Edit concept Question Editor Create issue ticket

Iron Deficiency Anemia

Anemias Iron Deficiency

Iron deficiency anemia is a common type of anemia, affecting millions of people worldwide.


Presentation

Iron deficiency anemia is often asymptomatic. Signs and symptoms are non-specific, unless the anemia is severe. Fatigue is the most common symptom [6]. Patients may complain of [1] [3] [8]:

Physical findings [5] [6]:

  • Impaired growth and development in children [5] [8]
  • Pallor of the mucous membranes
  • Spoon-shaped nails with decreased capillary refill
  • Angular stomatitis
  • Splenomegaly in severe, persistent, anemia
  • Decreased physical functioning, and mobility, diminished muscle strength
  • Cardiovascular complications
Anemia
  • People with severe anemia may have problems carrying out routine activities and can feel tired or experience shortness of breath with activity. 1 How common is iron deficiency anemia? Anemia due to iron deficiency is the most common type of anemia.[web.archive.org]
  • , Iron-Deficiency/diagnosis Anemia, Iron-Deficiency/drug therapy* Anemia, Iron-Deficiency/genetics* Anemia, Refractory/diagnosis Anemia, Refractory/drug therapy* Anemia, Refractory/genetics* Child Child, Preschool Chromosome Aberrations* DNA Mutational[ncbi.nlm.nih.gov]
  • , anemia prevalence, and urban/rural setting.[ncbi.nlm.nih.gov]
  • Many of the signs and symptoms of iron-deficiency anemia apply to all types of anemia . Signs and Symptoms of Anemia The most common symptom of all types of anemia is fatigue (tiredness).[web.archive.org]
  • Overview Iron-deficiency anemia is a common type of anemia . The term "anemia" usually refers to a condition in which your blood has a lower than normal number of red blood cells.[web.archive.org]
Fatigue
  • Signs and Symptoms of Anemia The most common symptom of all types of anemia is fatigue (tiredness). Fatigue occurs because your body doesn't have enough red blood cells to carry oxygen to its many parts.[web.archive.org]
  • Beyond anemia, lack of iron has protean manifestations, including fatigue, hair loss, and restless legs. The most efficient test for the diagnosis of iron deficiency is the serum ferritin.[ncbi.nlm.nih.gov]
  • Fatigue and other symptoms associated with anemia can interfere with your daily activities. Studies show that children with iron deficiency anemia have below-average height and weight.[web.archive.org]
  • In adults, ID is associated with fatigue in the absence of anemia, restless legs syndrome, pica and, in neonates, delayed growth and development. In adolescents, ID is associated with decrements in learning and behavioral abnormalities.[ncbi.nlm.nih.gov]
  • Iron-replacement therapy improved quality of life and reduced fatigue. CONCLUSION: Hemoglobin responses Copyright 2017 Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
Weakness
  • Anemia also can cause shortness of breath, dizziness, headache, coldness in your hands and feet, pale skin, chest pain, weakness, and fatigue (tiredness).[web.archive.org]
  • Symptoms include weakness, fatigue, and sometimes pallor, shortness of breath, coldness of extremities, changeable appetite, sore tongue, loss of hair, brittle fingernails, or dry skin.[britannica.com]
  • People may be weak, short of breath, and pale. Blood tests can detect low levels of iron. Iron supplements are used to restore iron levels.[merckmanuals.com]
  • It can lead you to feel weak and tired, and look pale. There are many forms of anemia, and you should see your physician for a proper diagnosis as anemia can be a sign of a more serious illness.[hospitals.jefferson.edu]
Pallor
  • Abstract A 3-year-old boy presented with recurrent strokes and pallor. Hematological investigations revealed severe iron deficiency anemia without thrombocytosis. The magnetic resonance angiogragraphy findings were suggestive of moyamoya syndrome.[ncbi.nlm.nih.gov]
