Iron deficiency anemia

Iron deficiency anemia can range from mild to severe. People with mild or moderate iron-deficiency anemia may not show any signs or symptoms. However, as the anemia worsens, the condition becomes more severe. A few symptoms of iron-deficiency anemia include:

• Unexplained fatigue or lack of energy
• Pale yellow skin
• Shortness of breath or chest pain
• Rapid heartbeat
• Generalized weakness
• Brittle nails
• Hair loss
• Sore or swollen tongue
• Tingling or crawling feeling in the legs
• Dysphagia (difficulty swallowing) due to the formation of esophageal webs (Plummer–Vinson syndrome)
• Irritability
• Pica (desire to eat peculiar substances such as dirt or ice)
• Headache
• Enlarged spleen

The main causes of iron deficiency anemia include:

• Diet low in iron: Iron is obtained from foods in our diet; however, only 1 mg of iron is absorbed for every 10 to 20 mg of iron ingested. Examples of iron-rich foods include meat, eggs, leafy green vegetables, and iron-fortified foods. If a person is unable to obtain a balanced iron-rich diet, he or she may suffer from some degree of iron deficiency anemia.
• Loss of blood: Blood contains iron within red blood cells. If a person loses blood, he or she will lose some iron. Iron deficiency is very common, especially among women with heavy periods, as blood is lost during menstruation. Chronic blood loss within the body, such as from a peptic ulcer, hiatus hernia, colon polyp, or colorectal cancer, can also cause iron deficiency anemia. Other conditions like hemorrhoids, gastritis (inflammation of the stomach), and cancer can contribute as well.
• Inability to absorb iron: Iron from food is absorbed into the bloodstream in the small intestine. An intestinal disorder such as celiac disease can impair the intestine's ability to absorb nutrients, leading to iron deficiency anemia. Surgical removal or bypassing of a part of the small intestine can also affect absorption. In some cases, children consuming more than 16 to 24 ounces of cow's milk daily may experience decreased iron absorption and potential irritation of the intestinal lining, causing chronic blood loss.
• Pregnancy: An increased iron requirement and heightened red blood cell production occur during pregnancy. Many pregnant women experience iron deficiency anemia because their iron stores must support increased blood volume and provide hemoglobin for the developing fetus.
• Endometriosis: Women with endometriosis may experience heavy blood loss during menstrual periods. This condition can be asymptomatic as it occurs in the abdominal or pelvic area outside of the uterus.
• Parasitic disease: The leading cause of iron deficiency anemia worldwide is helminthiasis, a parasitic disease caused by infestation with parasitic worms, specifically hookworms.
• Destruction of red blood cells (hemolysis): Inherited conditions such as sickle cell anemia and thalassemia, along with stressors like infections, drugs, snake or spider venom, or certain foods, can lead to the destruction of red blood cells. Intravascular hemolysis occurs when red blood cells break down in the bloodstream, releasing iron that is subsequently lost in urine. This can happen in individuals who engage in vigorous exercise, particularly jogging, and may also be seen in conditions like damaged heart valves or rare disorders such as thrombotic thrombocytopenic purpura (TTP) or disseminated intravascular coagulation (DIC).
• Gastrointestinal tract abnormalities: Blood loss from the gastrointestinal tract can occur due to gastritis (inflammation of the stomach), esophagitis (inflammation of the esophagus), ulcers in the stomach or bowel, hemorrhoids, angiodysplasia, infections such as diverticulitis, or tumors in the esophagus, stomach, small bowel, or colon.
• Increased demand by the body: Patients with chronic kidney disease (CKD) receiving intravenous erythropoietin therapy have increased iron demand. Similarly, iron demand rises during periods of rapid growth in infancy and adolescence.
• Genetics: Some conditions, like celiac disease, that hinder iron absorption can be hereditary. Genetic conditions or mutations, such as the TMRPSS6 mutation, can exacerbate the issue by causing excessive production of hepcidin, a hormone that inhibits intestinal iron absorption. Other genetic conditions like Von Willebrand disease and hemophilia may contribute to anemia through abnormal bleeding.

Anemia is a common health problem in children. Here's more about iron deficiency anemia in children.

Iron deficiency is very common, especially among women and in people who have a diet that is low in iron.

• Menstruating women, particularly if menstrual periods are heavy
• People who have undergone major surgery
• Vegetarians, vegans, and others whose diets do not include iron-rich foods
• Pregnant or breastfeeding women, or those who have recently given birth
• Athletes, especially young females, are at risk for iron deficiency
• Frequent blood donation
• Kidney transplant recipients
• Bariatric surgery patients

1. Physical examination and medical history

Iron-deficiency anemia may be suspected from general findings on a complete medical history and physical examination, such as complaints of fatigue, abnormal paleness or yellow-colored skin, or a fast heartbeat (tachycardia). Checking the medical and genetic background of the suspected individual is crucial. A thorough medical history helps differentiate common causes of the condition, such as menstruation in women or the presence of blood in the stool. Travel history to areas where hookworms and whipworms are endemic may also guide certain stool tests for parasites or their eggs.

