Iron Deficiency Anemia

Anemia is a deficiency of haemoglobin in the body, and iron deficiency anemia is one of its major causes. Iron deficiency anemia (IDA) affects nearly 2 billion people worldwide.

It is especially common in children, women (especially those of child-bearing age) and the underprivileged.

Role of Iron in the Body

Iron is a component of haemoglobin, which has a major role in carrying oxygen to various parts of the body. Hence, iron deficiency anaemia can present with a variety of symptoms.

Symptoms

• Fatigue, irritability, lack of concentration
• Breathlessness, tachycardia
• Hair loss, brittle nails
• Pale skin
• Restless legs
• Pica

Causes of IDA

1. Increased iron demand

• Infants
• Pre-school children
• Growth spurts in adolescents
• Pregnancy

2. Decreased intake

• Malnutrition, poverty
• Poor iron content in diet

3. Decreased iron absorption

• Cereal-based diets
• Surgery of the stomach, such as a partial gastrectomy
• Medical problems like H. pylori infection, coeliac disease, atrophic gastritis, IBD
• Drug intake

4. Chronic blood loss

Physiological:

• Menstruation
• Frequent blood donation

Pathological:

• GI tract: worm infestation, erosive gastritis, peptic ulcer, GI cancers, haemorrhoids, IBD
• Genito-urinary: menorrhagia
• Systemic: dialysis, inherited coagulopathies
• Drug intake: salicylates, NSAIDs, anticoagulants, corticosteroids

5. Inflammation

• Chronic kidney disease
• IBD
• Autoimmune disease
• Post-operatively

How Do We Diagnose IDA?

1. CBC with peripheral smear examination is important to look for the type of anemia. Haemoglobin levels can vary according to age and sex. RBC indices like MCV, MCH, MCHC and RDW are important parameters in the diagnosis of IDA. The Mentzer index is generally >13 in IDA.
2. Iron studies include the measurement of iron, UIBC, TIBC, % saturation and ferritin. This not only tells us about iron levels in the blood but also about iron stores.
3. Additional tests like HPLC and reticulocyte count help to distinguish between iron deficiency anemia and haemoglobinopathies.
4. Tests to find the underlying cause of anemia.

Patient → Diagnose → Treat → Follow-up.

Treatment

Treatment may include:

• Iron supplements
• Intravenous iron
• Dietary modifications
• Treatment for underlying conditions

Dietary Counselling

Dietary counselling may include guidance regarding:

Iron-rich foods

• Red meat (pork, lamb, organ meats such as liver)
• Poultry (chicken, turkey, duck)
• Fish
• Leafy greens: broccoli, kale, turnip greens
• Iron-rich grains
• Legumes
• Fortified cereals
• Dried fruits like apricots and raisins

Foods that enhance the absorption of iron

• Vitamin C-rich foods like orange, kiwi, strawberries and bell peppers
• Cooking in cast-iron cookware
• Include foods rich in vitamin B12 and folate

Foods to avoid with iron-rich foods

• Tea and coffee, which contain tannins that inhibit the absorption of iron
• Calcium-rich foods like milk and cheese

References

• American Society of Hematology
• Indian Society of Haematology and Blood Transfusion
• Iron deficiency and iron deficiency anemia: a comprehensive overview of established and emerging concepts.
• Iron Deficiency Anemia: Etiology, Pathology, Diagnosis and Treatment. Journal of Drug Delivery & Therapeutics, 14(11): 185–199, November 2024.