What is Iron Deficiency Anemia?
Anemia is when a person has a lower amount of hemoglobin, a component of blood, than the average range for their age and gender. Hemoglobin requires iron to work properly. Around the world, the most common reason for anemia is a lack of iron, which leads to smaller, paler red blood cells. Various factors, including age, gender, and financial circumstances, can influence why someone may become iron deficient. People with anemia often feel tired and struggle to breathe during physical activities due to this condition. The recommended treatment for this issue is to address the root cause and to increase the patient’s iron levels.
Iron supplementation can be taken orally, but in some cases, it might have to be given through an IV. Research has shown that patients with anemia due to a lack of iron spend more time in the hospital and experience more medical complications.
What Causes Iron Deficiency Anemia?
Iron-deficiency anemia can occur due to various reasons, differing according to age, sex, and socioeconomic conditions. Three main causes are not getting enough iron in the diet, the body not being able to absorb iron properly, or losing blood.
Most commonly, it’s due to blood loss, especially in older people. It might also be due to not eating enough iron-rich foods, needing more iron than usual (like during pregnancy) or struggling to absorb iron from food (such as in those with celiac disease).
For newborns, breastfeeding protects against this issue since breast milk has more easily absorbable iron than cow’s milk. Kids who primarily drink cow’s milk are more likely to get this form of anemia, which is one of the most common types in young children.
Parasites are also a significant cause of iron-deficiency anemia in developing countries. People can find iron in green vegetables, red meat, and milk products that have added iron.
Risk Factors and Frequency for Iron Deficiency Anemia
Worldwide, one in four people have anemia, a condition where your blood lacks enough healthy red blood cells or hemoglobin. The most common reason for this is a lack of iron in the body, and it accounts for half of all anemia cases. This problem is more common in developing countries compared to the United States.
- In the US, 1% of men under 50 have iron-deficiency anemia.
- For women of childbearing age, the rate rises to 10% due to iron loss during menstruation.
- About 9% of kids between 12 and 36 months old lack enough iron, and a third of these kids develop anemia.
- Despite lower overall rates, families with lower incomes in the US are particularly vulnerable to iron-deficiency anemia.
Signs and Symptoms of Iron Deficiency Anemia
Most people with this condition don’t experience any symptoms and are often discovered through a blood test. The most obvious sign is paleness, but this usually becomes noticeable only when the hemoglobin drops to 7 to 8 g/dL. Patients may experience fatigue, decreased work performance, breathlessness, or worsening symptoms of congestive heart failure. In children, mental sluggishness and delayed growth can occur.
It’s also important to ask patients about their eating habits, as well as any abnormal bleeding, such as heavy menstrual bleeding or from the digestive tract. Upon physical examination, you may observe pale skin and the inner lining of the eyelids, rapid heart rate when at rest, symptoms of congestive heart failure, and a positive stool test for hidden blood.
Testing for Iron Deficiency Anemia
When doctors suspect a patient is anemic, they might start with a lab test to understand the patient’s blood characteristics. Tests will look at the average amount of hemoglobin in a red blood cell, also known as mean corpuscular hemoglobin, and the size of the red blood cell, known as mean corpuscular hemoglobin volume. If these are low, it could indicate anemia.
Doctors will also use hematoscopy, a test to look at the size, shape, and color of red blood cells. If the cells are smaller than usual, pale in color, and if different cells are all sorts of sizes, this could be a clue toward anemia. Doctors will also look at the blood’s ability to distribute red cells; if this is higher than normal, it could be a step toward an anemia diagnosis.
Blood tests can also be run to look at the levels of ferritin, iron, and transferrin saturation – these are often decreased in anemic patients. Ferritin is particularly important, as it gives an idea of the body’s total iron stores.
Another test checks for unseen blood in the stool, which could indicate bleeding in the gastrointestinal system – a possible source of iron deficiency leading to anemia.
The Mentzer Index looks at the average amount of hemoglobin compared to the number of red blood cells. This helps to differentiate between iron deficiency anemia and another condition called thalassemia minor. Iron deficiency is suggested if the index is greater than 15, and thalassemia minor is suggested if the index is less than 11.
