Iron Deficiency Anemia

Iron deficiency anemia is a common disease world­wide; it affects 10% to 30% of the adult population of the United States. It's most prevalent among premenopausal women, infants (particularly premature or low-birth-weight infants), children, adolescents (especially girls), alcoholics, and elderly people (especially those who are unable to cook). The prognosis after replacement therapy is favorable.

Causes

The main causes of iron deficiency are: poor absorption of iron by the body ( Vitamin C aides in iron absorption), inadequate daily intake of iron, pregnancy, growth spurts or blood loss due to heavy period or internal bleeding.

Anemia develops slowly after the normal stores of iron have been depleted in the body and in the bone marrow. Women, in general, have smaller stores of iron than men. Women also lose iron more frequently than men because of the blood loss during menstruation.

In men and postmenopausal women, anemia is usually due to gastrointestinal blood loss associated with ulcers , the use of aspirin or nonsteroidal anti-inflammatory medications (NSAIDS), or colon cancer.

Gaucher Disease may also cause anemia.

Symptoms

The following are the most common symptoms of iron-deficiency anemia. However, each individual may experience symptoms differently. 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 (a condition called pica)

The symptoms of iron-deficiency anemia may resemble other blood conditions or medical problems. Always consult your physician for a diagnosis.

Diagnostic tests

Blood studies and stores in bone marrow may confirm iron deficiency anemia. However, the results of these tests can be misleading because of complicating factors, such as infection, pneumonia, blood transfusion, and iron supplements. Characteristic blood study results include:

• low hemoglobin levels (males, less than 12 g/dl; females, less than 10 g/dl)
• low hematocrit (males, less than 47 ml/dl; females, less than 42 ml/dl)
• low serum iron levels with high binding capacity
• low serum ferritin levels
• low RBC count with microcytic and hypochromic cells (in early stages, RBC count may be normal, except in infants and children)
• decreased mean corpuscular hemoglobin in severe anemia.

Bone marrow studies reveal depleted or absent iron stores (done by staining) as well as normoblastic hyperplasia.

GI studies, such as guaiac stool tests, barium swallow and enema, endoscopy, and sigmoidoscopy, rule out or confirm the diagnosis of bleeding causing the iron deficiency.

Diagnosis must rule out other forms of anemia, such as those that result from thalassemia minor, cancer, and chronic inflammatory, hepatic, and renal disease.

Treatment

The underlying cause of anemia must first be determined; then iron replacement therapy can begin. The treatment of choice is an oral preparation of iron or a combination of iron and ascorbic acid (which enhances iron absorption). In rare cases, iron may have to be administered I.M., for instance, if the patient is noncompliant with the oral preparation, if he needs more iron than he can take orally, if malabsorption prevents adequate iron absorption, or if a maximum rate of hemoglobin regeneration is desired.

Total-dose I.V. infusions of supplemental iron can be administered to pregnant and elderly patients with severe iron deficiency anemia. The patient should receive this painless infusion of iron dextran in normal saline solution over 8 hours. To minimize the risk of an allergic reaction to iron, an I.V. test dose of 0.5 ml should be given first.

Prevention

The child's diet is the most important way to prevent and to treat iron deficiency. Many foods are good sources of iron:

• Good -- Tuna, oatmeal, apricots, raisins, spinach, kale, greens, prunes.
• Better -- Eggs, meat, fish, chicken, turkey, soybeans, dried beans, peanut butter, peas, lentils, molasses.
• Best -- Breast milk (the iron is very easily used by the child), formula with iron, infant cereals, other iron-fortified cereals, liver, prune juice.

In addition, restrict milk to no more than 32 ounces daily. If the diet is deficient in iron, iron should be taken orally. During periods of increased requirements, such as teen pregnancy and lactation, increase dietary intake or take iron supplements.

If an oral iron supplement is recommended; patients should consult with their physicians to determine what type of iron is appropriate. Most OTC iron supplements are non-heme (meaning the iron included does not come from animal sources); but within that there are few types of iron to choose from. Those sensitive to ferrous sulfate can choose a carbonyl iron formulation.

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