2. Lab tests

• Complete blood count (CBC): A CBC test measures various blood-related issues, including red blood cell (RBC) count, white blood cell (WBC) count, hemoglobin, hematocrit, and platelets. A low RBC count may indicate iron deficiency anemia.
• Hemoglobin count: Iron-deficiency anemia is often discovered during a medical examination through a blood test that measures the amount of hemoglobin (the number of red blood cells) present.
• Serum iron (Fe): This laboratory test measures the amount of circulating iron bound primarily to transferrin and serum ferritin. Low levels of serum iron may indicate iron deficiency.
• Total iron-binding capacity (TIBC): A TIBC test measures the blood's ability to bind iron and transport it throughout the body. High TIBC levels may indicate low iron in the blood due to iron deficiency anemia.
• Peripheral smear: Examination of a blood smear under a microscope can help detect iron deficiency anemia. The RBCs may appear smaller and paler than usual.
• Ferritin test: Ferritin is an iron-containing protein in the blood. Measuring ferritin levels helps assess iron reserves. Low ferritin levels can be indicative of iron deficiency.
• Red cell protoporphyrin levels: Protoporphyrin is an intermediate in hemoglobin production. Under conditions where hemoglobin production is impaired, protoporphyrin accumulates within the red cells. Normal values are <30 µg/dL, while in iron deficiency, values are >100 µg/dL.
• Hemoglobin electrophoresis: This test measures hemoglobin A2 and fetal hemoglobin to rule out thalassemia. In certain cases, particularly in men, postmenopausal women, or younger women with severe anemia, additional testing may be recommended.
• Upper and lower endoscopy: This test examines the gastrointestinal tract, including the stomach, esophagus, and colon, to identify abnormalities and rule out sources of blood loss.
• Fecal occult blood test (FOBT): This test can help identify patients with iron deficiency anemia who may have gastrointestinal lesions. Occult gastrointestinal bleeding is usually discovered when FOBT results are positive.
• Urine routine: Blood in the urine can indicate internal bleeding, which may contribute to anemia.
• Bone marrow aspiration and biopsy: This test is performed in rare cases to diagnose certain types of cancers like leukemia and myeloma, as well as to evaluate anemia. It involves taking a small sample of bone marrow fluid or tissue for examination.

Here’s more about the hemoglobin test and what the results mean.

When caused by inadequate iron intake and blood loss due to menstruation, iron-deficiency anemia can be prevented by eating a diet high in iron-rich foods. For infants, breast milk or iron-fortified infant formula can be given. Some of the foods rich in iron include:

• Leafy greens such as spinach
• Non-vegetarian foods such as lamb, pork, chicken, and beef
• Iron-fortified dry and instant cereals
• Seafood such as clams, sardines, shrimp, and oysters
• Raisins and other dried fruits

Treatment guidelines from the American College of Physicians (ACP) for adult patients with anemia and iron deficiency include the following:

• Patients hospitalized with coronary heart disease, with hemoglobin levels as low as 7-8 g/dL, are recommended to receive a red blood cell transfusion strategy.
• Agents that stimulate red cell production are not recommended for patients with mild to moderate anemia and either congestive heart failure or coronary heart disease.

Specific treatment for iron-deficiency anemia will be determined by your doctor based on the following:

• Medical history, genetic history, and age
• Cause of the anemia
• Extent of anemia

The treatments consist of the following:

1. Iron-rich diet

   Eating a diet rich in iron can help treat iron-deficiency anemia. Good sources of iron include:

   • Meat such as beef, pork, or lamb, and organ meats such as liver
   • Leafy green vegetables including broccoli, kale, and turnip
   • Iron-enriched pasta, grains, rice, and cereals
   • Legumes including beans, peas, pinto beans, and black-eyed peas
   • Poultry such as chicken, duck, and turkey
2. Iron supplements

   These can be taken over several months to increase iron levels in the blood. The amount of iron needed to treat patients with iron deficiency is higher than that found in multivitamin supplements. Most people with iron deficiency need 150-200 mg per day of elemental iron (2 to 5 mg of iron per kilogram of body weight per day). The purpose of oral iron supplementation is to treat symptoms by increasing the levels of iron and hemoglobin in the body. Examples include:

   • Folic acid
   • Methylcobalamin
   • Carbonyl iron
   • Ferrous fumarate
   • Ferrous sulfate
   • Ferrous gluconate

   It is recommended by some doctors to take Vitamin C (ascorbic acid) with iron supplements, as it improves iron absorption. Note: You should avoid taking oral iron supplements with milk, tea, coffee, antacids, or calcium supplements, as these may reduce the absorption of iron.