  • Anterior segment examination in both eyes showed conjunctival pallor. Results of ophthalmoscopic examination and optical coherence tomography were consistent with macular preretinal hemorrhage in both eyes with macular star in the left eye.[ncbi.nlm.nih.gov]
  • Except mild pallor, he was asymptomatic of his anemia. Although he had a slight response to intravenous iron therapy, his hemoglobin remained A and maternally inherited c.1807G C mutations were eventually identified.[ncbi.nlm.nih.gov]
  • Symptoms include weakness, fatigue, and sometimes pallor, shortness of breath, coldness of extremities, changeable appetite, sore tongue, loss of hair, brittle fingernails, or dry skin.[britannica.com]
Asymptomatic
  • Abstract The US Preventive Services Task Force (USPSTF) makes recommendations to primary care providers regarding preventive services for asymptomatic patients.[ncbi.nlm.nih.gov]
  • Our results suggest that a combination strategy of FIT and IDA may be helpful in selecting and prioritizing asymptomatic men for colonoscopy. Copyright: Yonsei University College of Medicine 2017[ncbi.nlm.nih.gov]
  • Although in most cases, gastric IHPs are asymptomatic and are found incidentally, these polyps may cause anemia secondary to chronic bleeding.[ncbi.nlm.nih.gov]
  • Author information 1 Department of Gastroenterology, Wright State University, School of Medicine, Dayton, OH 45428, USA. [email protected] Abstract Colonic lipomas are frequently small and asymptomatic.[ncbi.nlm.nih.gov]
  • This recommendation applies to children ages 6 to 24 months living in the United States who are asymptomatic for iron deficiency anemia.[ncbi.nlm.nih.gov]
Dyspnea
  • […] bleeding, such as from an ulcer or a polyp in the intestines Iron deficiency anemia symptoms Call your primary care doctor to schedule an appointment if you have any of the following symptoms and they don’t go away: Fatigue Dizziness Shortness of breath (dyspnea[rush.edu]
  • Treatment Transfusion should be considered for patients of any age with IDA complaining of symptoms such as fatigue or dyspnea on exertion.[aafp.org]
Loss of Appetite
  • People with colon or rectal cancer may have weight loss, fatigue (excessive weakness), loss of appetite, and a family history of cancer. Everyone over the age of 50 should be screened with a sigmoidoscopy.[chemocare.com]
  • Some soil-transmitted helminths also cause loss of appetite and, therefore, a reduction of nutritional intake and physical fitness. In particular, T. trichiura can cause diarrhoea and dysentery.[who.int]
  • Some soil-transmitted helminths also cause loss of appetite and therefore a reduction of nutritional intake and physical fitness. In particular, T. trichiura can cause diarrhoea and dysentery.[web.archive.org]
  • Gastrointestinal (GI) tract symptoms may include constipation, chronic or acute abdominal pain that may be diffuse or focused, nausea and vomiting, abdominal distention, and loss of appetite.[emedicine.com]
Geophagia
  • We report a case of a 14-year-old boy who presented with iron deficiency anemia, hepatosplenomegaly, geophagia and growth retardation with pubertal delay. Investigations ruled out hypopituitarism and coeliac disease.[ncbi.nlm.nih.gov]
  • In particular, geophagia (soil or clay ingestion) has been associated with soil-borne parasitic infections (eg, toxoplasmosis and toxocariasis ).[emedicine.com]
  • Geophagia in Turkey: Iron and zinc deficiency, iron and zinc absorption studies and response to treatment with zinc in geophagia cases. In: Zinc Deficiency in Human Subjects. Eds. Prasad AS, Cavdar AO, Brewer GJ, Aggett PJ.[indianpediatrics.net]
Cheilitis
  • Symptoms of Iron Deficiency Anemia An iron deficiency anemia has the same symptoms than any other anemia: Image : “Angular cheilitis as marked by the oval” by James Heilman, MD.[lecturio.com]
  • Additional features are glossitis, angular cheilitis and koilonychia. Enlargement of the spleen and thyroid may also be observed.[ojrd.com]
Heart Murmur
