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Iron-Deficiency Anemia - Its Causes, Diagnosis, and Treatment

Published on Mar 28, 2017 and last reviewed on Jun 15, 2022   -  4 min read


Iron-deficiency anemia is a global burden on the communities, prevalent everywhere. This article discusses iron-deficiency anemia in detail.

Iron-Deficiency Anemia - Its Causes, Diagnosis, and Treatment

What Is Iron-Deficiency Anemia?

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?

What Are the Clinical Features of Iron-Deficiency Anemia?

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.

How to Diagnose Iron-Deficiency Anemia?

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.

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;

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.

How to Manage Iron-Deficiency Anemia?

The first line of treatment is to find the cause of the iron deficiency and treat them.

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?


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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