Iron Deficiency Anemia: symptom, diagnosis, and treatment

Iron metabolism

Iron is very important in maintaining many body functions, including the production of hemoglobin, the molecule in your blood that carries oxygen. Iron is also necessary to maintain healthy cells, skin, hair, and nails.

Iron from the food you eat is absorbed into the body by the cells that line the gastrointestinal tract; the body only absorbs a small fraction of the iron you ingest. The iron is then released into the bloodstream, where a protein called transferrin attaches to it and delivers the iron to the liver. Iron is stored in the liver as ferritin and released as needed to make new red blood cells in the bone marrow. When red blood cells are no longer able to function (after about 120 days in circulation), they are re-absorbed by the spleen. Iron from these old cells can also be recycled by the body. (https://www.hematology.org/education/patients/anemia/iron-deficiency) 

What is iron deficiency anemia (IDA)?

Iron deficiency anaemia is a common type of anaemia — a condition in which blood lacks adequate healthy red blood cells. Red blood cells carry oxygen to the body's tissues.

As the name implies, iron deficiency anemia is due to insufficient iron. Without enough iron, your body can't produce enough of hemoglobin in red blood cells that enables them to carry oxygen. As a result, iron deficiency anemia may leave you tired and short of breath. (https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/symptoms-causes/syc-20355034) 

What are the stages of IDA?

Iron-deficiency anemia develops when your body uses the iron stores faster than they can be replaced, or when the flow of iron into your system slows. This occurs in three stages:

• First stage: Iron stores decrease. Your low iron supply hasn’t affected your red blood cells yet.
• Second stage: When iron stores are low, your body alters the way it processes red blood cells. Your bone marrow makes red blood cells without enough hemoglobin.
• Third stage: Haemoglobin drops below the normal range. You may develop signs of iron deficiency anemia. (https://my.clevelandclinic.org/health/diseases/22824-iron-deficiency-anemia)  

What are the symptoms of IRA?

• Being pale or having yellow "sallow" skin
• Unexplained fatigue or lack of energy
• Shortness of breath or chest pain, especially with activity
• Unexplained generalized weakness
• Rapid heartbeat
• Pounding or "whooshing" in the ears
• Headache, especially with activity
• Craving for ice or clay - "picophagia"
• Sore or smooth tongue
• Brittle nails or hair loss 

Who isanemia at risk of getting IDA?

Iron deficiency is very common, especially among women and in people who have a diet that is low in iron. The following groups of people are at highest risk for iron-deficiency anemia:

• Women who menstruate, particularly if menstrual periods are heavy
• Women who are pregnant or breastfeeding or those who have recently given birth
• People who have undergone major surgery or physical trauma
• People with gastrointestinal diseases such as celiac disease (sprue), inflammatory bowel diseases such as ulcerative colitis, or Crohn's
• People with peptic ulcer disease
• People who have undergone bariatric procedures, especially gastric bypass operations
• Vegetarians, vegans, and other people whose diets do not include iron-rich foods (Iron from vegetables, even those that are iron-rich, is not absorbed as well as iron from meat, poultry, and fish.)
• Children who drink more than 16 to 24 ounces a day of cow's milk (Cow's milk not only contains little iron, but it can also decrease absorption of iron and irritate the intestinal lining causing chronic blood loss.) (https://www.hematology.org/education/patients/anemia/iron-deficiency)  

Other less common causes of IDA include:

• Blood loss from the gastrointestinal tract due to gastritis (inflammation of the stomach), esophagitis (inflammation of the esophagus), ulcers in the stomach or bowel, hemorrhoids, angiodysplasia (leaky blood vessels similar to varicose veins in the gastrointestinal tract), infections such as diverticulitis, or tumors in the oesophagus, stomach, small bowel, or colon
• Blood loss from chronic nosebleeds
• Blood loss from the kidneys or bladder
• Frequent blood donations
• Intravascular haemolysis, a condition in which red blood cells break down in the bloodstream, releasing iron that is then lost in the urine. This sometimes occurs in people who engage in vigorous exercise, particularly jogging. This can cause trauma to small blood vessels in the feet, so-called "march haematuria." Intravascular hemolysis can also be seen in other conditions including damaged heart valves or rare disorders such as thrombotic thrombocytopenic purpura (TTP) or diffuse intravascular hemolysis (DIC).

What are the complications of IDA?

• Brain fog
• Growth or developmental delays in children
• Heart conditions like enlarged heart or heart failure
• Restless leg syndrome (https://my.clevelandclinic.org/health/diseases/22824-iron-deficiency-anemia) 

How is IDA diagnosed?

• Red blood cell size and color: With iron deficiency anaemia, red blood cells are smaller and paler in color than normal.
• Haematocrit: This is the percentage of your blood volume made up by red blood cells. Normal levels are generally between 35.5 and 44.9 percent for adult women and 38.3 to 48.6 percent for adult men. These values may change depending on your age.
• Haemoglobin: Lower than normal hemoglobin levels indicate anemia. The normal hemoglobin range is generally defined as 13.2 to 16.6 grams (g) of hemoglobin per decilitre (dL) of blood for men and 11.6 to 15 grams (g) of hemoglobin per decilitre (dL) of blood for women.
• Ferritin: This protein helps store iron in your body, and a low level of ferritin usually indicates a low level of stored iron.
• Other tests like endoscopy, colonoscopy, or ultrasound may be required to find the source of internal bleeding which may be contributing to IDA. (https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/diagnosis-treatment/drc-20355040) 

What is the treatment for IDA?

• Your doctor may prescribe iron supplements with suitable dosage, preferably for an empty stomach. 
• Antacids may relieve heartburn symptoms, and can interfere with the absorption of iron. Take iron two hours before or four hours after you take antacids.
• Vitamin C improves the absorption of iron. Your doctor might recommend taking your iron tablets with a glass of orange juice or with a vitamin C supplement.
• Iron supplements can cause constipation, so your doctor may also recommend a stool softener. Iron may turn your stools black, which is a harmless side effect. 

Treating the underlying cause of iron deficiency may include:

• Medications, such as oral contraceptives to lighten heavy menstrual flow
• Antibiotics and other medications to treat peptic ulcers
• Surgery to remove a bleeding polyp, a tumor or a fibroid (https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/diagnosis-treatment/drc-20355040)