  • This can lead to irregular heartbeats called arrhythmias (ah-RITH-me-ahs), a heart murmur , an enlarged heart, or even heart failure .[web.archive.org]
  • At that point, symptoms may include: tiredness and weakness pale skin, especially around the hands, nails, and eyelids rapid heartbeat or a heart murmur irritability low appetite dizziness or feeling lightheaded In rare cases, a child with iron-deficiency[kidshealth.org]
  • This can lead to arrhythmia, heart murmur, an enlarged heart, or even heart failure. In infants and young children, signs of anemia include poor appetite, slowed growth and development, and behavioral problems.[theoncologyinstitute.com]
  • When your heart has to work harder, this can lead to several conditions: irregular heartbeats called arrhythmias , a heart murmur , an enlarged heart, or even heart failure .[nhlbi.nih.gov]
Heart Disease
  • Release Date: 01/28/2019 Heart Disease is the leading cause of death for both men and women in the United States. Each year, one in four deaths are caused by heart disease.[emmc.org]
  • Iron deficiency anemia occurs in almost one third of patients with congestive heart failure (CHF) and 10% to 20% of patients with coronary heart disease (CHD).[symptoma.com]
  • Remind your doctor or healthcare provider if you have a history of diabetes, liver, kidney, or heart disease. You should restrict the amount of alcohol you take in, or avoid it all together. Alcohol may adversely interact with many medications.[chemocare.com]
  • disease ( 18 , 19 ).[dx.doi.org]
  • Without medical treatment, people with hereditary hemochromatosis can develop serious problems such as liver cirrhosis , liver cancer, and heart disease . People with this disorder should avoid using iron supplements and vitamin C supplements.[ods.od.nih.gov]
Tachycardia
  • Symptoms may include: Abnormal paleness or lack of color of the skin Irritability Lack of energy or tiring easily (fatigue) Increased heart rate (tachycardia) Sore or swollen tongue Enlarged spleen A desire to eat peculiar substances such as dirt or ice[chop.edu]
  • License: CC BY-SA 3.0 Tachycardia Fatigue Weakness Lack of concentration Diminished strength Further clinical symptoms are dry skin, possible headache and hair loss.[lecturio.com]
  • Symptoms may include: Paleness or lack of skin color Irritability Lack of energy or tiring easily (fatigue) Increased heart rate (tachycardia) Sore or swollen tongue Wanting to eat nonfood things such as dirt or ice (a condition called pica) Feeling dizzy[massgeneral.org]
  • Symptoms resulting from anemia such as weakness, pallor, fatigue and tachycardia may dominate the clinical picture. Furthermore, it is characterized by glossitis, angular cheilitis and koilonychia (spoon-shaped finger nails).[ojrd.com]
Hypotension
  • Analyzed safety concerns include gastrointestinal side effects (oral iron) and risks of hypotension, anaphylaxis, infection, hypophosphatemia, oxidative stress and mortality (IV iron).[ncbi.nlm.nih.gov]
Koilonychia
  • Nutritional deficiency (Not in USA) Malabsorption (Sprue, gatrectomy) Rare causes Hemoglobinuria Hereditary hemorrhagic telengiectasia (Nose bleeds, GI bleeds) Clinical sequelae to iron deficiency anemia Asymptomatic until late Pica Angulostomatitis Koilonychias[meddean.luc.edu]
  • Additional features are glossitis, angular cheilitis and koilonychia. Enlargement of the spleen and thyroid may also be observed.[ojrd.com]
  • […] foods (from esophageal webbing) Worsened symptoms of comorbid cardiac or pulmonary disease Findings on physical examination may include the following: Impaired growth in infants Pallor of the mucous membranes (a nonspecific finding) Spoon-shaped nails (koilonychia[emedicine.com]
Conjunctival Pallor
  • Anterior segment examination in both eyes showed conjunctival pallor. Results of ophthalmoscopic examination and optical coherence tomography were consistent with macular preretinal hemorrhage in both eyes with macular star in the left eye.[ncbi.nlm.nih.gov]