3. Intravenous iron infusion

   In some cases, the doctor may recommend intravenous (IV) iron. This may be necessary for patients who do not absorb iron well in the gastrointestinal tract. In cases of severe iron deficiency or chronic blood loss, patients can receive supplemental erythropoietin, a hormone that stimulates blood production, or for those who cannot take oral iron supplements. Examples of IV infusions include:

   • Iron sucrose
   • Iron dextran
   • Ferric gluconate
   • Low molecular weight iron dextran
   • Ferric carboxymaltose

   Feraheme (ferumoxytol injection) was initially approved by the FDA in 2009 to treat iron deficiency anemia in adults with chronic kidney diseases (CKD). In 2018, the FDA expanded the indication for ferumoxytol injection to include all eligible adults with iron deficiency anemia who have an intolerance or unsatisfactory response to oral iron. Ferric derisomaltose (monoferric) was approved by the FDA in January 2020 for iron deficiency anemia in adults who have an intolerance to oral iron or have had an unsatisfactory response to oral iron. Note: Large doses of iron can be given at one time using iron dextran. Iron sucrose and ferric gluconate require more frequent doses spread over several weeks.

4. Blood transfusions

   Red blood cell transfusions may be given to patients with severe iron-deficiency anemia who are actively bleeding or have significant symptoms such as chest pain, shortness of breath, or weakness. While red blood cell transfusions provide only temporary improvement, it is important to find and treat the underlying cause of anemia.

Watch this video to know more about the symptoms and treatment of iron deficiency anemia.

Home remedies

• Drumstick: Drumsticks are loaded with vitamins A and C, iron, calcium, and magnesium that can help cure anemia. Chop the leaves, blend them, and drink this juice for about a month.
• Raisins (Kismish) and Dates (Khajur): These dried fruits offer a combination of iron and Vitamin C, enabling the body to quickly and effectively absorb the iron from them.
• Green Vegetables: Green veggies like kale, spinach, radish greens, mustard greens, and broccoli contain high amounts of chlorophyll and are a good source of iron, helping in the treatment of anemia.
• Vitamin C Rich Foods: Anemia tends to weaken your immune system, making you more prone to infections and inflammatory diseases. Fruits like orange, apple, lime, lemon, grapefruit, tangerine, gooseberries, and berries are loaded with Vitamin C and other essential vitamins and minerals that aid in the production of RBCs and hemoglobin.
• Figs (Anjeer): Figs are a great source of iron and are rich in Vitamin A, folate, and magnesium.
• Beetroot (Chukandar): It is one of the healthiest and richest sources of iron. Consuming it regularly can help treat and prevent iron deficiency.
• Shilajit: This herbal remedy is useful in gradually increasing iron levels. The use of these herbal remedies for anemia also ensures proper oxygen supply to all organs and improves their health.

Iron deficiency negatively affects the growth and development of both the mind and body of a child. Here’s an article highlighting the significance, detection, and prevention of iron deficiency in children. Click and Read!

• Yoga and Exercise: Engaging in yoga and exercise three times a week can enhance blood circulation, help the body feel rejuvenated, and alleviate fatigue. To minimize stress on the body, it is advisable to exercise only when your condition has improved and you feel stronger.
• Water Therapy: Hydrotherapy, which utilizes water at varying temperatures and pressures, may serve as an adjunct treatment for iron deficiency anemia. It is believed that water can stimulate circulation and, consequently, promote the production of red blood cells (RBCs).
• Lifestyle Changes: Modifying lifestyle habits can aid in the management of iron deficiency anemia. Cooking with iron pots is an effective remedy, and sun exposure (sunbathing) can increase red blood cell production due to enhanced blood circulation.

Self-management can help in taking care of yourself. It includes:

• Understanding your condition: Iron deficiency anemia can sometimes affect a person's mental health, leading to anxiety and depression. Talking to loved ones can alleviate emotional strain and contribute to an effective treatment plan.
• Exercising daily: Regular exercise increases blood circulation and helps relieve tension and stress.
• Taking your medicine on time: Adhering to medication schedules provides a sense of control and awareness of your condition.
• Talking with a doctor: Patients should feel free to ask any questions related to their disease to gain clarity and understanding.
• Lowering stress levels: Practicing meditation and yoga can help reduce stress and promote overall happiness.
• Getting adequate sleep: Quality sleep calms the body and mind, helping to reduce feelings of fatigue.

In this video, Dr. Akta Bajaj discusses anemia issues during pregnancy and various strategies to manage the condition without causing side effects in infants.