregnant and post-partum women, infants and toddlers, people with gastrointestinal disorders, and indigenous populations in Canada all have increased risk.¹  

Women are disproportionately affected by IDA due to biological, socioeconomic, and health system factors.⁶ Thirty percent (30%) of women aged 15-49 worldwide are estimated to have the condition, with prevalence even higher during pregnancy.⁷ The World Health Organization estimates 37% of pregnant women worldwide have IDA.⁷

What does normal iron look like?

On September 9, 2024, Ontario Health raised the baseline thresholds of normal iron levels across the province.⁸ “This will – and already has – improved the quality of life of people in Ontario,” says Dr. Lim. 

The new lab testing guidelines revised ferritin clinical decision limits to the new threshold minimums of 30 µg/L for adults and 20 µg/L for children.⁸ 

“Patients, particularly women and those who have experienced years and even decades of untreated IDA, often believe their experience is the norm,” notes Dr. Lim. “They see it as something they have to live with – an inevitability.”

Ensuring clinical testing guidelines consider the diversity of the patient experience is therefore critical.

Common misconceptions about IDA management 

Unfortunately, misconceptions surrounding IDA diagnosis, treatment and management still poorly impact patient outcomes.⁹  

There is the belief that once hemoglobin is corrected and acute symptoms have subsided, IDA treatment is complete and the patient cured. Conversely, rapid relapses are frighteningly common. Treatment should continue until iron stores are repleted, ongoing blood source issues resolved, and the root cause addressed.¹

Further, the notion that intravenous (IV) iron is dangerous or should only be used in very severe cases of IDA is incorrect. Modern IV iron formulations are “very safe, very effective, and well-tolerated,” observes Dr. Lim, and severe adverse reactions are rare. This misconception is false and can negatively impact patient care.¹ 

In Canada, access to emerging treatment options, including new formulations of oral iron and IV iron therapies, have the potential to fundamentally change patient care. 

While not all IV irons are the same, modern IV iron formulations can be prescribed for the treatment of IDA in patients when oral iron is not tolerated or is ineffective, including pregnant and postpartum women, patients with gastrointestinal conditions or chronic kidney disease.¹  

“We can now personalize treatment,” says Dr. Lim. By considering patient-specific factors like comorbidities, inflammation, and degree of anemia, the patient can be treated holistically. 

Prioritizing an interdisciplinary approach to care 

Family physicians, nurses, allied health professionals, pediatricians, obstetricians, gynecologists, gastroenterologists, and nephrologists – they all play a critical role in working alongside hematologists in the successful treatment and prevention of IDA. 

IDA is a common condition that affects 2% of Canadians;¹⁰ but it doesn’t have to. Through proactive screening for at-risk populations, multidisciplinary collaboration, and innovative treatments, the Canadian healthcare community can come together to address this common, treatable and preventable problem.¹ 

This article is sponsored by CSL Canada. 

¹Lim, W. Personal communication, January 30, 2026.

²Kingston Health Sciences Centre. Primary Care Management Pathway: iron deficiency anemia. Kingston Health Sciences Centre; 2022. https://kingstonhsc.ca/sites/default/files/legacy/files/subsite-basic-page/iron_deficiency_anemia_pathway_2022july20.pdf. Last accessed February 4, 2026. 

³Kung, M W et al. Anemia and the Risk of Cognitive Impairment: An Updated Systematic Review and Meta-Analysis. Brain Sci Jun 11 2021 11;11(6):777.

⁴American Society of Hematology. Iron-Deficiency Anemia. American Society of Hematology; 2026. https://www.hematology.org/education/patients/anemia/iron-deficiency/. Last accessed: February 4, 2026.

⁵Alberta Doctors. Iron Deficiency Anemia (IDA): Clinical Practice Guideline. Alberta Doctors; 2018. https://www.albertadoctors.org/media/atabokv2/iron-deficiency-anemia-guideline.pdf. Last accessed: February 9, 2026.

⁶Sholzberg, M et al. Diagnosis and management of iron deficiency in females. CMAJ July 02, 2025 197 (24) E680-E687; DOI: https://doi.org/10.1503/cmaj.240570 

⁷World Health Organization. Anemia. World Health Organization (Published 2026).  Available from: https://www.who.int/health-topics/anaemia#tab=tab_1 

⁸Harrison, Lane. Ontario’s new iron deficiency guidelines may change lives: doctors. CBC News; 2024 https://www.cbc.ca/news/canada/toronto/iron-deficiency-bloodwork-testing-ontario-1.7314795. Last accessed February 4, 2026.   

⁹Moss, A S et al. Iron Deficiency: We Think We Know It All!. Blood 2024; 144 (Supplement 1): 7559. 

¹⁰Cooper, M., Bertinato, J., Ennis, J. K., Sadeghpour, A., Weiler, H. A., & Dorais, V. (2023). Population iron status in Canada: Results from the Canadian Health Measures Survey 2012–2019. The Journal of Nutrition, 153(5), 1534–1543. https://doi.org/10.1016/j.tjnut.2023.03.012