  • Hence, in areas where iron deficiency is so widespread as in the present study population (87% iron deficient), children presenting with pica or conjunctival pallor may be suspected to have anemia and intervention recommended.[indianpediatrics.net]
  • The relation of conjunctival pallor to the presence of anemia. J Gen Intern Med . 1997;12:102–6. 23. Cook JD. Diagnosis and management of iron-deficiency anaemia. Best Pract Res Clin Haematol . 2005;18:319–32. 24.[aafp.org]
Headache
  • Anemia also can cause shortness of breath, dizziness, headache, coldness in your hands and feet, pale skin, chest pain, weakness, and fatigue (tiredness).[web.archive.org]
  • Omeprazole Side Effects Patients taking omeprazole may experience common side effects such as stomach pain, diarrhea, constipation, gas, nausea, headache, vomiting and fever, according to PubMed.[livestrong.com]
  • Symptoms usually develop when anemia is moderate to severe, and can include fatigue, weakness, pale skin, chest pain, dizziness, irritability, numbness or coldness in your hands and feet, trouble breathing, a fast heartbeat, and headache.[web.archive.org]
  • Symptoms may include: Feeling weak or tired more often than usual, or with exercise Headaches Dizziness Palpitations Problems concentrating or thinking As the anemia gets worse, symptoms may include: Brittle nails Blue color to the whites of the eye Desire[nlm.nih.gov]
Dizziness
  • Anemia also can cause shortness of breath, dizziness, headache, coldness in your hands and feet, pale skin, chest pain, weakness, and fatigue (tiredness).[web.archive.org]
  • Symptoms usually develop when anemia is moderate to severe, and can include fatigue, weakness, pale skin, chest pain, dizziness, irritability, numbness or coldness in your hands and feet, trouble breathing, a fast heartbeat, and headache.[web.archive.org]
  • Symptoms of Iron Deficiency Anemia Patients with iron deficiency anemia caused by the use of omeprazole experience symptoms such as extreme fatigue, pale skin and gums, weakness, headache, irritability, shortness of breath, chest pain, dizziness, cold[livestrong.com]
  • Symptoms may include: Feeling weak or tired more often than usual, or with exercise Headaches Dizziness Palpitations Problems concentrating or thinking As the anemia gets worse, symptoms may include: Brittle nails Blue color to the whites of the eye Desire[nlm.nih.gov]
Irritability
  • Areca nut is considered the primary etiology along with other local irritants like capsaicin, pungent and spicy food, nutritional deficiency, defective iron metabolism, collagen metabolic disorder and genetic predisposition.[ncbi.nlm.nih.gov]
  • Supplements can cause irritation of the stomach and cause stools to become black in color. Iron supplements should be taken on an empty stomach or with orange juice to increase absorption.[illinoiscancercare.com]
  • The successful treatment of infection with Helicobacter pylori (the bacteria associated with irritation of the stomach lining and stomach ulcers) may also resolve iron deficiency anemia.[medicinenet.com]
  • Iron supplements can cause irritation of the stomach and discoloration of bowel movements. They should be taken on an empty stomach or with orange juice to increase absorption.[chop.edu]
  • Symptoms usually develop when anemia is moderate to severe, and can include fatigue, weakness, pale skin, chest pain, dizziness, irritability, numbness or coldness in your hands and feet, trouble breathing, a fast heartbeat, and headache.[web.archive.org]
Apathy
  • In addition, children may experience apathy and failure to thrive, and macrocytic anemia is a common feature at all ages. Zinc Vegetarians are often considered to be at risk for zinc deficiency.[dx.doi.org]
Paresthesia
  • Vitamin B-12 deficiency can produce abnormal neurologic and psychiatric symptoms that include ataxia, psychoses, paresthesia, disorientation, dementia, mood and motor disturbances, and difficulty with concentration ( 75 ).[dx.doi.org]

