- Hookworms attach to the intestinal mucosa and feed on blood, causing chronic intestinal bleeding.
- This persistent blood loss leads to iron deficiency anemia due to depletion of iron stores.
- Unlike other causes, the main problem is not poor absorption or destruction of red cells, but continuous blood loss from mucosal injury.
- This explains why anemia is the primary manifestation of hookworm infection.

Reference: Robbins Basic Pathology, 10th Edition, Chapter 21: Infectious Diseases