Iron Deficiency Anemia
Written by Dr. Ioanna Michail, MD, Hematologist ,M.B.,B.Ch., M.Sc
Do you feel tired and exhausted while doing your everyday activities? Do other people tell you that you look very pale? Where you ever told “Take some iron, you’ll feel better”? Well maybe it is time to wonder if you have anemia and specifically iron deficiency anemia.
Anemia is a condition in which the body lacks enough healthy red blood cells. Red blood cells are responsible to carry oxygen to body tissues. Anemia is defined as reduction in the Hemoglobin concentration in the blood. Normal values of Hemoglobin can vary between laboratories, but typical normal values for Hemoglobin would be 11.5-15.5g/dl in women and 13.5- 17.5g/dl in men. So, in case of anemia hemoglobin would be less than 13.5g/dl in men and less than 11.5 in women. There are many types of anemia. Iron deficiency anemia is one of the commonest causes of anemia.
What is iron deficiency anemia?
Iron deficiency anemia, as its name implies, occurs when the body doesn’t have enough iron. Iron is involved in the production of new red blood cells. If there is no enough iron the body will make smaller and fewer red blood cells.
What can cause iron deficiency anemia:
Iron deficiency anemia could be either due to increase blood and iron loss more than what the body can replace, diminished iron absorption, decreased dietary intake or increased requirements.
Commonest causes of blood loss:
1. Heavy and prolonged menstruation
2. Irregular and frequent vaginal bleeding
3. Peptic ulcer
4. GIT cancer: cancer in the stomach, oesophagus, small intestine, colon
5. Use of aspirin and other anti-inflammatory drugs may cause gastrointestinal bleeding
7. Oesophageal varices
Commonest causes of diminished iron absorption: (Iron is absorbed in the small intestine)
1. Crohn’s Disease
2. Celiac Disease
3. Bypass or removal of part of the stomach or small intestine
Commonest causes of decreased dietary intake:
1. Being strict vegetarian
2. Not having a balanced diet. Iron- rich foods include: leafy green vegetables, meat and eggs.
Commonest cause of increased requirements:
2. Growth: Children, teens
Who are at risk for developing iron deficiency anemia:
- Women of childbearing age
- Pregnant women
- Infants and young children esp. those born prematurely or with low birth weight
- Frequent blood donors
Symptoms and signs of iron deficiency anemia:
If the anemia is mild you might not have any symptoms at all. As anemia gets worst symptoms gradually develop and they include:
- Easy fatigability, weakness
- Difficulty in concentrating
- Dizziness, lightheadedness
- Shortness of breath, palpitation, chest pain
- Falling of hair
- Brittle nails
- Tongue soreness or swelling
- Craving for non- nutritive substances for example: ice, dirt, clay (PICA)
- Pounding or "whooshing" in the ears
Also symptoms of the cause of the anemia might be present:
- Heavy menstrual bleeding or irregular vaginal bleeding (women)
- Upper abdominal pain (peptic ulcer)
- Black tarry stool or blood in stool
How to diagnose:
To diagnose iron deficiency anemia your hematologists will perform several tests. Initially a full blood count will be ordered to check your hemoglobin and hematocrit levels, red blood cells indices and morphology and platelet count. Also iron studies will be performed to evaluate your serum iron level and iron stores. In rare cases, bone marrow aspirate and biopsy may be performed. After diagnosing iron deficiency anemia several other tests might be required to detect the cause, for example: upper GIT endoscopy, colonoscopy, abdominal ultrasound, transvaginal ultrasound.
What can we do to avoid iron deficiency anemia:
If the cause of iron deficiency anemia is inadequate intake, then having a balanced diet high in iron- rich foods and vitamin C will prevent it and help in treating it.
Mothers should make sure to feed their babies breast milk or iron-fortified infant formula. Vegetarians should replace meat with another iron- rich food.
When to go to a doctor:
If you have symptoms of iron deficiency anemia or if you notice blood in your stool.
How to treat iron deficiency anemia:
1. Iron Supplements by mouth
Your Hematologist might prescribe you iron tablets. Iron therapy should be given for long enough both to correct the anemia and to replenish your body iron stores, which usually means for at least 6 months. Iron supplements may cause constipation or black stools.
For better benefit from oral iron therapy you can take the pills with Vitamin C or with a glass of orange or citrus juice. Do not take iron tablets with milk, coffee, tea, foods with high fiber (cereals) or antacids.
If you think you have anemia, do not try to treat yourself. If you take iron tablets on your own without talking to your doctor, the pills might increase your blood iron too much causing serious complications. In addition, your low iron levels might be due to a serious underlying problem, for example peptic ulcer or cancer, which requires different treatment.
2. Intravenous iron (IV)
In some cases, your doctor may recommend intravenous iron. IV iron may be necessary to treat iron deficiency in patients who cannot tolerate iron by mouth, patients who do not absorb iron well in the gastrointestinal tract, patients with severe iron deficiency or chronic blood loss.
Eating foods high in iron might help treating iron deficiency anemia. Also, food rich in Vitamin C help your body to absorb iron.
Foods high in iron include:
- Meat, i.e.: chicken, red meat, liver
- Leafy greens, such as spinach
- Raisins and other dried fruit
- Seafood, such as clams, shrimp, and oysters
Foods high in vitamin C:
- Citrus fruits i.e. oranges, grapefruits, strawberries, kiwis, guavas, pineapples, melons, mangoes
- Leafy green vegetables
- Red and green bell peppers
- Brussels sprouts
4. Treatment of the underlying cause
Treatment of the cause of iron deficiency is very important as iron therapy might not be enough to correct your anemia. Depending on the cause treatment may involve:
- Medication for peptic ulcer
- Managing heavy menstruation
- Surgery to remove a polyp, hemorrhoids or cancer
5. Blood Transfusiont
In severe cases of iron deficiency anemia blood transfusion may be required to rapidly increase hemoglobin levels.