Anemia/Iron deficiency anemia

Overview – There is lower than the normal amount of iron levels in the body which causes a lack of healthy red blood cells. In iron deficiency anemia the body doesn’t have enough iron to produce hemoglobin. Hemoglobin is a part of red blood cells that carry oxygenated blood throughout the body. As a result, there is shortness of breath.

The causes of iron deficiency are decreased dietary intake, reduced absorption, and blood loss.

Blood loss that occurs due to heavy menstrual periods, peptic ulcer, a hiatal hernia, a colon polyp or colorectal cancer, gastrointestinal bleeding due to regular use of NSAID’s (aspirin, ibuprofen, naproxen, etc), gastrointestinal parasites (eg, hookworm, whipworm) can cause iron deficiency.

The absorption of iron can be affected in conditions such as celiac disease, h.pylori infection, bariatric surgery (surgery performed on the stomach or the intestines to induce weight loss).

Iron deficiency can occur in pregnancy because there is an increased blood volume. Blood donors who frequently donate blood can also have iron deficiency anemia.
 

Symptoms

  • Weakness
  • Pale skin
  • Shortness of breath
  • Dizziness
  • Chest pain
  • Irritability
  • Pica (unusual cravings for non-nutritive substances, such as ice, dirt or starch)
  • Poor appetite 

Complications

  • Severe anemia can lead to heart failure, myocardial infarction (heart attack),
  • In pregnant women, iron deficiency has been linked to premature births and low birth weight babies.
  • In infants and children, severe iron deficiency can lead to anemia as well as delayed growth and development.
  • Besides anemia low iron levels also cause restless leg syndrome, also called Willis-Ekbom disease. This is a disorder in which there is an unpleasant or uncomfortable urge to move the legs during periods of inactivity and has been linked to low iron stores in the body. 

Diagnosis

  • Anemia due to iron deficiency is diagnosed with a blood test to look for the number and appearance of the red blood cells, hemoglobin levels, hematocrit, ferritin (a protein that helps store iron in the body) levels. A hemoglobin <13.5 g/dL represents anemia in men, and a value <12.0 g/dL, respectively, represents anemia in women.
  • Additional tests may be done to determine the cause of the iron deficiency. Endoscopy may be done to check for bleeding from a hiatal hernia, an ulcer or the stomach. Colonoscopy may be done to rule out the intestinal causes of bleeding. Pelvic ultrasound may be done to look for the cause of excessive menstrual bleeding. 

Lifestyle management

  • Follow a healthy diet and exercise program recommended by your doctor. Your doctor will recommend you eat a diet rich in iron. Foods that are rich in iron include red meat, pork, poultry, beans, seafood, spinach, dark green leafy vegetables, apricots, raisins, iron-fortified cereals. People who consume a vegan or strict vegetarian diet generally should increase your intake of iron-rich, plant-based foods to absorb the same amount of iron as does someone who eats meat. The body absorbs more iron from meat than it does from other sources.
  • Vitamin C helps the body to better absorb dietary iron. Your doctor may also recommend vitamin C rich foods. Brocolli, leafy greens, kiwi, grapefruit, oranges, strawberries, melons, tomatoes are foods that are rich in vitamin C.
  • Breast milk or iron-fortified formulas are recommended to prevent iron deficiency in infants. Cow’s milk is not recommended to babies under one year of age.
  • If your doctor has prescribed iron supplements than talk to your doctor about the best way to take iron supplements. Iron supplements are best absorbed when taken empty stomach. However, because iron tablets can upset your stomach, you may need to take your iron tablets with meals.
  • Antacids can reduce the absorption of iron when taken together. Iron supplements are generally recommended two hours before or four hours after you take antacids.
  • Iron supplements can cause constipation. Your doctor may recommend a stool softener along with iron supplements. Iron can cause black discoloration of the stool and this is a harmless side effect of the supplements.
     

Medical management

  • The treatment is done with iron supplements. The underlying cause of deficiency is also treated, if necessary.
  • Oral contraceptives are given to lighten heavy menstrual bleeding.

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