Three White Coats
Iron Deficiency Anemia
Anemia is a condition characterized by the deficit of healthy red blood cells, which play the vital role of supplying our tissues with oxygen. Iron deficiency anemia is the most common type of anemia caused by the shortage of iron in the body. Insufficient amount of iron compromises the synthesis of hemoglobin (a protein in red blood cells that uses iron to bind oxygen) as well as the production of red blood cells. Iron deficiency is the most prevalent nutritional disorder in the world, primarily affecting children and women of reproductive age. Fortunately, in the majority of cases its treatment is relatively simple and effective.
Symptoms
Depending on the extent of iron deficiency, symptoms vary from very mild (and often overlooked) to severe.
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Fatigue
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Weakness
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Irritability
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Brittle nails
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Paleness
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Yellowish, sallow skin
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Rapid heartbeat
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Shortness of breath
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Painful cracking at the corners of the mouth (angular cheilitis)
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Burning sensation in the tongue
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Craving for non-food substances, such as ice, clay, paper, dirt
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Tingling feeling in the legs
Causes
Loss of iron. Approximately 70% of iron in the body is contained within hemoglobin in the red blood cells. Thus, it is not surprising that the most common cause of iron depletion is blood loss. In women of childbearing age, the leading causes of blood loss are menstrual bleeding and childbirth. In general population, blood loss can be caused by a variety of factors, such as major surgery or slow chronic bleeding associated with various conditions (peptic ulcers, hiatal hernia, diverculitis, hemorrhoids, colorectal and other tumors). By the same token, frequent blood donors have a higher risk of developing iron deficiency.
There are, then, numerous reasons for blood loss – from relatively benign to serious. It is essential that the exact cause be found and properly addressed.
Poor absorption of iron. Iron is absorbed from food in the upper part of the gastrointestinal (GI) tract. Disorders affecting the GI tract, such as celiac disease, Crohn’s disease or gastritis, can reduce the absorption of dietary iron. Gastric bypass surgery can also lead to iron deficiency, as it causes food to bypass the upper part of the small intestine where most of the iron absorption takes place. The acidic environment in the stomach greatly facilitates iron absorption. This is why in conditions such as achloridia and hypochloridia - in which acid production is, respectively, absent or reduced - dietary iron absorption is severely compromised.
Dietary deficiency. Iron is present in a variety of foods and is also added to bread, pasta, and breakfast cereal. Because of iron’s widespread availability in food, its dietary deficiency is not a common problem in the developed countries. However, in the developing countries, poor and monotonous diet significantly contributes to iron deficiency. Elimination of certain iron-rich foods, such as meat or eggs, without proper dietary adjustment (to compensate for the reduction in iron intake), can also lead to deficiency.
Increased need for iron. Rapid growth in puberty increases the need for a variety of nutrients, including iron. In pregnancy, the need for iron soars to accommodate the growth of the fetus and the placenta and the increase of blood volume. If the increased need for iron is not met, deficiency will develop.
Diagnosis
Iron deficiency anemia is diagnosed following a series of blood tests.
Complete blood count (CBC) is a group of tests used to determine factors of relevance in iron deficiency anemia:
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number of red blood cells (RBCs),
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amount of hemoglobin present in blood (hemoglobin)
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percentage of blood that is made up of RBCs (hematocrit)
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size of RBCs (mean corpuscular volume, MCV)
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amount of hemoglobin per RBC (mean corpuscular hemoglobin, MCH)
In addition, peripheral blood smear evaluates the shape and color of RBCs.
If CBC indicates iron deficiency anemia, additional tests specifically related to iron are performed. These tests assess:
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iron stores in the body (ferritin)
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level of iron in the blood (serum iron)
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amount of protein that binds and transports iron (total iron binding capacity, TIBC, transferrin)
Once iron deficiency anemia is confirmed using blood tests, further evaluation (of gastrointestinal tract, urinary tract or gynecological examination) may be performed to determine the exact cause of anemia.
Treatment
Treatment of iron deficiency anemia will depend on its cause. Generally, deficiency is addressed by increasing dietary iron and by iron supplementation. While dietary changes to optimize iron intake and absorption can and should be self initialized and applied, iron supplementation must be done in consultation with your doctor. Exceeding the required dose can lead to iron overload and toxicity. Always keep iron supplements out of the reach of children.
Lifestyle Medicine
Increase intake and absorption of iron
Our bodies cannot synthesize iron, so absorption from food is the only way to make up for the small amounts of iron that are lost daily. There is much value in dietary approaches to preventing iron deficiency anemia. They not only improve nutrition but also minimize the need for iron supplements, which are known to cause various side effects. To efficiently increase your iron levels, you should optimize both your iron intake and absorption.
Boosters
Iron Supplementation
Sometimes, dietary approaches intended to increase iron intake are not enough to address its deficiency. In such cases, iron supplements offer an effective and inexpensive way to rapidly correct iron-related anemia. A number of oral preparations are available, differing in the chemical state of iron, the type of its salt, dosage, and pharmaceutical formulation. Consult your doctor about the type of iron supplementation that is right for you.
Last updated: October 25, 2016