Iron Deficiency Anemia

1 What is iron deficiency anemia?

Anemia occurs when there is less than normal level of red blood cells (RBC) in the blood. Iron deficiency anemia is the most common type of anemia caused by insufficient amount of iron in the body.

There is a possibility for people to suffer from iron deficiency anemia for years and experience the symptoms without being aware of the cause.

This protein is very essential for the body tissues and muscles to function properly. Lack of iron affects the production of hemoglobin, resulting in anemia. When there is lack of iron in the blood, the rest of the body will not get the required amount of oxygen.

Iron is an important part of the protein hemoglobin that carries oxygen in red blood cells. Lack of iron affects the production of hemoglobin, resulting in anemia.

Iron deficiency anemia may remain asymptomatic and people may ignore the symptoms. Doctors usually recommend an iron-rich diet and iron supplementation to correct the condition. At times the patients will have to undergo various tests and there may be a need for some treatments to cure iron deficiency anemia in cases where the doctor suspects internal bleeding.

Heavy menstrual bleeding and pregnancy increases the requirement of iron and may lead to anemia when iron is not supplemented through proper diet.

Nutritional deficiency and intestinal disease also result in iron deficiency anemia. An iron-rich diet and iron supplementation helps to correct the condition. 

Iron deficiency anemia in women

Heavy menstrual bleeding and pregnancy increase the requirement of iron and may lead to anemia when the deficiency is not supplemented through proper diet.

Heavy menstrual bleeding is a condition in which women tend to bleed for a longer duration or bleed more than women who normally bleed during their menstrual cycle. In a normal scenario, a woman bleeds for around three to five days and the blood lost during menstruation is around two to three tablespoons. Women who have heavy menstrual bleeding will continue bleeding for more than seven days and will bleed more than the normal amount.

Almost 20% of women who are of child-bearing age suffer from iron deficiency anemia. Pregnant women are more vulnerable to anemia because their body requires more blood and nutrients for proper growth of their babies.

2 Symptoms

Early symptoms of iron deficiency anemia are mild, and sometimes ignored. People mostly come to know that they are suffering from this mild deficiency condition when they have a routine blood test. Signs and symptoms of the condition are noticed when iron deficiency worsens.

Some of the common symptoms of the condition include:

  • Chronic fatigue
  • Weakness
  • Shortness of breath
  • Paleness
  • Dizziness
  • Frequent infections
  • Chest pain
  • Cold hands and feet
  • Headaches
  • Rapid heartbeat
  • Tingling feeling in legs
  • Lack of appetite
  • Unusual cravings to eat substances like dirt, ice, or starch
  • Swelling or soreness of tongue
  • Brittle nails
  • Irritated, grumpy and cranky
  • Difficulty in concentrating

Symptoms of anemia in infants and children include:

  • Cranky and fussy
  • Short attention span
  • Slow physical growth than normal
  • Slow development of other skills like walking and talking compared to normal babies

This condition in babies and children must be treated promptly so that any mental and behavioral disorders do not become long-term.

3 Causes

Iron deficiency anemia is caused by inadequate amounts of iron in the body. Lack of iron affects the production of hemoglobin, the protein in red blood cells that carries oxygen. Less than normal amounts of hemoglobin affects oxygen delivery, resulting in anemia.

Iron deficiency is caused by:

  • Inadequate iron intake: Insufficient amounts of iron in the diet for an extended period reduces the iron stores in the body. Pregnant women and small children need more iron for growth and development. Some of the examples of foods that are rich in iron content are meat, eggs, leafy vegetables etc.
  • Blood loss: The blood in the body contains iron, which is present in the red blood cells. And if the body is losing a lot of blood, the body will also lose iron and there is a possibility of iron deficiency to occur. Heavy menstrual bleeding and blood loss during childbirth are common causes of iron deficiency in women.
  • Internal bleeding: If there is slow but continuous loss of blood from the body due to certain medical conditions like ulcers, hemorrhoids, hiatal hernia, polyps in colon, colon cancer, it can lead to iron deficiency anemia. Also regular use of certain over-the-counter pain relievers, for example aspirin, can lead to gastrointestinal bleeding which can result in this condition.
  • Problems in iron absorption: Certain intestinal disorders or surgeries in the past affect the absorption of iron in the intestine for instance if a person has celiac disease or a part of their small intestine in removed. Even when there is sufficient amount in the diet, body fails to absorb iron. 

Risk of iron deficiency anemia is more common among women, infants and children, vegetarians, and blood donors.

Women lose blood during each menstrual period which has to be replenished. Children have growth spurts and lack of iron during this period lead to anemia.

4 Making a diagnosis

Complete blood cell (CBC) test is the diagnostic test for iron deficiency anemia. CBC is used to measure all the components in the blood including red blood cells, white blood cells, hemoglobin, and platelets.

