Zinc is an essential micronutrient which is involved in many physiological processes in the human body including immune system regulation, cellular survival, neurologic function, and erythropoiesis. Therefore, a wide range of clinical manifestations can be associated with zinc deficiency, such as impaired immune function, dermatologic findings, and decreased growth. Another significant, yet often underrecognized, manifestation of zinc deficiency is anemia. This review discusses the pathophysiology leading to zinc deficiency-associated anemia, highlighting zinc’s role in erythropoiesis, heme biosynthesis, and red blood cell stability. It also outlines various populations which are more at risk for developing zinc deficiency-associated anemia as identifying these groups can aid clinicians to improve screening, especially in patients with unexplained or refractory anemia. Numerous trials in selected populations have demonstrated significant improvement in anemia following zinc supplementation. However, additional studies are critical in order to streamline screening guidelines and establish optimal zinc supplementation dosing. This review aims to increase awareness of zinc deficiency’s contribution to anemia in order to improve screening and clinical outcomes for patients.

Zinc is an essential micronutrient involved in many physiological processes in the human body, including immune system regulation, cellular survival, neurologic function, and erythropoiesis. Zinc deficiency can result in a wide range of clinical manifestations, including impaired immune function, dermatologic findings, and decreased growth. Anemia has been reported as a hematologic manifestation of zinc deficiency and may be underrecognized in clinical practice. This narrative review examines the pathophysiology of zinc deficiency-associated anemia, highlighting zinc’s role in erythropoiesis, heme biosynthesis, and red blood cell stability. It also outlines populations at increased risk for zinc deficiency, including patients with chronic kidney disease, sickle cell disease, malabsorptive disorders, chronic proton pump inhibitor use, and older adults. Emerging evidence suggests that zinc deficiency-associated anemia may represent a potentially modifiable contributor to anemia in selected at-risk populations, although the strength of evidence varies across clinical settings and study designs. Assessment of zinc status may be considered in patients with unexplained or refractory anemia and additional risk factors for deficiency. Further prospective studies are needed to clarify the role of zinc deficiency in anemia and define appropriate screening, supplementation, and monitoring strategies.