Anemia, Iron Deficiency
Basic Information
When the body does not have enough iron to generate red blood cells iron deficiency anemia results. A severe or chronic blood loss can often cause this condition but it is also associated with a less than adequate supplementation of iron.
Chronic blood loss is responsible for most of the cases of iron deficiency in the United States and Europe whereas inadequate amounts of iron in nutrition is the more usual cause of iron deficiency anemia in poor or developing countries. Iron deficiency also can be seen in women during pregnancy because of a greater demand for iron or can come as a result of a woman's frequent menstrual periods. It can also be seen in some infants who do not have iron supplements through milk diets. Also patients who have had small bowel or gastric surgery may have inadequate iron absorption..
One of the necessary elements in hemoglobin, iron comes mostly from food -- especially those animal products like eggs, meat and milk. Even though we conserve iron in our bodies when there is a destruction of red blood cells the iron inside produces new red blood cells. Yet there is a daily iron loss which needs to be restored nutritionally.
Vegetarians who do not eat animal products can be at risk even if they each such vegetables as broccoli and spinach which are iron-rich. The problem is that it is not able to be absorbed by the intestines. Those who have suffered chronic blood losses due to tumors in the intestines or gastric ulcers are also at risk. In fact, iron deficiency anemia is often the first sign of an intestinal tumor.
Iron deficiency can have serious consequences during pregnancy even causing perinatal mortality or mental dysfunction in a child's early years.
Symptoms
In initial stages most patients do not have any symptoms. One of the first symptoms that present is:
- fatigue which interferes with the patient's daily routine
But for cases that have been of long duration or severe duration these symptoms may occur:
- dizziness
- nail changes, usually a softening or curling like a spoon
- shortness of breath
- atrophy of the GI mucosa
- chest pain
- sore mouth
- an obsessive swallowing of ice or clay to make up for the absence of iron
- heart palpitations
Diagnosis/Treatment
In diagnosing iron deficiency anemia it is important to evaluate the patient's medical history for any conditions that might be responsible for GI blood loss, especially since most patients show no physical signs of illness, though sometimes the skin may be pallid. Laboratory tests are usually indicated to diagnose this illness though they may vary depending on the stage of deficiency. The first signs of iron deficiency anemia are absent iron marrow stores and decreased serum ferritin. Also decreased serum iron and increased TIBC (total iron-binding capacity) are the next signs to look for.
Under a microscope the red blood cells take on a shape characteristic of the disease. Sometimes your health care professional will feel that a bone marrow exam be performed, especially when the diagnosis is not clear. This can be done in the health care professional's office using local anesthesia. Of course the reason why a patient has iron deficiency is important to determine (i.e. whether it is because of decreased absorption, inadequate iron intake or chronic blood loss). Gynecological symptoms and GI histories must be studied and tests for occult blood in the stools should be performed.
Treatment for most cases can be accomplished by taking an iron tablet or supplement three or four times a day. It can also be taken in liquid form. Most of these doses contain 45--50mg of elemental iron . Your health care provider will help find what regimen is best for you so that your system can get used to the medication and side effects such as gastric upset or constipation which often discourage patients from taking the doses. Most iron is recommended to be taken about an hour before meals and at bedtime. If a patient has nausea or upper abdominal pain the medication can be readjusted to a reduced dose. It is thought that liquid preparations may be best for absorption and is usually prescribed after a gastric operation.
A nutritionist will help you maintain a diet that will allow a good iron balance. This is the most common anemia and besides being easily diagnosed can be treated without great expense and usually with great effectiveness but follow ups are important to be certain that your iron therapy is working and that there are no side effects of the medication. Pregnant women should consult their gynecologist or nutritionist about pre-natal care and pre-natal vitamins. It is usually recommended that you do not exert yourself more than necessary.
If you feel you have or are at risk for iron deficiency anemia please consult your health care provider promptly.
Additional Resource(s):
- National Heart, Lung, and Blood Institute Information Center 301-251-1222