The doctor will examine and scrutinize the blood using a microscope and recommend additional blood testing to study the following aspects from the test:

  • The size and color of RBC: A person who is suffering from iron deficiency anemia will have red blood cells that are smaller and paler.
  • Hematocrit: This is the percent of blood volume made up of red blood cells, and gives an indication of the level of RBCs in blood. The normal range is 34.9 – 44.5% for women and 38.8-50% for men. This will vary basis the age of the person.
  • Hemoglobin level: The hemoglobin level will be lower than normal level.  Normal hemoglobin level in healthy men ranges from 13.5 to 17.5 g of hemoglobin per deciliter of blood, while in women it is 12 -15.5 g//dL of blood. However for children the normal range will be different and will vary basis their gender and age.
  • Ferritin: This is a protein within the body that helps to store the iron. And if the ferritin level is low, it can indicate a low storage of iron which can lead to anemia.
  • Total iron-binding capacity: The TIBC test is used to check the amount of transferrin, which is a protein that transports the iron in the body.

Additional tests are recommended to check the underlying cause of anemia and to assess the severity of deficiency.

Endoscopy: This procedure will help the doctor to check for internal bleeding from a hiatal hernia or ulcers. In the method, a thin tube with light and video camera is inserted into the patient’s throat and it passes right through their stomach. This will enable the doctor to look for any type of internal bleeding that is causing anemia.

Colonoscopy: To identify if intestinal bleeding is causing anemia, the doctor will recommend this procedure. In this method, a fine and flexible tube with a video camera is inserted through the rectum and it moves right up to the colon. In this test, the patient is usually given sedatives. Through this procedure,  the doctor will be able to scan some or the entire colon and look for any sources of bleeding.

Pelvic ultrasound: This is used to identify the cause of heavy menstrual bleeding in women for instance uterine fibroids that is leading to iron deficiency anemia.  Like iron deficiency anemia, even uterine fibroids do not have any symptoms in the earlier stage. But this condition is caused due to muscular tumor growths within the uterus. This is mostly not cancerous, but  leads to heavy menstrual bleeding and this can cause iron deficiency anemia.

The doctor will usually suggest to undergo these tests or some other test after providing the patient with treatment for couple of weeks with iron supplements to make up for the deficiency.

5 Treatment

Treating the underlying cause of iron deficiency and iron supplementations are the two methods to control symptoms of iron deficiency anemia.

Iron stores in the body are replenished with iron-rich foods and over-the-counter iron supplements. These supplements are to be taken for several months to replenish the stores.

If possible, one should take iron supplements with an empty stomach, since this will help the body to absorb the iron better. But it may not suit all, and in such cases one can take the iron supplements with a meal. There is a possibility that iron supplements can cause constipation or discolored stools.

Heavy menstrual flow is controlled with the help of oral contraceptives. Peptic ulcers are treated with antibiotics and other medications.

Tumors and fibroids that cause internal bleeding are removed by surgery. For severe form of iron deficiency, iron is given intravenously. Blood transfusions also help to replenish red blood cells and iron. 

6 Prevention

Eating iron-rich foods is the best way to prevent iron deficiency anemia.

Opt for iron-rich foods like:

  • Red meat
  • Poultry
  • Green leafy vegetables
  • Dry fruits
  • Iron-fortified foods
  • Peas
  • Seafood

Iron absorption from the intestine can be improved by having vitamin C.

Breast milk and iron-fortified formula help to prevent iron deficiency anemia in infants.

Vegetarians should try to include more plant-based iron-rich foods in their diets instead of meats. 

7 Alternative and homeopathic remedies

A few alternative and homeopathic remedies exist for iron deficiency anemia:

  • Ferrum metallicum
  • Aletris farinosa
  • China
  • Natrum mur
  • Ferrum phos

These are the common medicines suggested in homeopathy to improve production of hemoglobin and control anemia.

Herbal medicines like chive, quinoa, and dandelion are considered to improve symptoms of anemia.

Reflexology, juice therapy, and ayurveda are also used in treating this condition. 

8 Lifestyle and coping

Lifestyle modifications are necessary in order to cope with iron deficiency anemia.

Adjusting the diet with iron-rich foods boosts energy levels.

Supplementation is very important if symptoms are moderate.

Taking a digestive enzyme is considered to maximize the benefit of taking iron supplements. 

9 Risks and complications

Iron deficiency anemia in most cases is mild and does not lead to many complications. It can be easily treated, but if ignored for very long this condition can become severe and lead to a lot of complications. 

Some complications associated with iron deficiency anemia include:

  • Irregular heartbeats: When a person has severe iron deficiency anemia, the heart will have to pump more blood to cover up for the reduced amount of oxygen. This overexertion can cause irregular heartbeats and in certain severe deficiency cases it can lead to heart problems or an enlarged heart.
  • Pregnancy problems: In severe cases of iron deficiency anemia, there is a possibility of premature birth or low birth weight. Therefore women are recommended by their doctors to take iron supplements during pregnancy to avoid such complications.
  • Slow growth and development in infants: Infants who are suffering from iron deficiency tend to grow and develop more slowly compared to normal children. They will also be more prone to infections.
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