Jada first suspected she had a problem when she was applying eyeliner in the mirrors in the toilets at breaktime.

Standing next to her friend, Aqsa, she noticed that the insides of Aqsa’s eyelids were a pink red, unlike her own which were pale and bloodless.

“My mum had that,” Aqsa told her. “She had anaemia.”

Googling on her phone on the way home, Jada realised other symptoms for anaemia matched, too: tiredness, broken nails, breathlessness.

She thought back to her recent poor test scores, and how she’d dropped out of the netball team because the practice sessions became too much - could it all be because of anaemia?

Quick read:The disturbing link between education and health

Quick listen: GCSE revision: a guide to what works best

Want to know more? Why the body is as vital as the brain when it comes to learning

There are 4 million people in the UK living with iron deficiency anaemia, and it is particularly common for teenage girls, partly due to menstruation and dietary habits. Although not all girls will develop anaemia, it is common enough for some health organisations to be calling for regular blood tests for teenage girls to allow for early identification.

“Iron deficiency affects teenage girls, primarily due to the combination of menstrual losses (blood is iron-rich) and limited dietary iron intake (meat is a particularly good source of dietary iron),” explains Dr Jonathon Snook, consultant physician and gastroenterologist at Poole University.

What symptoms should you look out for?

Subject teachers and form tutors are often well placed to spot the signs of anaemia in their students. A teacher might notice that a student has begun to look very pale, or that they have suddenly stopped participating in a sporting activity.

“Teachers might notice that a student is complaining of shortness of breath, or that they’re arriving in registration exhausted blaming heavy legs for being slow to arrive,” says Sharon Benton, renal anaemia specialist nurse at Royal Cornwall Hospital. 

In these situations, a teacher might let the head of year aware of their concerns, or if they feel it is appropriate, flag it up with a parent if the girl’s tiredness is impacting upon their performance in school.

How do the symptoms of anaemia impact upon the school day?

If you’re suffering with anaemia, the school day can feel like a gargantuan task.

Benton explains: “Someone with anaemia could expect to experience chronic fatigue, and they might be unable to concentrate for long periods.

“The effects are muscular as well - because you’re lacking the oxygen component in your blood cells, so your legs feel heavy and you’ll be getting out of breath.”

What is the treatment?

The treatment is relatively simple, but it can have uncomfortable side effects.

“The iron tablets that we use to treat iron deficiency anaemia don’t have the nicest side effects,” explains Benton. “Iron tablets can make you either constipated, or very loose. We use intravenous iron with renal patients, and that doesn’t come with those side effects, but GPs will go down the route of oral iron first.”

How can schools support teenage girls with anaemia?

1. Make small adjustments to the timetable to minimise physical exertion

“Schools could consider changing the timetable for the student to minimise the use of stairs during the school day. By limiting the physical activity, you’ll find the student with anaemia will be able to preserve their energy,” advises Benton.

2. Make it easy to take the medication

“Drinking orange juice when you take iron tablets can help with the absorption of iron,” explains Benton. “Caffeinated drinks, such as coca-cola, tea or coffee can actual inhibit the absorption of iron, and therefore stops the medication working effectively.”

Fresh orange juice and long hot days in a school bag don’t really mix; schools could offer anaemic students who are taking iron tablets the option of storing orange juice in a fridge.

3. Instead of skipping PE lessons, offer different roles

“If you exclude students with anaemia from PE, then you’re going to have all sorts of psychological problems from feeling left out,” says Benton. “Instead, the PE teacher could offer more rest periods, or give them a different job to do, such as refereeing.”

If the student is particularly active and a member of a sports team, it might be a good idea to give the option to “take a break” for a few weeks until their iron levels return to normal. This means they won’t have to lose their place on the team, and can still attend matches in a supportive role.

4. Apply for dispensations for anaemic students who qualify for special consideration

According to the Joint Council for Qualification (JCQ), students who have had a “temporary illness or accident/injury at the time of the assessment” are allowed special consideration in their exams.

JCQ gives more details about applying for special consideration here.

5. Signpost to the right support

For advice and support, Anaemia Nurse Specialist Association (ANSA) has lots of information for anaemic students and their families.

For help regarding nutrition for anaemic students, there is some good advice on food to consume and avoid from the British Nutrition Foundation.