Workup

Iron deficiency anemia is diagnosed by the presence of two or more abnormal indices: serum ferritin, transferrin saturation, erythrocyte protoporphyrin.

Initial laboratory testing should include [3] [6]

  • Complete blood count (CBC)
  • Red blood cell evaluation: hemoglobin, hematocrit, reticulocyte count
  • Red blood cell indices: mean cell volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), Red blood cell distribution/width (RDW)
  • White blood cell count with cell differential
  • Platelet count
  • Iron studies
  • Serum iron
  • Serum ferritin
  • Total iron binding capacity (TIBC)
  • Transferrin saturation percentage
  • Reticulocyte count (immature RBC) count, a measure of erythropoietic activity 
  • Cell morphology

Additional laboratory testing to identify comorbid conditions [3] [6]:

  • Serum cobalamin (B-12) and folate levels 
  • Hemoglobin electrophoresis
  • Serum methylmalonic acid and homocysteine levels 
  • C-reactive protein (CRP) or IL-6 assays, are nonspecific inflammatory markers
  • Liver function tests
  • Lead level
  • Thyroid stimulating hormone (TSH) test 
  • Serum creatinine and/or calculated glomerular filtration rate
  • Complete metabolic panel and hemoglobin A-1-C 

Other procedures to further identify possible cause [3]:

  • Fecal occult blood test 
  • Endoscopy
  • Electrocardiogram 
  • Bone marrow aspiration

Serum ferritin is a glycoprotein that indicates available iron stores. It is the first test to become abnormal as iron deficiency begins to develop. It is the best test to assess the degree of iron deficiency as it is not affected by recent ingestion of iron [3].

Microcytic Anemia
  • We report our experience with an 11-year-old Japanese girl with hypochromic microcytic anemia, low serum iron, and high serum ferritin, with anemia that was refractory to the oral iron that was prescribed frequently from early childhood.[ncbi.nlm.nih.gov]
  • Patients have hypochromic microcytic anemia refractory to oral iron and are only partially responsive to parenteral iron administration.[ncbi.nlm.nih.gov]
  • IRIDA is characterized by hypochromic microcytic anemia unresponsive to oral iron treatment, low transferrin saturation, and a high level of iron-regulated hormone hepcidin.[ncbi.nlm.nih.gov]
  • Thalassemia traits (TTs) and iron deficiency anemia (IDA) are the most common disorders of hypochromic microcytic anemia (HMA).[ncbi.nlm.nih.gov]
  • Far from trivial, a massive human colonization by bed bugs may cause such a hematic depletion that severe microcytic anemia may result. M. Sabou et al., published by EDP Sciences, 2013.[ncbi.nlm.nih.gov]
Thrombocytosis
  • OBJECTIVE: In order to inquire into the pathogenesis of increased platelet counts in peripheral blood of patients with iron deficiency anemia (IDA), the phenomenon of thrombocytosis was confirmed, and then the expression of tubulin within platelets from[ncbi.nlm.nih.gov]
  • Hematological investigations revealed severe iron deficiency anemia without thrombocytosis. The magnetic resonance angiogragraphy findings were suggestive of moyamoya syndrome.[ncbi.nlm.nih.gov]
  • Abstract Iron deficiency anemia is commonly associated with thrombocytosis and normal leukocyte count. Thrombocytopenia has occasionally been reported in iron deficiency anemia, but pancytopenia is very rare.[ncbi.nlm.nih.gov]
  • The physiological mechanisms that may factor in the development of ischemic stroke in patients with IDA include thrombocytosis, hypercoagulable state, and anemic hypoxia.[ncbi.nlm.nih.gov]
  • Abstract Iron deficiency anemia (IDA) is commonly associated with reactive thrombocytosis, but thrombocytopenia is relatively uncommon and generally associated with more severe IDA.[ncbi.nlm.nih.gov]
Iron Decreased
  • This iron and recently absorbed iron decrease uptake of iron from the gut lumen by satiation of iron-binding proteins with iron, by stimulating an iron regulatory element, or both.[emedicine.com]
Hemoglobin Decreased
  • Although the risk of GI cancer (GIC) increases as hemoglobin decreases, guidelines do not usually recommend hemoglobin thresholds for IDA investigation.[ncbi.nlm.nih.gov]
  • decreases and the red cells become small (microcytic with reduced hemoglobin concentration (hypo chromic) Microcytic anemia Iron deficiency Retic count decreased RDW is high Thalassemia Retic count elevated RDW is normal Chronic disease Retic count decreased[meddean.luc.edu]

Treatment

The treatment of iron deficiency anemia involves a two-step approach; restoring iron stores [10] and treating the underlying etiology. Management of the causative disease process will usually improve hemoglobin levels [7].

