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

Author: Dr. Parth R Goswami - Blood Health  

Clinical Features:

Most of the patients will present with fatigue, tiredness, and dizziness. If anemia is severe, then breathlessness (dyspnea) is also present. 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 neurotransmitter synthesis and myelination. Hence, neurological features can be seen. Pica is sometimes associated with iron-deficiency anemia (IDA). If not treated, then IDA can cause heart failure or ischemic heart disease.

Causes:

  1. Less nutritional intake, like protein energy malnutrition, poor quality food, etc.
  2. Blood loss, like in vaginal bleeding, parasitic infection, gastric ulcer, etc.
  3. Increased demand, like in pregnancy, adolescent, hyperthyroid patient.

Diagnosis:

  • CBC (Complete Blood Count) and PS (Peripheral Smear): These are the common mode of screening, it will show low hemoglobin levels and microcytic hypochromic RBC (red blood cell).
  • Blood Indices: In IDA, as microcytic hypochromic RBC are present, which means reduced red blood cell size, 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, and PCV (packed cell volume) is reduced.
  • Bone Marrow: If needed, 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, FEP (free erythrocyte protoporphyrin) will be raised.

Management:

  1. Find the cause of iron deficiency first and treat it. If a parasitic infection is the cause, then an antihelminthic drug like Albendazole is needed. And if IDA is caused by a peptic ulcer, then Pantoprazole should be used. For nutritional anemia, good food with more green leafy vegetables, jaggery, meat, etc. are beneficial.
  2. Ferrous sulfate is available in syrup and tablet form. This medicine can make the stool black in color, so no need to worry.
  3. 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.

For more information consult an anemia specialist online --> https://www.icliniq.com/ask-a-doctor-online/hematologist/anemia

Last reviewed at: 27.Dec.2018

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