One crucial test to rule out thalassemia minor is hemoglobin electrophoresis. If iron deficiency is severe or if iron therapy is not working, an iron profile may be necessary. Low ferritin is a good indicator of iron deficiency, but normal or high levels aren’t as useful when the patient has other conditions like cancer, infection, or certain autoimmune diseases because ferritin responds to inflammation.
The gold standard test for establishing iron deficiency is a bone marrow aspiration or biopsy, where doctors take a sample and stain it for iron. This is not affected by inflammation. However, because it’s both costly and invasive, it’s rarely performed.
Treatment Options for Iron Deficiency Anemia
If you have iron-deficiency anemia, the treatment usually involves tackling the root cause, such as bleeding in the digestive tract, and taking iron supplements. These supplements should be taken on an empty stomach for better absorption, as iron is best absorbed in an acidic environment.
Patients typically show signs of improvement, like increased hemoglobin levels, after two weeks of treatment. However, iron supplements need to be taken for at least three months to properly rebuild the body’s iron reserves and need to continue for at least a month even after hemoglobin levels are back to normal.
Ferrous sulfate is an affordable and effective type of iron supplement that’s usually taken two to three times a day. But it can have side effects like constipation, nausea, loss of appetite, and diarrhea.
If a patient can’t tolerate oral supplements, has a condition like celiac disease that prevents proper nutrient absorption, or is losing too much iron for oral supplements to be effective, they might need to have iron administered intravenously, or directly into a vein. This method ensures iron is distributed more reliably and quickly throughout the body, though it doesn’t raise hemoglobin levels any faster than oral supplements.
Injecting iron intravenously can cause side effects like nausea. Although it’s rare, it can also cause a severe allergic reaction. If the iron solution leaks into the skin, it can leave permanent, unattractive brownish stains. Therefore, along with the medical treatment, dietary counseling is often recommended for better management of the condition.
Teenage girls who lose a lot of blood during their periods may benefit from iron supplements and hormone therapy.
What else can Iron Deficiency Anemia be?
When trying to diagnose iron deficiency anemia, doctors might also have to rule out other conditions that have similar symptoms. These can include:
- Lead poisoning
- Microcytic anemia (anemia with smaller than normal red blood cells)
- Anemia of chronic disease (anemia caused by chronic illnesses like cancer or autoimmune diseases)
- Hemoglobin CC and DD diseases (types of abnormal hemoglobin — the protein in red blood cells that carries oxygen)
- Autoimmune hemolytic anemia (a condition where the immune system mistakenly destroys red blood cells)
- Hemoglobin S-beta thalassemia (a type of sickle cell disease where the body makes abnormal hemoglobin and doesn’t make enough red blood cells)
It’s critical for doctors to consider all these possibilities and perform the necessary investigations to properly diagnose the condition.
What to expect with Iron Deficiency Anemia
The immediate outlook for most patients is generally very good. However, if the root cause isn’t addressed, the long-term outcomes could be poor.
Persisting iron deficiency can result in death, particularly if there is an existing heart or lung condition that hasn’t been treated.
Possible Complications When Diagnosed with Iron Deficiency Anemia
Iron deficiency anemia can lead to various complications, which include:
- Higher chances of getting infections
- Heart-related issues
- Delayed growth and development in children
- Complications during pregnancy
- Depression
Recovery from Iron Deficiency Anemia
For individuals suffering from severe iron deficiency anemia, it’s recommended to restrict physical activity until the anemia is under control.
Iron deficiency anemia can also be caused by a condition known as March hemoglobinuria. People dealing with this might need to adjust their footwear or level of physical exercise.
Preventing Iron Deficiency Anemia
Groups that are at high risk of iron deficiency should think about preventative treatment with iron supplements. These groups include women with heavy monthly periods, regular blood donors, teenage girls, and individuals who strictly follow vegetarian diets. However, it’s not advised to have iron supplements without any specific need. This is because there’s no proof of any benefit from doing this, and it could potentially be harmful.
