Iron-deficiency anemia is a global burden on the communities, prevalent everywhere. This article discusses iron-deficiency anemia in detail.
Anemia refers to the condition where hemoglobin in the blood is below the normal range. Hemoglobin is an oxygen-carrying protein in the red blood cells of the blood. Iron is an important component of hemoglobin structure. Iron deficiency results in microcytic (smaller cells with less volume) and hypochromic (less red color) red blood cells.
Iron deficiency is the most common reason for anemia which accounts for nearly 50 % of all anemias.
Iron plays an essential role in the production of hemoglobin. Cells require iron to construct the molecule called heme. Four subunits of heme combine to form single metalloprotein hemoglobin. Absorption of iron takes place in the small intestine, and they are transported through transferrin. The major storage depot for iron is the liver and stored in the form of ferritin and hemosiderin.
When the body lacks iron, the heme assembly does not form or disintegrate, and the cells are devoid of hemoglobin. Therefore, the cells are formed in a small size with reduced volume and look lighter in color.
There are three stages in the development of iron-deficiency anemia,
Stage I: Iron storage in the body is exhausted and indicated by the decrease in serum ferritin levels.
Stage II: Diminished production of red blood cells where iron content does not meet the demand.
Stage III: Established iron-deficiency anemia with abnormal iron status identified in all laboratory tests.
Less nutritional intake, like protein-energy malnutrition, poor quality food, etc.
Blood loss, like vaginal bleeding, gastric ulcer, and pulmonary blood loss.
Increased demand for energy, like in pregnancy, adolescence, and hyperthyroid patients.
Decreased iron absorption, like in celiac disease and inflammatory bowel disease.
Intestinal parasitic (worm) infection.
Most of the patients will present with,
If anemia is severe, then breathlessness (dyspnea) will also be present. The patient's working capacity is restricted, and palpitation can be present. If iron-deficiency anemia is present from early life (from six months to two years), then mental sluggishness and low IQ-like neurological manifestations can be permanent. Iron is required for the synthesis of chemical messengers (neurotransmitters - to convey the message between the cells) and myelination (formation of an insulating layer around the nerves). Hence, neurological features can be seen. Pica (an eating disorder where patients crave to eat non-food items like clay, soil, etc.) is sometimes associated with iron-deficiency anemia (IDA). If not treated, then iron-deficiency anemia can cause heart failure or ischemic heart disease.
Other features of iron-deficiency anemia include a smooth pale tongue, brittle spoon-shaped nails, and cracking sores in the corners of the mouth.
Most patients with iron-deficiency anemia remain asymptomatic and are identified through investigations.
Physicians may check for pale-colored skin and eye layer, increased heart rate, and abdominal changes.
CBC (Complete Blood Count) and PS (Peripheral Smear):
These are the common mode of screening, and it will show low hemoglobin levels and microcytic hypochromic RBC (red blood cell).
In iron-deficiency anemia, as microcytic hypochromic red blood cells are present, there is reduced red blood cell size. The following parameters are checked;
MCV (mean corpuscular volume) will be less than 80.
MCH (mean corpuscular hemoglobin) will be less than 25.
MCHC (mean corpuscular hemoglobin concentration) will be low.
PCV (packed cell volume) is reduced.
If needed, a bone marrow biopsy is done to check erythroid hyperplasia and normoblast maturation.
TIBC (total iron-binding capacity) is increased, serum ferritin (iron storage) is decreased, serum transferrin receptor assay shows increased value, and FEP (free erythrocyte protoporphyrin) will be raised.
The first line of treatment is to find the cause of the iron deficiency and treat them.
If a parasitic infection is a cause, then an antihelminthic drug-like Albendazole is needed.
If iron deficiency is caused by a peptic ulcer, then Pantoprazole should be used.
For nutritional anemia, good food with more green leafy vegetables, jaggery, meat, etc., is beneficial.
Ferrous sulfate is available in syrup and tablet form. This medicine can make the stool black in color.
For severe anemia (hemoglobin less than 7 g/dL) and for those who cannot take medicines orally, injectable Iron is given, for example, Iron sucrose.
The hemoglobin level increases as early as 14 days after the start of the treatment, and supplements are continued for up to three months to establish body storage.
In iron-deficiency anemia, the natural immunity of the body is compromised and increases the risk of infection.
Increased demand for oxygen in the tissues pushes the heart to pump more to make up the supply, which in the long run can induce heart failure.
Children with iron-deficiency anemia have impaired development of cognition and motor skills.
Demand for red blood cells increases during pregnancy which in turn requires more iron and vitamins. Severe iron-deficiency anemia can lead to premature childbirth, low-weight babies, and postpartum depression.
Anxiety, mood swings, sleep deprivation, extreme fatigue, and depression are associated with iron-deficiency anemia.
Long-term iron deficiency is fatal.
Intravenous Iron given to treat iron-deficiency anemia may have a few adverse effects like brownish discoloration of the skin and sometimes anaphylactic reaction.
People with gastrointestinal problems, heavy menstrual bleeding, and pregnant ladies are at risk of developing iron-deficiency anemia and hence they are screened for the same and advised prophylaxis. Iron-deficiency anemia can lead to several medical complications and therefore a multidisciplinary approach is followed to treat them effectively. Early diagnosis, proper treatment, and strict follow-up are recommended for the best outcome.
Green leafy vegetables and red meat are good sources of iron to be included in the diet to reduce the occurrence of iron-deficiency anemia.
Last reviewed at:
15 Jun 2022 - 4 min read
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