Iron Deficient Anemia- Some facts you should know
Joyce is an energetic girl who has been on her school’s swimming team throughout secondary school. Recently, her mother noticed Joyce looking pale and complaining of easy fatigue, affecting her performance in swimming competitions. Joyce’s mother took her to see their family doctor, Dr. Chan. Some blood was drawn for testing.
A week later, Dr. Chan told them that Joyce has iron-deficiency anemia, likely due to heavy menstruation over the past year. Her haemoglobin level was low at 8.5 g/dL, below the normal female minimum of 11.5 g/dL. Her red blood cells were smaller than normal, with a mean cell volume (MCV) of 70 fL, well below the normal lower limit of 80 fL. Her serum ferritin level was only 8 μg/L, confirming iron deficiency as levels under 15 μg/L in her age group indicate a lack of iron.
What is iron-deficiency anemia?
Haemoglobin is an iron-containing protein in red blood cells that carries oxygen from the lungs to all body tissues. With iron deficiency, inadequate haemoglobin is produced, causing anemia – low haemoglobin concentration in blood. With decreased haemoglobin synthesis, red blood cells become small in size, resulting in microcytic anemia. Anemia means less haemoglobin level and oxygen-carrying ability, leading to easy fatigue, lack of energy, and decreased exercise tolerance. People may look pale with significant anemia.
What are common causes of iron-deficiency anemia?
Iron deficiency occurs when iron intake is less than its usage and loss. About 70% of the body’s iron is in haemoglobin. A normal adult male and female iron store is 600-1000 mg and 200-300 mg respectively. Each ml of blood contains 0.4-0.5 mg iron and so blood loss of 600 ml can deplete a woman’s iron stores. In young women, heavy periods are a common cause. In men and post-menopausal women, iron loss through the gastrointestinal tract from peptic ulcers or colon cancer is a major cause. A small amount of iron is lost through shedding of intestinal cells and sweating. Iron consumption increases in certain conditions such as pregnancy, lactation, menstruating female, teenagers during rapid growth period and athletes in training and they are more prone to develop iron deficiency.
How is iron-deficiency anemia diagnosed?
A complete blood count (CBC) checks for anemia. The CBC also measures MCV – low levels with anemia indicate microcytic anemia, usually from iron deficiency or thalassemia. Serum ferritin test is a blood test which measures the body iron store and could be used to confirm if a person is having iron deficiency if the serum ferritin level is low. The first thing is to ensure an adequate intake of iron in the diet. Dietary iron is found in two forms, heme and non-heme iron. Heme iron is present mainly in meat, poultry and fish and is much better absorbed. Non-heme iron is found mostly in plants and is much less absorbed. Also, the absorption of non-heme iron can be affected by other food or drinks. For example, phytates and tannin in cereal based food products or phenolic compounds in tea, coffee and red wine would bind to non-heme iron and prevent it from absorption. Some foods would enhance non-heme iron absorption, e.g., ascorbic acid, meat and seafood can enhance non-heme iron absorption. When the body consumption of iron is increased, e.g., during pregnancy or lactation, iron supplement would be required to prevent iron deficiency. Iron deficiency due to blood loss should be detected as soon as possible in order to prevent further blood loss. For example, doctors may prescribe hormonal drug to decrease menstrual blood loss in patients with heavy period. Investigations may be done to detect the source of bleeding in order to eradicate the cause, e.g., testing for occult blood in stool and to use endoscopy to look inside the stomach or large intestine in order to find out the cause of the bleeding.
How is it treated?
Oral iron supplements are usually prescribed for 3-6 months to replenish stores. Intravenous iron may be given if oral iron is not tolerated or rapid haemoglobin and iron repletion is needed before surgery. The underlying cause must also be treated, such as surgery for gastrointestinal bleeding. Transfusions are rarely needed unless anemia is life-threatening.
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