Treatment depends on the level of iron deficiency and the severity of the anemia, as well as any underlying conditions.

  • Oral ferrous iron salts, ferrous sulfate, is the first recommendation, because it is effective and safe. Recommended dosage is 100–200 mg elemental iron daily [3]. Once hemoglobin is normal iron therapy should continue for 3 months to replenish iron stores [3]. Combined iron and folic acid preparations may also be used [3]. 
  • Oral iron should be taken on an empty stomach [3]. Nausea, constipation, and epigastric discomfort are possible adverse effects and may result in non-compliance in 21% of patients [12]. Preparations with lower iron content, slow-release, or enteric-coated forms may prevent these effects [3]. Intermittent iron administration, weekly or on alternate days, may decrease adverse effects. These appear to be as effective as daily dosing.
  • Parenteral iron is effective, but should be reserved for patients who cannot tolerate or absorb oral preparations, or whose anemia does not respond to oral medication [3] [7].
  • Transfusions with packed red blood cells should be used only in patients with acute bleeding, severe hypoxia, or coronary insufficiency [10]. Management of anemia in pregnancy may require transfusions to prevent maternal or fetal morbidity and mortality [3] [7]. 
  • Erythropoiesis-stimulating agents may also be effective in the treatment of iron deficiency anemia of chronic disease [5]. However, these drugs are not without adverse effects, particularly thromboembolism [1] [7]. 
  • Dietary interventions are necessary in all patients to supplement other forms of treatment.
  • Iron absorption depends on the amount of iron in the diet, its bioavailability and physiological needs of the body [3] [10]. The main sources of dietary iron are red meats, fish and poultry [3]. Iron from meat (heme-iron) is absorbed more readily than other forms of iron. Meat also contains compounds that promotes better iron absorption [4]. But approximately 95% of iron in the diet comes from non-hem iron sources [4].

Other dietary recommendations:

  • Vitamin C (ascorbic acid) aids iron absorption from non-hem sources [3]. The quality of the source influences this effect [9].
  • Tannins in tea and coffee inhibits the absorption of iron when consumed with the iron source [3].

Treatment of iron deficiency anemia should also include patient education including [3]:

  • Dietary information regarding iron intake and absorption.
  • Need for iron supplements and ways to avoid adverse effects. 
  • Benefits of Vitamin C.
  • Signs and symptoms of worsening anemia.

Excess iron can be toxic, and can lead to cell death and organ damage. Therefore, iron supplementation needs to be carefully monitored [1].

Prognosis

Iron deficiency anemia is a disorder with a good outcome, but it may be caused by an underlying condition with a poor prognosis.

Etiology

Iron deficiency anemia is defined as a hemoglobin level less than 11g/dL (not associated with hemoglobinopathies) [3] [8] [9].
Iron status can be classified as iron sufficient, iron depleted, or iron deficiency anemia [8].

Iron sufficiency indicates that iron supplies are sufficient to supply normal and atypical body requirements for hematopoiesis [9]. In iron depletion, the total stored iron, serum ferritin concentration, is decreased, but the amount of transport iron remains normal [4] [9]. In iron deficiency anemia both stored iron and transport iron are decreased [3]. Therefore, the amount of iron is insufficient to provide what is needed for normal function. This results in inadequate hemoglobin production [3] [8] [9].

Iron deficiency anemia may also be classified by the underlying cause of the disorder [4] [6] [9] [10]:

  • Nutritional deficits
  • Blood loss
  • Malabsorption
  • Metabolic dysfunctio
  • Diabete
  • Chronic renal disease
  • Chronic heart disease

Chronic iron deficiency anemia is a common occurrence in the elderly [5] [6] and in chronic disease. Anemia in diabetes and chronic kidney disease is a result of the kidney‘s inability to produce erythropoietin in response to abnormally low hemoglobin [10].

Epidemiology

The prevalence of iron deficiency anemia is affected by diet and socioeconomic factors. It is seen more frequently in those living in poverty [8]. It varies worldwide from 10% in developed nations to 50% in less developed societies [8].

