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Iron Deficiency

A reduction in the total iron content in the human body is called iron deficiency. Iron is essential for several metabolic processes as well as erythropoiesis. Iron deficiency can develop insidiously leading to increased fatigability, lassitude, poor immunity, irritability, and iron deficiency anemia. Causes of iron deficiency are several and early identification is the key to managing the condition.


Presentation

Iron deficiency (ID) is more frequent than ID anemia [1] and between 2 -5% of postmenopausal women and adult men suffer from ID anemia [2] [3]. ID develops when the iron intake falls short of the iron requirements of the body (pregnancy, adolescence) or when the output of iron exceeds the intake (gastrointestinal bleeding).

ID often presents insidiously with non-specific symptoms like tiredness, poor immunity to infections and low exercise tolerance. The incidence of ID is more common in premenopausal women due to menstrual blood loss while in pregnancy, adolescence and during breastfeeding, ID is due to increased requirements of iron. ID can lead to increased fatigability, especially in women [4] [5] [6]. Athletes are also at risk of iron deficiency as studies have shown urinary loss of iron following repeated minor intravascular hemolysis [7] [8]. ID can lead to anemia which can present with koilonychia, atrophic glossitis, fissured tongue, angular cheilitis, pica, pallor, decreased intellectual abilities, dyspnea, hepatosplenomegaly (in hemolytic anemias), high output cardiac failure, and recurrent upper respiratory tract as well as other infections. Chronic diseases like celiac disease, chronic renal failure, cirrhosis and even cancers can be associated with ID with patients manifesting symptoms and signs of these conditions. Gastrointestinal tract bleeding is another potential presenting feature in individuals taking non-steroidal anti-inflammatory drugs (NSAIDs) over long periods of time or in those with malignancies of the gastrointestinal tract.

Weight Gain
  • Iron deficiency also results in anaemia, abnormalities in weight gain, appetite, gastrointestinal function, exercise tolerance and immune response to infections.[starship.org.nz]
  • Hypothyroidism if often missed -- six in 10 people with a thyroid disease don't know they have it, according to the American Thyroid Association -- so if you notice low energy levels, weight gain, or even a lower body temperature, talk to your doc. 19[abcnews.go.com]
Photosensitivity
  • […] an autosomal recessive disorder of heme synthesis characterized by reduced activity of uroporphyrinogen III synthase and the accumulation of nonphysiologic isomer I porphyrin metabolites, resulting in ineffective erythropoiesis and devastating skin photosensitivity[ncbi.nlm.nih.gov]
Neglect
  • Abstract Anaemia is the most frequent, though often neglected, comorbidity of inflammatory bowel disease (IBD).[ncbi.nlm.nih.gov]
  • Peter J Hotez, David H Molyneux, Alan Fenwick, Eric Ottesen, Sonia Ehrlich Sachs and Jeffrey D Sachs, Incorporating a Rapid-Impact Package for Neglected Tropical Diseases with Programs for HIV/AIDS, Tuberculosis, and Malaria, PLoS Medicine, 10.1371/journal.pmed[doi.org]

Workup

ID can develop insidiously with or without anemia. Therefore early diagnosis of the condition is difficult. In all patients, a detailed history of symptoms, history of chronic intake of NSAIDS and blood loss in urine or stools or excessive menstrual blood loss should be obtained. NSAID enteropathy is associated with significant amounts of blood loss [9]. A thorough physical examination to identify features of ID and ID anemia like pallor, koilonychia, glossitis and even high output cardiac failure should be performed.

Routine laboratory tests like complete blood count, hemoglobin levels, hematocrit, urinalysis for hematuria and stool test for occult blood as well as other tests like liver enzymes, renal function tests, echocardiography are indicated depending on the history and physical examination findings. Specific tests for iron deficiency detection include serum ferritin, serum iron, and transferrin saturation.

Tests to detect the cause of the ID include celiac disease serology, gastroscopy and colonoscopy [1]. Repeated endoscopies or capsule endoscopies may be necessary to detect persistent ID [1].

Pseudomonas
  • Saccharomyces cerevisiae, Candida albicans, and Komagataella pastoris) and prokaryotes (Pseudomonas fluorescens).[ncbi.nlm.nih.gov]
  • Hergenrother, Iron Salts Perturb Biofilm Formation and Disrupt Existing Biofilms of Pseudomonas aeruginosa, Chemistry & Biology, 12, 7, (789), (2005). S.[doi.org]
  • ., Pseudomonas aeruginosa, Escherichia coli, Shigella flexneri, and Bacillus subtilis [8]. Many high G C content Gram-positive bacteria express an additional iron-dependent repressor belonging to the DtxR family.[doi.org]
Candida
  • Saccharomyces cerevisiae, Candida albicans, and Komagataella pastoris) and prokaryotes (Pseudomonas fluorescens).[ncbi.nlm.nih.gov]

Treatment

  • Demographics, medical diagnoses and treatments were extracted.[ncbi.nlm.nih.gov]
  • A smartphone application providing information on nutrition and treatment is provided.[ncbi.nlm.nih.gov]
  • Iron deficiency in late prenatal and early postnatal periods can lead to long-term neurobehavioral deficits, despite iron treatment.[ncbi.nlm.nih.gov]
  • Current options for treatment include oral iron, which can be ineffective and poorly tolerated, and red blood cell transfusions, which carry an inherent risk and should be avoided. Ferric carboxymaltose is a modern treatment option.[ncbi.nlm.nih.gov]
  • Importantly, anaemia in IBD is often multifactorial and a careful diagnostic workup is mandatory for optimized treatment. Nevertheless, limited information is available on optimal therapeutic start and end points for treatment of anaemia.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis Iron deficiency anemia is an easily treated disorder with an excellent outcome; however, it may be caused by an underlying condition with a poor prognosis, such as neoplasia.[emedicine.com]
  • N/A What should you tell the patient and the family about prognosis? The patient and family should be told that the prognosis for iron deficiency itself is excellent, and that an excellent response to either oral or parenteral iron can be expected.[cancertherapyadvisor.com]
  • Follow-up data in these patients suggested a favorable prognosis, and the subsequent discovery of gastrointestinal tract lesions was rare. Most of these patients were asymptomatic.[doi.org]

