Iron Deficiency Anemia

Iron deficiency anemia is the most common type of anemia. The major cause of iron deficiency is decreased dietary intake, blood loss, and reduce Fe absorption.

Causes of Iron Deficiency Anemia

In developed countries where there is ample resources, blood loss is the most common cause of iron deficiency. In developing countries where there is resource scarcity, dietary deficiency is the most common cause. Iron in ingested as heme (meat) or non-heme (vegetables). Deficiency will lead to deficient in synthesis of heme, hemoglobin and cause anemia. Blood loss from iron deficiency anemia can be occult or overt. Common cause of overt blood loss that lead to iron deficiency anemia include: Traumatic hemorrhage, Hematemesis or melena, Hemoptysis, Menorrhagia, Pregnancy and delivery, Hematuria.

Other occult blood loss include: Frequent blood donation, Excessive diagnostic blood testing, Underestimation of the degree of menorrhagia, Lactation, Occult bleeding, typically gastrointestinal (eg, gastritis, malignancy (gastric, polyp, colon cancer), telangiectasia, angiodysplasia) but may also include hemolysis with urinary losses. Hemodialysis can also cause iron deficiency anemia.

Other causes of iron deficiency anemia include

• Infant Breast Feeding (human milk low Fe²⁺⁾
• Children poor diet
• Adults: peptic ulcer or female menorrhagia or pregnancy in females or other chronic blood loss
• Elderly – colon polyps/carcinoma in western world or Parasitic infection with hookworms (Ancyclostoma duodenale, Necator americanus) in developing world.
• Others: Celiac Disease, Malnutrition, Malabsorption, Gastrectomy (acid aid Fe²⁺ absorption by maintain in Fe²⁺ state hence more readily absorbed.)

Clinical presentation and Symptoms of Iron Deficiency Anemia

The most common symptom of iron deficiency anemia is fatigue and weakness, angina, exercise intolerance and headache, vertigo. Other symptoms of iron deficiency anemia include:

• Koilonychia (Spooning of nails)
• PICA (crave for non-food stuff)
• Cheilitis (lips inflammation)
• Glossitis (tongue inflammation)
• Fatigue

Effects of anemia:

• Tachycardia
• Congestive heart failure
• Pallor

Diagnosis of iron deficiency anemia

This involves a basic CBC and blood smear will show hypochromic, microcytic anemia.

CBC (complete blood count) is done to find the cause of anemia

• ↓ Hemoglobin,  ↓ MCV, ↑ RDW (microcytic hypochromic, tear drop RBC)
• ↓ Serum Fe²⁺,  ↓RBC count,  ↓Reticulocyte (RC),  Platelets ↑↑↑
• Ferritin ↓,  TIBC ↑,  % Fe Saturation ↓
• Free Erythrocyte protoporphyrin (FEP) ↑

Most Accurate diagnosis

• Depletion of bone marrow (BM) stores of Fe²⁺ → absence of stainable Fe²⁺ in BM specimen using Prussian Blue Stain

Stages of Iron Deficiency Anemia

1. Ferritin ↓, TIBC ↑ (storage is depleted)
2. Serum Fe²⁺ ↓, Fe²⁺% Saturation ↓ and ↓ recticulocyte (RC)
3. Normocytic anemia, BM makes fewer, but normal sized RBC
4. Microcytic Hypochromic anemia, BM makes fewer, small size RBC

• (You don’t have the resource to make, whey bother make so many RBC, hence the RBC count ↓) – as long as Hb synthesis affected, will always be low, unlike in Globin, u can replace it with something else like tetramer alpha to compensate and just make more RBC to make up for it.
• Progress from Normocytic Normochromia to Microcytic Normochromia to Microcytic hypochromic.

Treatment of Iron Deficiency Anemia

The treatment of iron deficiency anemia involves replenishing iron. FeSO₄ Supplementation and treat the sources. Transfusion usually when hemoglobin less than 10. Coagulation functions should also be assessed: INR, Platelets, APTT to determine if there is any clotting abnormality.