Anaemia in South Asian Women: Causes, Tests and Warning Signs

Anaemia affects nearly half of adolescent girls and women in South Asia. WHO and regional partners estimate that 259 million are currently affected, with another 18 million potentially becoming anaemic by 2030 without stronger action.

Anaemia means that the blood has too little haemoglobin, the protein that carries oxygen. It is not a diagnosis by itself. Iron deficiency is common, but inherited blood conditions, vitamin deficiencies, inflammation, infection and blood loss can produce similar results.

Key point: Anaemia is not always caused by iron deficiency. Long-term iron treatment should not begin without confirming the likely cause.

Why South Asian women may be affected

Risk differs between individuals and communities. Important contributors include:

1. Heavy or prolonged menstrual bleeding
2. Pregnancy, childbirth and the postpartum period
3. Low dietary iron intake or poor absorption
4. Tea or coffee taken close to iron-containing meals
5. Gastrointestinal bleeding, coeliac disease or other digestive disorders
6. Chronic kidney disease, inflammation or infection
7. Thalassaemia and other inherited haemoglobin disorders
8. Deficiency of vitamin B12 or folate

Vegetarian diets can be healthy, but plant iron is absorbed less efficiently than iron from animal foods. This does not mean every vegetarian woman needs a supplement; diet, symptoms and test results should be considered together.

Common symptoms

Mild anaemia may cause no obvious symptoms. When symptoms occur, they can include:

• Persistent tiredness or reduced exercise tolerance
• Shortness of breath on exertion
• Dizziness, headaches or difficulty concentrating
• Palpitations or a faster heartbeat
• Paler skin, gums or inner eyelids
• Cold hands and feet

These symptoms are not specific to anaemia. A blood test is needed rather than relying on appearance, fatigue or a symptom checklist.

Warning signs that need prompt care

Seek urgent medical assessment for chest pain, fainting, severe breathlessness, confusion, a very rapid heartbeat, vomiting blood, or red or black tar-like stools. Heavy bleeding during pregnancy also needs urgent attention.

Iron tablets commonly darken stools. However, sticky tar-like stools, visible blood or dark stools accompanied by pain, weakness or feeling unwell should not be assumed to be a harmless supplement effect.

Which blood tests are used?

Full blood count

A full blood count measures haemoglobin and red-cell characteristics. WHO commonly defines anaemia below 120 g/L in non-pregnant women and below 110 g/L during pregnancy, although laboratories and pregnancy guidance may use context-specific thresholds.

MCV and MCH describe red-cell size and haemoglobin content. Low results can support iron deficiency, but they also occur in thalassaemia and some chronic illnesses.

Ferritin and iron studies

Ferritin reflects stored iron and is usually the most useful initial test for iron deficiency. A low ferritin strongly supports depleted stores. However, inflammation, infection, liver disease or pregnancy can alter interpretation, so a normal result does not always exclude deficiency.

Depending on the situation, a clinician may request transferrin saturation, C-reactive protein or other iron studies.

Tests for other causes

Vitamin B12, folate, kidney or liver tests may be appropriate. Haemoglobin analysis or electrophoresis can be important when red cells are unusually small but iron studies are normal, or when personal or family history suggests thalassaemia.

Heavy periods, pregnancy and hidden blood loss

Women with heavy menstrual bleeding should have a full blood count. Mention flooding, frequent changes of protection, large clots, bleeding lasting more than seven days, or periods that disrupt daily life. Treating iron deficiency without addressing the bleeding invites recurrence.

Pregnancy increases iron requirements and usually includes antenatal anaemia screening. Preventive supplements used in public-health programmes are not the same as an individual treatment plan. Product, dose and follow-up should follow local maternity guidance.

New iron-deficiency anaemia without an obvious explanation may require assessment for digestive-tract blood loss or poor absorption. Report persistent abdominal symptoms, altered bowel habits, unexplained weight loss, blood in stool or a family history of gastrointestinal disease.

What happens after a diagnosis?

Treatment depends on the cause. It may involve iron replacement, improving dietary intake, treating heavy menstrual bleeding, replacing vitamin B12 or folate, managing an underlying illness, or specialist assessment for an inherited blood disorder.

Do not assume that thalassaemia trait requires iron. Iron deficiency and thalassaemia can coexist, but iron should be given only when deficiency is supported by appropriate assessment.

Medical disclaimer: This article provides general educational information. It is not a diagnosis, prescription or substitute for advice from a qualified healthcare professional. Do not start, stop or change iron treatment based only on this article. Seek urgent help for severe symptoms or significant bleeding.

References

1. World Health Organization. Anaemia fact sheet (2025). WHO
2. WHO South-East Asia. Reducing anaemia in South Asian girls and women (2025). WHO South-East Asia
3. British Society of Gastroenterology. Iron deficiency anaemia in adults: clinical guideline. BSG guideline
4. British Society for Haematology. Laboratory diagnosis of iron deficiency. BSH
5. NICE. Heavy menstrual bleeding: assessment and management. NICE
6. World Health Organization. Daily iron and folic acid supplementation during pregnancy. WHO