Anemia is defined as a reduction of the oxygen-carrying capacity of blood as measured by the
hematocrit. And the most common type of anemia is iron deficiency anemia.
What causes Iron deficiency anemia?
Iron deficiency can result from
Dietary lack
Dietary lack is more common in developing countries, where iron-rich foods like meat are less abundant. And iron from the green leafy vegetables is less bioavailable because it is found in inorganic form.
Impaired absorption
Conditions that result in impaired absorption of iron include sprue, other causes of fat malabsorption also known as steatorrhea, and chronic diarrhea. Gastrectomy (remove part of the stomach) impairs iron absorption by decreasing the acidity of the proximal duodenum, and also by increasing the speed with which gut contents pass through the duodenum. So the absorption will be impaired.
Increased iron requirement
The increased iron requirement is a common cause of iron deficiency anemia in developed countries. For example: – growing infants, children, and adolescents, as well as premenopausal women, particularly during pregnancy. A woman who has a history of heavy periods are also in the high-risk category. Because since blood contains iron in it, loss of blood also means loss of iron so it results in iron deficiency anemia.
Chronic blood loss
Chronic blood loss is the most common cause of iron deficiency in the Westerns. External hemorrhage, repeated bleeding into the gastrointestinal, urinary, or genital tracts depletes iron store.
Iron deficiency in adult men and postmenopausal women should be attributed to gastrointestinal blood loss until proven otherwise.
Different Morphology of Red blood cells
Whatever its cause, iron deficiency results in hypochromic microcytic anemia although sometimes it might cause normocytic normochromic anemia.
Progressive depletion of these reserves first lowers serum iron and transferrin saturation levels without producing anemia. In this early stage, there is increased erythroid activity in the bone marrow.
Anemia appears only when iron stores are completely depleted and is accompanied by lower than normal serum iron, ferritin, and transferrin saturation levels.
Clinical Features of iron deficiency anemia
The clinical manifestations of the anemia are nonspecific. The patient may present with a different sign and symptoms like
- Fatigue,
- Malaise,
- Blurring of vision,
- Vertigo,
- Headache,
- Tinnitus,
- Pallor of skin and mucosa (e.g., conjunctiva),
- Koilonychia or spooning of nails,
- Alopecia or loss of hair,
- Atrophic changes in the tongue and gastric mucosa, and
- Pica (consuming non-foodstuffs) & periodical movement of limbs during sleep.
Diagnosis of iron deficiency anemia
Even if we can diagnosis anemia clinically, laboratory studies are also important. Especially to differentiate the type of anemia.
Important investigations are : –
- Complete blood count – Both the hemoglobin and hematocrit are depressed, usually to a moderate degree,
- Peripheral morphology– hypochromic, microcytic, and modest poikilocytosis or abnormal cells can be seen.
- Further studies like bone marrow aspiration and biopsy can be done.
Prevention and treatment of iron deficiency anemia
Prevention
- Adequate breastfeeding of a neonate
- Don’t start cow milk if the age of your baby is under 1 year of age
- Include iron-rich foods when your baby start complementary food
- Iron supplementary for pregnant mother
- Eat iron-rich food like red meat, pork, poultry, seafood, dark green leafy vegetables, dried fruit, and iron-fortified cereals.
Treatment
- The supplementary dose of oral or parenteral iron preparations. Oral iron corrects the anemia just as rapidly and completely as parenteral iron in most cases (provided that absorption is intact).
- For patients with advanced chronic kidney disease who are on erythropoietin treatment, parenteral iron administration is preferred.
- And sometimes if hemoglobin is below 7, the patient may need a blood transfusion.
See the video below for a better explanation