Prevalence of iron deficiency anemia in the elderly increases with age from 8 % at age 65, 12% at age 75, and 23% at age 85+ [6].
The incidence of iron deficiency anemia is higher in men than in women in all age groups [6].

Studies have reported the prevalence of iron deficiency anemia in elderly African Americans to be 3 times higher than in Caucasians, Hispanics, and Asian Americans [6]. However, normal hemoglobin levels are lower in those of African descent, a factor that is not always taken into account [3].

Iron deficiency anemia occurs in almost one third of patients with congestive heart failure (CHF) and 10% to 20% of patients with coronary heart disease (CHD) [2].

Sex distribution
Age distribution

Pathophysiology

Iron is necessary for the production of hemoglobin, myoglobin, and enzymes of cellular metabolism. Iron deficiency results in abnormal hemoglobin synthesis leading to reduced ability of the red blood cells to carry oxygen [5]. Iron is involved in the development of the central nervous system, immune system, endocrine system and cardiovascular system [2] [5].

Iron absorption is regulated to replace body losses. Hepcidin is the key regulator of iron absorption in the intestinal tract and the distribution from body stores [1] [8]. Hepcidin, produced in the liver, responds to iron levels and needs by activating ferroportin [1] [9]. Ferroportin is present on the surface of duodenal mucosal cells and facilitates iron absorption. Decreased levels of ferroportin inhibit the absorption of iron into the plasma [1].

Iron deficiency anemia of chronic disease is the result of reduced glomerular filtration rate, reduced plasma flow, impaired erythropoietin production, and hemodilution [5] [11]. These findings are associated with elevated levels of inflammatory cytokines which indicate an autoimmune inflammatory process [7] [11].

Iron is also important in the production of myoglobin and myelin in the brain [8]. Iron deficiency, therefore, affects neurotransmitter metabolism, interfering with psychomotor, intellectual, and emotional function. These effects are seen particularly in children, but may also be responsible for symptoms in the elderly [8].

Prevention

Ways of preventing and treating iron deficiency anemia include [9]:

  • Health education regarding diet and iron needs.
  • Fiscal measures to fund prevention and treatment programs.
  • Screening programs; early identification and treatment may prevent serious complications [3] [9].
  • Fortified foods; infant formula, breads and cereals.
  • Iron supplementation in pregnant women, at risk infants, and adults at risk [3].

Summary

Iron deficiency anemia is defined as a decrease in red blood cells (RBCs), hemoglobin, and/or red blood cell volume a result of insufficient iron [1]. Iron deficiency is a major public health concern and the most common nutritional deficiency, affecting more than 2 billion people worldwide [2] [3] [4]. Although it is more prevalent in underdeveloped countries, it is still a problem in developed nations [3] [5]. The World Health Organization defines anemia as a hemoglobin (Hgb) level less than 12-13 g/dL [6]. Approximately 50% of anemia is due to iron deficiency [3].

The causes of iron deficiency anemia include: Nutritional deficits, malabsorption, excessive blood loss, and chronic disease [4] [7]. The cause of anemia is determined by patient history, dietary history, and the indices of iron status [7].

Iron deficiency anemia increases with age and as a result of chronic diseases, such as chronic heart disease, diabetes, and chronic renal disease [7].

The effects and complications of iron deficiency anemia are significant. Iron deficiency may interfere with psychomotor development and cognitive function in children [8]. It may increase maternal and fetal morbidity and mortality. Iron deficiency anemia in the elderly and chronically ill decreases quality of life, independence, and productivity. It has an important economically impact by diminishing the individual’s ability to work and perform physical labor [2].

Patient Information

What is iron deficiency anemia?

Iron deficiency anemia refers to a lower than normal level of hemoglobin (the oxygen carrying part of the blood) as a result of insufficient amounts of iron to produce it.

What are the symptoms of iron deficiency anemia?

Mild to moderate iron deficiency anemia is often asymptomatic. The symptoms of iron deficiency anemia include:

What causes iron deficiency anemia?

