Iron Deficiency

What is Iron deficiency?

Iron deficiency or sideropenia is a state where total body iron stores are inadequate to support normal metabolic functions. Iron is essential for multiple biological functions of the body and is required for the synthesis of haemoglobin, myoglobin, cell regulation and DNA synthesis.

Iron deficiency occurs in three stages-

• Pre-latent stage: iron stores are low or absent, but serum iron concentration is normal.
• Latent stage: transferrin saturation and serum iron become reduced in addition to low ferritin.
• Last stage: It is marked by a drop in haemoglobin along with depletion of iron stores and a reduction in serum iron and transferrin saturation.

Iron is the most common nutritional worldwide deficiency and is the most common cause of anaemia among an estimated 2 billion people worldwide. According to WHOעs Global Burden of Disease Project 2000 (GBD 2000), iron deficiency is responsible for 841,000 deaths worldwide with the major burden of mortality seen in Africa and parts of Asia.

Causes

Bleeding from any site is one of the major causes of iron deficiency. Overt causes of bleeding like hematemesis, menorrhagia, multiple pregnancies, and childbirth, etc. can easily be recognized based on history alone. Also, occult gastrointestinal bleeding, parasitic infections like hookworm and frequent blood donations can also lead to iron loss.

Inadequate intake of dietary iron is also responsible for iron deficiency. People from poor socio-economic backgrounds, vegetarians/vegans, and elderly who do not eat a balanced diet are prone to developing iron deficiency.

Iron deficiency also occurs in chronic disease conditions like chronic kidney disease (CKD), chronic heart failure, inflammatory bowel disease, certain malignancies, and rheumatoid arthritis, etc.

Malabsorption syndromes like celiac disease, atrophic gastritis, H.pylori infection can decrease the concentration of iron in the body.

Sign and symptoms

Nonspecific symptoms like generalized weakness, fatigue, poor concentration, irritability, headaches, shortness of breath on exertion, and decreased exercise capacity are seen. Pica occurs in half of the patients and craving for ice (pagophagia) is a common presentation in iron deficiency. Beeturia is common in individuals with iron deficiency as a result of change in gastrointestinal function due to iron deficiency.

On physical examinations, findings like dry skin, hair loss, atrophic glossitis, cheilosis, pallor, brittle nails, and koilonychia (spoon-shaped nails) are present. On auscultation, systolic murmur may be present.

Diagnosis

The diagnosis of iron deficiency is based mainly on history, examination, and laboratory tests. Iron profiles including serum iron, transferrin, ferritin, TIBC, and TSAT must be performed. Absolute iron deficiency is diagnosed when serum ferritin is less than 30 ng/ml. Haemoglobin does not become low until a significant percentage of body iron becomes depleted. Hence, normal haemoglobin does not exclude iron deficiency.

Blood peripheral smear can be studied for reticulocytes.

General management

Patients with uncomplicated iron deficiency without comorbidities should receive treatment with oral iron therapy.

Disclaimer: The information provided herein on request, is not to be taken as a replacement for medical advice or diagnosis or treatment of any medical condition. DO NOT SELF MEDICATE. PLEASE CONSULT YOUR PHYSICIAN FOR PROPER DIAGNOSIS AND PRESCRIPTION.