Iron-deficiency anemia may be present without a person experiencing symptoms, it tends to develop slowly; therefore the body has time to adapt, and the disease often goes unrecognized for some time. If symptoms presents, patients may present with the sign of pallor (reduced oxyhemoglobin in skin or mucous membranes), and the symptoms of feeling tired, weak, dizziness, lightheadedness, poor physical exertion, headaches, decreased ability to concentrate, cold hands and feet, cold sensitivity, increased thirst and confusion. It may be accompanied by other symptoms, such as, hair loss and thinning, cracked and dry lips, and a dark circles around the eyes. None of these symptoms (or any of the others below) are sensitive or specific. The symptom most suggestive of iron deficiency anemia in children is pallor of mucous membranes (primarily the conjunctiva). Even so, a large study showed that pallor of the mucous membranes is only 28% sensitive and 87% specific (with high predictive value) in distinguishing children with anemia (defined as hemoglobin < 11.0 g/dl) and 49% sensitive and 79% specific in distinguishing severe anemia (hemoglobin < 7.0 g/dl). Thus, this sign is reasonably predictive when present, but not helpful when absent, as only one-third to one-half of children who are anemic (depending on severity) will show pallor. In severe cases, shortness of breath can occur. Pica may also develop; of which consumption of ice, known as pagophagia, has been suggested to be the most specific for iron deficiency anemia. Other possible symptoms and signs of iron-deficiency anemia include: Koilonychia (spoon-shaped nails) Child development Iron-deficiency anemia is associated with poor neurological development, including decreased learning ability and altered motor functions. This is because iron deficiency impacts the development of the cells of the brain called neurons. When the body is low on iron, the red blood cells get priority on iron and it is shifted away from the neurons of the brain. Exact causation has not been established, but there is a possible long-term impact from these neurological issues.
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