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.

How Does Iron-Deficiency Anemia Develop?

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.

What Are the Stages of Iron-Deficiency Anemia?

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.

What Are the Causes of Iron-Deficiency Anemia?

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.
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Decreased iron absorption, like in celiac disease and inflammatory bowel disease.
Intestinal parasitic (worm) infection.

What Are the Clinical Features of Iron-Deficiency Anemia?

Most of the patients will present with,

Fatigue.
Tiredness.
Dizziness.

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.

How to Diagnose Iron-Deficiency Anemia?

Most patients with iron-deficiency anemia remain asymptomatic and are identified through investigations.

Physical Examination:

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).

Blood Indices:

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.

Bone Marrow:

If needed, a bone marrow biopsy is done to check erythroid hyperplasia and normoblast maturation.

Biochemical Investigations:

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.

How to Manage Iron-Deficiency Anemia?

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.

What Are the Complications of Iron-Deficiency Anemia?

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.

Conclusion:

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.

Frequently Asked Questions

1. Is Iron Deficiency Anemia Hereditary?

Iron deficiency anemia can be genetic in some cases as an alteration in the genetic code of a person can pass it to their children. The parents usually have the affected genes but do not necessarily have any signs and symptoms. The leading cause of iron deficiency includes dietary factors, blood loss, or underlying health conditions.

2. Can Stress Lead To Anemia?

In some cases, stress can be one of the reasons for anemia. This is because excessive stress can interfere with the production of hydrochloric acid in the body, which is very important for integrating iron and proteins. It results in the deficiency of iron in the body, causing a lack of hemoglobin, leading to anemia.

3. Is Iron Deficiency Anemia a Serious Problem?

Mild iron deficiency anemia does not cause serious complications; however, if left untreated, it can cause severe health problems such as heart problems, problems during pregnancy, and growth problems. In addition to that, it also increases the susceptibility to developing new infections.

4. How to Manage Low Iron Deficiency Anemia?

The treatment of iron deficiency anemia involves taking iron supplements prescribed by the doctor. Along with that, the patient is advised to make some dietary changes by including iron-rich foods such as red meat, beans, pork, and dark green leafy vegetables. Moreover, vitamin C is also advised to facilitate iron absorption in the body.

5. Can Iron Deficiency Cause Weight Gain?

There is no data available on iron deficiency anemia causing weight gain. However, taking iron supplements to treat iron deficiency anemia can lead to weight gain as a side effect in some people. But in some cases, weight loss can be seen due to underlying conditions along with iron deficiency anemia.

6. Can Low Iron Cause Joint Pain?

Iron deficiency anemia is associated with multiple symptoms. And having severe pain in joints and limbs is one of the common symptoms. Moreover, prolonged iron deficiency can lead to bone loss and osteoporosis risk.

7. How Do Low Iron Headaches Feel Like?

Low iron levels in the body cause the brain to receive less oxygen. Less oxygen causes problems in the functioning of the brain and leads to headaches. In some cases, it can also cause lightheadedness or dizziness. Iron deficiency anemia is also associated with migraine, especially in women.

8. Does Low Iron Cause Sleep Issues?

Iron deficiency anemia does affect the quality of sleep. Iron deficiency can lead to tiredness and headaches. This can be associated with insufficient sleep in the majority of patients. In adults with iron deficiency anemia, insomnia is a common sign.

9. Can Iron Deficiency Cause a Bloated Stomach?

Iron deficiency cannot be linked directly to gastrointestinal symptoms. However, it usually has symptoms like gas and bloating which can be present due to an underlying condition.

10. What Are the Serious Signs and Symptoms Seen in Iron Deficiency Anemia?

Iron deficiency anemia usually develops slowly and shows only mild symptoms; in some cases, people do not even experience any symptoms. But in serious cases, when the anemia causes severe symptoms like weakness and fatigue, it gets exaggerated along with other symptoms such as
- Dizziness.
- Headaches.
- Low body temperature.
- Pale or yellowish skin.
- Rapid or irregular heartbeat.
- Shortness of breath or chest pain.
- Brittle nails.
- Pica, an unusual craving for ice or icy drinks or nonfood items like paper.

11. What Are the Effects of Iron Deficiency Anemia on the brain?

Iron deficiency anemia causes various neurological or brain problems. Common problems associated with iron deficiency include less oxygen transportation, impaired DNA synthesis, and poor executive function, such as attention and memory.

12. How to Increase Iron Levels Fast?

The iron levels can be maintained or increased in the body by following some of the below steps, which include -
Eating iron-rich foods such as -
- Red meat, pork, and poultry.
- Seafood.
- Beans.
- Dark green leafy vegetables, such as spinach.
- Dried fruits.
- Iron-fortified cereals, such as bread and pasta.
- Peas.
Taking iron supplements along with vitamin C increases iron absorption.

13. How Much Time Do Iron Supplements Take to Show Results?

The patient has to take iron supplement tablets to increase the iron level in the body. This normally takes around two to three weeks to feel any noticeable change. However, it usually depends on the case, and the dosage can be increased according to the need.