Q. Do decreased iron levels cause pins and needles and muscle weakness?

Answered by
Dr. Mubashir Razzaq Khan
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 07, 2021

Hello doctor,

I have a history of anemia. I also just recently found out I have chronic gastritis. My iron is at a level of 41 percent, but my ferritin and saturation are low. How does that work? I have been on my iron pills. Do pins and needles and muscle weakness have anything to do with iron level?



Welcome to

I hope you are fine and safe from the pandemic.

The data you provided in quantitative and qualitative terms indicate mixed micronutrient deficiency, especially Iron, Vitamin B12, Folic acid, Pyridoxine. Get it treated according to local guidelines. For gastritis, rule out Helicobacter pylori infection. Get H.pylori antigen in stool and endoscopy and share the reports.

Low hemoglobin is also called anemia.

Grade 1 anemia: Hemoglobin less than usual for age and gender up to 9.9 g/dL. It is mild anemia. No Investigation is needed. Just improve diet, give hematinics. Rule out renal disease, liver disease, thyroid disease, thalassemia minor, or any drug-induced cause.

Grade 2 anemia: Hemoglobin range from 8.9 to 9.8 g/dL. It is moderate anemia. Investigate the cause, which might include combined nutritional deficiency or other reasons mentioned above. No blood transfusion is needed at this level.

Grade 3 anemia: Hemoglobin range from 7.9 to 8.8 g/dL. It is moderately severe anemia. Causes may be hemolysis, acute or chronic blood loss, along with the causes mentioned above. No need for transfusion at this level unless a surgical emergency is there. Treat the cause.

Grade 4 anemia: Hemoglobin range from 6.9 to 7.8 g/dL. It is severe anemia. However, no transfusion needed even at this level unless there is some surgical emergency. Causes include thalassemia intermedia or major, G6PD (glucose-6-phosphate dehydrogenase) deficiency, hereditary spherocytosis, and above mentioned ones.

Grade 5 anemia: Hemoglobin level 5.9 to 6.8 g/dL. It is very severe anemia. You may need a blood transfusion according to the cause. If there is a production disorder, transfuse the patient. Transfuse in thalassemia major. There is no need for transfusion in mere combined nutritional deficiency or renal disease. Also, assess the cardiovascular system at this level.

Critically low hemoglobin or grade 6 anemia: Hemoglobin level less than 5 g/dL. Transfusion is needed regardless of the cause. For example, consider PRCA (pure red cell aplasia), thalassemia major, aplastic anemia.

The workup for anemia includes CBC (complete blood count) with red-cell indices, platelets, reticulocytes, and peripheral blood smear report, LDH (lactate dehydrogenase), hematuria workup, and melena or hematemesis or hemoptysis work up, bone marrow biopsy report, Ferritin, Vitamin B12 and RBC (red blood cells), folate levels, RFTs (renal function test), LFTs (liver function test).


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