Pharmacist warns of seven anaemia signs missed by millions of Britons — including changes to nails and skin

"From breathlessness, brittle nails and brain fog, symptoms can develop gradually, making them easy to overlook in the early stages."

Dr Bhogal has identified seven understated indicators of the condition that Britons would do well not to ignore — along with guidance on when professional advice ought to be sought.

Unrelenting fatigue is often the first symptom of anaemia to appear

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The first telltale sign, according to Dr Bhogal, is unrelenting fatigue that persists regardless of how much rest one gets.

With fewer healthy red blood cells transporting oxygen throughout the body, even a proper night's sleep may fail to replenish energy levels.

Routine activities can begin to feel increasingly taxing over time. Dr Bhogal recommends maintaining a straightforward energy diary, recording when tiredness strikes and noting possible triggers such as diet, stress or disrupted sleep — information that can prove invaluable when consulting a healthcare professional.

Breathlessness during ordinary tasks represents the second subtle sign. The body attempts to compensate for diminished oxygen-carrying capacity by accelerating the breathing rate, meaning previously effortless activities may suddenly leave one gasping.

Should shortness of breath become a regular occurrence, Dr Bhogal advises speaking with a local pharmacist, who can evaluate symptoms and suggest next steps, potentially including a blood test.

Cold chills constitute the third warning sign, with an unusual sensitivity to low temperatures — particularly in the hands and feet — potentially pointing to iron deficiency anaemia.

Dressing in layers offers short-term relief, but Dr Bhogal notes that persistent cold sensitivity warrants investigation, especially for those with risk factors such as heavy menstrual periods, which can steadily deplete the body's iron reserves.

The fourth indicator is recurring headaches that cannot be explained by stress, dehydration or lack of sleep.

Anaemia causes the brain to dilate blood vessels in an effort to boost blood flow, which can provoke a dull, bilateral ache rather than pain concentrated on one side.

Dr Bhogal said: "Others may experience headaches alongside difficulty concentrating or fatigue.

"If headaches become more frequent or start to interfere with daily activities, it's worth discussing your symptoms with a healthcare professional."

Pale skin is the fifth sign Dr Bhogal highlights, and one that many dismiss as a consequence of British weather or simple tiredness.

Anaemia lowers haemoglobin levels — the protein responsible for giving blood its characteristic red hue — which can leave the complexion noticeably washed out.

This pallor is not limited to the face. Reduced haemoglobin may also become apparent in the gums, the inner eyelids and the inside of the lower lip.

For those whose iron levels may be contributing to the change, Dr Bhogal suggests incorporating iron-rich foods into daily meals — eggs paired with spinach for breakfast, for instance, or lean red meat alongside dark leafy greens at supper.

Combining these with vitamin C-rich ingredients such as citrus fruits or peppers can further enhance the body's ability to absorb iron effectively.

Brittle nails mark the sixth overlooked symptom, often brushed aside as merely cosmetic. Iron is essential for healthy nail growth, and when levels drop, nails may crack, split or become noticeably thinner and slower to grow.

Dr Bhogal advises giving nails a rest from gel and acrylic treatments, as repeated application and removal can compound the damage to already fragile nails. Allowing them to recover naturally also makes it simpler to monitor whether improvements are taking place.

The seventh and final sign is brain fog — that frustrating inability to concentrate, retain information or complete routine mental tasks. When oxygen delivery to the brain is compromised, cognitive sharpness suffers.

Dr Bhogal recommends spending a few minutes outdoors in natural daylight early in the morning to boost alertness and support the body's sleep-wake cycle. Tracking when fog descends can help identify patterns worth raising with a professional.

Millions of Britons may be living with undiagnosed anaemia

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Knowing when to seek help is crucial. A local pharmacist can review symptoms, recommend appropriate measures such as iron supplements, and arrange blood tests whose results are typically available within days. Where necessary, a referral to one's GP can follow.

However, certain symptoms demand more urgent attention. Dr Bhogal warns that headaches arriving suddenly alongside blurred vision, jaw pain, confusion or numbness should prompt immediate action — Government guidance recommends contacting NHS 111 in such circumstances.