Serum zinc levels in patients with iron deficiency anemia and its association with symptoms of iron deficiency anemia

Ann Hematol. 2016 Apr;95(5):751-6. doi: 10.1007/s00277-016-2628-8. Epub 2016 Mar 2.


Iron deficiency anemia (IDA) is a major public health problem especially in underdeveloped and developing countries. Zinc is the co-factor of several enzymes and plays a role in iron metabolism, so zinc deficiency is associated with IDA. In this study, it was aimed to investigate the relationship of symptoms of IDA and zinc deficiency in adult IDA patients. The study included 43 IDA patients and 43 healthy control subjects. All patients were asked to provide a detailed history and were subjected to a physical examination. The hematological parameters evaluated included hemoglobin (Hb); hematocrit (Ht); red blood cell (erythrocyte) count (RBC); and red cell indices mean corpuscular volume (MCV), mean corpuscular hemoglobin (МСН), mean corpuscular hemoglobin concentration (МСНС), and red cell distribution width (RDW). Anemia was defined according to the criteria defined by the World Health Organization (WHO). Serum zinc levels were measured in the flame unit of atomic absorption spectrophotometer. Symptoms attributed to iron deficiency or depletion, defined as fatigue, cardiopulmonary symptoms, mental manifestations, epithelial manifestations, and neuromuscular symptoms, were also recorded and categorized. Serum zinc levels were lower in anemic patients (103.51 ± 34.64 μ/dL) than in the control subjects (256.92 ± 88.54 μ/dL; <0.001). Patients with zinc level <99 μ/dL had significantly more frequent mental manifestations (p < 0.001), cardiopulmonary symptoms (p = 0.004), restless leg syndrome (p = 0.016), and epithelial manifestations (p < 0.001) than patients with zinc level > 100 μ/dL. When the serum zinc level was compared with pica, no statistically significant correlation was found (p = 0.742). Zinc is a trace element that functions in several processes in the body, and zinc deficiency aggravates IDA symptoms. Measurement of zinc levels and supplementation if necessary should be considered for IDA patients.

Keywords: Anemia; Iron deficiency; Iron metabolism; Zinc.

MeSH terms

  • Adolescent
  • Adult
  • Anemia, Iron-Deficiency / blood*
  • Anemia, Iron-Deficiency / complications
  • Anemia, Iron-Deficiency / epidemiology
  • Anemia, Iron-Deficiency / psychology
  • Case-Control Studies
  • Cognition Disorders / etiology
  • Dyspnea / etiology
  • Erythrocyte Indices
  • Fatigue / etiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pica / blood
  • Restless Legs Syndrome / etiology
  • Skin Diseases / etiology
  • Spectrophotometry, Atomic
  • Symptom Assessment
  • Turkey / epidemiology
  • Young Adult
  • Zinc / blood*
  • Zinc / deficiency
  • Zinc / pharmacokinetics


  • Zinc