Iron deficiency anemia can be due to blood loss, more physiologic demands of iron by the body, and mal-absorption. There are 3 ways by iron deficiency anemia can happen:
1) Iron Deficiency Anemia due to blood loss
Commonly seen in men and post-menopausal women due to gastrointestinal blood loss. This condition occurs due to:
- Occult gastric or colorectal malignancy
- Peptic ulceration
- Inflammatory bowel disease
- Angiodysplasia lesions
Gastrointestinal blood loss gets worse by using certain drug groups like Aspirin or NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). These drugs exacerbate the condition by causing impaired platelet function and erosions in the intestine.
2) Iron Deficiency Anemia in Puberty, Pregnancy and Breast Feeding
- Pregnancy or menstrual blood loss,
- Childbearing-aged women or
- A breastfeeding woman
They are at risk of Iron deficiency anemia as these conditions require more blood, and thus there is depletion of iron stores in the body. In addition, in rare cases, chronic hematuria can often lead to blood loss.
Now, the second cause is iron deficiency anemia due to more physiologic demands of iron by the body:
Physiologic demand means the period of rapid growth, such as infancy and puberty. During these times, the body demands more iron, and the demand may be more than the iron stores in the body. In a pregnant lady, Iron demand is more because, during pregnancy, the iron produced in the body reaches the fetus and the placenta, thus shows an increased demand for iron and even the increased maternal red cell mass. This blood loss happens during parturition.
3) Iron Deficiency Anemia due to Mal-absorption
A person with minimal food intake or not having a proper healthy diet may suffer from Iron deficiency anemia. For such a case,
- Measure iron intake of all the patients and assess a diet plan
- The main hero here is gastric acid. Yes, this gastric acid helps release iron from the food and keeps an iron insoluble ferrous state.
Symptoms of Iron Deficiency Anemia
Symptoms of iron deficiency anemia are:
- Weakness in body
- Muscle fatigue
- Difficulty in breathing or shortness of breathing
- Pale skin tone due to low Hb (Hemoglobin)
- Cold hands and feet
- A burning or creeping sensation in the legs
- Skull feels lighter
- Loss of appetite or decreased appetite
- Distension of tongue
- Body feels cold
As you can see, symptoms of iron deficiency anemia range from mild to severe. Sometimes, it is impossible to detect iron deficiency anemia due to its asymptomatic nature.
Diagnosis of Iron Deficiency Anemia
We can diagnose iron deficiency anemia on two levels. The first one is the confirmation of iron deficiency and the second one is to rule out the cause for iron deficiency.
So, confirmation of iron deficiency can be done by plasma ferritin, a form of iron stored in the tissues. Reduction in plasma ferritin levels can be in the case of iron deficiency, hypothyroidism, or vitamin C deficiency. An increase in plasma ferritin levels can be seen in the case of liver disease or as an acute phase response. These levels can be raised to 100 micrograms per liter. The measure of iron availability can be based on plasma iron and total iron-binding capacity, and these levels are affected by many factors except iron stores.
A protein called transferrin also shows lower levels of malnutrition, nephrotic syndrome, and liver disease. However, it can also increase in case of pregnancy or the one on contraception.
An immunoassay test can measure poor iron stores in the body that helps distinguish storage iron depletion during any acute phase response or in the liver disease state.
Now, let’s discuss how to know the cause of iron deficiency?
As in the case of men and post-menopausal women that have a routine diet, the upper and lower GI tract should be examined by endoscopy or barium milk study.
A duodenal biopsy is indicated to detect coeliac disease in iron-deficient patients that show Mal-absorption or in the case of young men with everyday dietary habits and regularly menstruating women and diet.
Iron Deficiency Anemia Treatment
Oral iron supplements in ferrous sulfate should be given 200 mg 8 hourly and should be continued for 3 to 6 months. Only in cases of patients with heart disease or cerebral hypoxia, transfusion become necessary.
In case if the patient is intolerant to ferrous sulfates, like dyspepsia or bowel disease, you need to reduce the dose to 200 mg 12 hourly or use ferrous gluconate 300 mg 12 hourly.
After giving supplements, you need to check for the rise in hemoglobin levels every 7 to 10 days, and an increase of 10 g per liter should be evident.
Parenteral iron therapy in case of mal-absorption or in patients with the chronic gut disease. They can also be given intravenous iron therapy or dextran.
You need to check for anaphylaxis during the test dose.
How to Prevent Iron Deficiency Anemia?
You can prevent iron deficiency anemia by intake a high iron-rich diet. Foods that are high in iron are:
Foods high in iron include:
- Squash and Pumpkin Seeds
- Seafood such as Oysters, Clams, etc.
- Liver of a chicken
- Beef and Lamb
- Dry fruits such as Cashew, Hazelnut, Almond, Apricots, etc.
- Whole Grains, Cereals, and Wheat Bran
- Dark Chocolate or Cocoa Powder
- Pulses and Beans
- Green leaves such as Spinach
These all are high iron-rich diets, so add them to your diet and bring your iron levels to normal to prevent iron deficiency anemia.