Etiology

  • Causes Once iron deficiency anemia is identified, the goal is to determine the underlying etiology.[aafp.org]
  • Management Treatment of iron deficiency anemia consists of correcting the underlying etiology and replenishing iron stores.[emedicine.com]
  • Etiology The most common cause of iron deficiency is dietary insufficiency, caused by poor bioavailablity of iron in food or factors relating to poor absorption.[kidsnewtocanada.ca]
  • Pathophysiology reference Etiology Because iron is poorly absorbed, dietary iron barely meets the daily requirement for most people.[merckmanuals.com]

Epidemiology

  • The lack of adequate and robust epidemiological data in SSA makes it difficult to recognise the significance of anaemia and ID in HF.[ncbi.nlm.nih.gov]
  • This review will highlight the epidemiology, physiology, clinical presentation, and treatment options.[ncbi.nlm.nih.gov]
  • To address the changing epidemiology of iron deficiency in the United States, CDC staff in consultation with experts developed new recommendations for use by primary health-care providers to prevent, detect, and treat iron deficiency.[ncbi.nlm.nih.gov]
  • Author information 1 Department of Nephrology, Saint-Joseph University, Beirut, Lebanon. 2 Ministry of Public Health, Beirut, Lebanon. 3 Faculty of sciences and medical sciences, Lebanese University, Beirut, Lebanon. 4 Department of Epidemiology and Biostatistics[ncbi.nlm.nih.gov]
  • In the last decade, epidemiological studies have emerged that connected allergy with a deficient iron-status.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Franziska.roth-walter@meduniwien.ac.at and Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.[ncbi.nlm.nih.gov]
  • Despite this, the pathophysiological mechanisms for progressive ID in either chronic or acute HF are still poorly understood.[ncbi.nlm.nih.gov]
  • Atrial fibrillation (AF) has many similarities to HF, including a chronic inflammatory pathophysiology; however, the prevalence of ID and other hematinic deficiencies in AF patients have not been determined.[ncbi.nlm.nih.gov]
  • Here we want to briefly present (1) the burden of anaemia in IBD, (2) its pathophysiology, which mostly arises from bleeding-associated iron deficiency, followed by (3) diagnostic evaluation of anaemia, (4) a balanced overview of the different modes of[ncbi.nlm.nih.gov]
  • Therefore studies are needed to provide more insight into the burden and peculiarities of and intervention for anaemia and ID in HF in SSA, where the pathophysiology might be different from that in high-income countries.[ncbi.nlm.nih.gov]

Prevention

  • Abstract The US Preventive Services Task Force (USPSTF) makes recommendations to primary care providers regarding preventive services for asymptomatic patients.[ncbi.nlm.nih.gov]
  • These recommendations update the 1989 "CDC Criteria for Anemia in Children and Childbearing-Aged Women" (MMWR 1989;38(22):400-4) and are the first comprehensive CDC recommendations to prevent and control iron deficiency.[ncbi.nlm.nih.gov]
  • Other steps you can take to prevent iron deficiency include: Serve iron-rich foods.[mayoclinic.org]
  • The prevention and treatment of iron deficiency is a major public health goal in India It is now well recognized that iron deficiency has detrimental effects in patients with coronary artery disease, heart failure, and pulmonary hypertension, and possibly[ncbi.nlm.nih.gov]
  • Whether these strategies prevent iron deficiency-induced brain dysfunction has yet to be determined.[ncbi.nlm.nih.gov]

References

Article

  1. Bermejo F, Garcia-Lopez S. A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases. Worl J Gasteroenterol. 2009 Oct 7;15(37): 4638 -4643
  2. Goddard AF, McIntyre AS, Scott BB. Guidelines for the management of iron deficiency anaemia. British Society of Gastroenterology. Gut. 2000;46 Suppl 3-4:IV1–IV5.
  3. Sayer JM, Long RG. A perspective on iron deficiency anaemia. Gut. 1993;34:1297–1299.
  4. Vaucher P, Druais PL, Waldvogel S, Favrat B. Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial. CMAJ. 2012;184:1247–1254.
  5. Verdon F, Burnand B, Stubi CL, et al. Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial. BMJ. 2003;326:1124.
  6. Krayenbuehl PA, Battegay E, Breymann C, et al. Intravenous iron for the treatment of fatigue in nonanemic, premenopausal women with low serum ferritin concentration. Blood. 2011;118:3222–3227.
  7. Peeling P, Dawson B, Goodman C, et al. Athletic induced iron deficiency: new insights into the role of inflammation, cytokines and hormones. Eur J Appl Physiol. 2008;103:381–391.
  8. Robertson JD, Maughan RJ, Davidson RJ. Faecal blood loss in response to exercise. Br Med J (Clin Res Ed) 1987;295:303–305.
  9. Bowen B, Yuan Y, James C, et al. Time course and pattern of blood loss with ibuprofen treatment in healthy subjects. Clin Gastroenterol Hepatol. 2005;3:1075–1082.

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Last updated: 2018-06-22 08:55