Iron deficiency anemia is caused by a decreased intake or absorption of iron and/or an increased need for or loss of hemoglobin. Chronic diseases, such as diabetes, chronic renal disease, and chronic heart disease, may also contribute to iron deficiency anemia.

Who gets iron deficiency anemia?

Anyone, at any age, may develop iron deficiency anemia. Individuals living in poverty or in developing parts of the world, where malnutrition and poor health conditions abound, are at highest risk.

Also at high risk are:

  • Women of child bearing age
  • Pregnant women
  • Infants and toddlers
  • Adolescents
  • The elderly
  • Individuals with chronic disease

How is iron deficiency anemia diagnosed?

Iron deficiency anemia is diagnosed by simple blood tests and is often found with routine blood screening. It may be suspected by symptoms of fatigue and activity intolerance.

How is iron deficiency anemia treated?

Iron deficiency anemia is treated by increasing the intake and absorption of iron. This may be done by increasing the iron in the diet or by supplementing with iron medications. Treating any other underlying cause is also needed.

What are the complications of iron deficiency anemia?

There are many possible complications of iron deficiency anemia. Iron is essential for the production of hemoglobin and for proper development and functioning of the nervous system.
Iron deficiency anemia may cause:

  • Increased maternal/fetal mortality and morbidity.
  • Increased problems associated with heart and respiratory disease.
  • Alterations in growth and development.
  • Decreased quality of life of the elderly and chronically ill.

How can iron deficiency anemia be prevented?

Iron deficiency anemia can be prevented by a balanced diet containing sufficient iron, from meats and non-meat sources, folic acid, and Vitamins C and B-12. It may also be prevented by iron supplementation of those at risk for developing iron deficiency anemia. Complications of iron deficiency anemia may be prevented by early detection and treatment through routine screening.

References

Article

  1. Sun CC, Vaja V, Babitt JL, Lin HY. Targeting the hepcidin–ferroportin axis to develop new treatment strategies for anemia of chronic disease and anemia of inflammation. American Journal of Hematology. 2012;87:392–400.
  2. Qaseem A, Humphrey LL, Fitterman N, Starkey M, Shekelle P. Treatment of Anemia in Patients With Heart Disease: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2013;159(11):770-779. 
  3. Pavord S, Myers B, Robinson S, Allard S, Strong J, Oppenheimer C. UK guidelines on the management of iron deficiency in pregnancy. British Journal of Haematology, 2012, 156, 588–600.
  4. Cameron BM, Neufeld LM. Estimating the prevalence of iron deficiency in the first two years of life: technical and measurement issues. Nutrition Reviews. 2011; 69(1):S49–S56.
  5. Chen MH, Su TP, Chen YS, Hsu JW, Huang KL, Chang WH, et al. Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study. BMC Psychiatry. Jun 4 2013;13:161.
  6. Sabol VK, Resnick B, Galik E, Gruber-Baldini A, Morton PG, Hicks GE. Anemia and its impact on function in nursing home residents:What do we know? Journal of the American Academy of Nurse Practitioners. 2010; 22: 3–16.
  7. Cullis JO. Diagnosis and management of anaemia of chronic disease: current status. British Journal of Haematology. 2012; 154: 289–300. 
  8. Wang B, Zhan S, Gong T, Lee L. Iron therapy for improving psychomotor development and cognitive function in children under the age of three with iron deficiency anaemia. The Cochrane Library. 2013;6:1-50.
  9. Wharton BA. Iron Deficiency In Children: Detection And Prevention. British Journal of Haematology, 1999, 106, 270-280.
  10. Stevens PE. Anaemia, Diabetes And Chronic Kidney Disease: Where Are We Now? Journal of Renal Care. 2012;38(1):67-77.
  11. Gonza´lez-Costello J, Comı´n-Colet J. Iron deficiency and anaemia in heart failure: understanding the FAIR-HF trial European Journal of Heart Failure. 2010;2:1159–1162.
  12. Kulnigg S, Gasche C Systematic review: managing anaemia in Crohn’s disease. Aliment Pharmacol Ther. 2006; 24:1507–1523.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-22 00:07