Iron Deficiency Anemia
Iron Deficiency Anemia
Dr Abdulsalam Al-Ani
Ass. Prof. and Consultant Hematologist
College of Medicine, University of Anbar
Iron deficiency anemia is the most common type of anemia which is caused by lack of body iron.
The human body need amount of iron a day about 8.7mg for men over 18 and women over 50, 15mg for boys aged <18 years and women 19-50 years. While during pregnancy the body needs up to 27mg.
Deficiency of iron leads to defect in the heme synthesis with subsequent Hb synthesis which is crucial for oxygen transportation to the body. Iron is an essential element not only for the Hb synthesis, but also to many body enzymes.
Although iron the most common elements in the earth's crust, its deficiency still the most common cause of anemia all over the world (more than 1/2 of billion affected(. The highest prevalence is in preschool-age children (47.4%) and non-pregnant women up to 49%, which due to menstrual blood loss, while the lowest in men (12.7%). In Iraq the prevalence shows different results (about 20-30%).
Causes of iron deficiency anemia
The most common causes of anemia include nutritional deficiencies, particularly iron deficiency. However, lack body iron often because of:
· Increase of body demand, mostly during age of growth and pregnancy.
· Due to increased loss;
- Mostly by heavy periods.
- Bleeding, especially chronic blood loss from the stomach and intestines, either due to ulcer or less common cancer of bowel or stomach.
- Taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin may cause ulceration and blood loss.
- Piles (hemorrhoids).
Check for iron deficiency anemia
The main features include:
· Tiredness and lack of energy.
· Shortness of breath.
· Noticeable heartbeats (heart palpitations).
· Pale skin.
A simple blood test will confirm if you have iron deficiency anemia. The most important laboratory test result include:
· Complete blood count (CBC);
- Low hemoglobin level for age and sex; <12gm/dL for male and <11gm/dL for females and variable levels for the children according to the age.
- Low Mean cell haemoglobin (MCH) and Mean cell volume (MCV).
· Low levels of serum ferritin (SF) and serum iron (SI) with high total iron binding capacity (TIBC) and low serum hepcidin level.
· Blood film reveals hypochromic microcytic red blood cells with anisocytosis (difference in cells size) and poikilocytosis (difference in cells shape).
· Bone Marrow Aspirate; not indicated, but may be used for the assessment of iron stores.
· Stool examination for presence of worm infestation, such as hookworm.
Treatment:
Although the condition causes serious effect, the treatment is cheap. It's treated with iron tablets and by eating iron-rich foods.
There are certain important issues need to be considered:
• Usually by oral treatment (tablets or syrup) and injections have no priority and did not have faster response and can be used in very limited conditions.
• the best is ferrous sulphate.
• The drug needs to be taken with empty stomach, i.e.; before meal.
• Should be long enough (about 6 months), to replenish stores.
• Hb response usually 1g/dL per 3 weeks.
• Injection or IV slow infusion of iron-dextran indicated in cases with oral intolerance or need rapid storage replenishment.
• Some people get side effects when taking iron tablets like: constipation or diarrhea, tummy pain, heartburn, feeling sick, black poo.
• Try taking the tablets with or soon after food to reduce the chance of side effects. It's important to keep taking the tablets, even if you get side effects.
ü Things you can do by the patient
If the diet is partly causing iron deficiency anaemia, foods are rich in iron that can be eaten more, of them;
• Dark-green leafy vegetables like spinach and watercress.
• Meat, especially the red, and liver (better to be avoided during pregnancy).
• Fish and eggs.
• Pulses (beans, peas and lentils).
In addition, to eat and drink less, as large amounts of these foods and drinks make it harder for your body to absorb iron:
• Tea.
• Coffee.
• Milk and dairy.
• Foods with high levels of phytic acid, such as wholegrain cereals or bread, which can stop body absorbing iron from other foods and pills.
Complications:
Untreated iron deficiency anemia can give rise to:
· Can make the person more at risk of illness and infection as a lack of iron affects the immune system.
· May increase your risk of developing serious effects on the heart or lungs, such as an abnormally fast heartbeat (tachycardia) or heart failure.
· In pregnancy, can cause a greater risk of complications before and after birth.
References:
1- The World Health Organization (WHO). Anaemia. 2022.
2- The National Health Service (NHS) in England. Iron deficiency anaemia. 2023.
3- Hoffbrand AV. Postgraduate haematology. Seventh ed. 2016.