Iron-Deficiency

What is iron deficiency anaemia?

Anaemia is a condition in which there aren't enough healthy red blood cells in your body to carry sufficient oxygen to tissues of your body.1 In India, 57% of women aged between 15-49 years are anaemic.2

The most common type of anaemia is iron deficiency anaemia.3 Iron deficiency anaemia is a form of anaemia that occurs when your body doesn't have enough iron to produce normal red blood cells.4 Iron is a mineral required by your body to produce haemoglobin. Haemoglobin is a part of your red blood cells and helps in carrying oxygen from the lungs to the rest of the body.5,6 Every organ and tissue in your body requires oxygen to function.7 If you have iron deficiency anaemia, you may experience weakness, shortness of breath, headache, etc.1

References:
1. Mayo Clinic. Anemia. [Internet] 2022 Feb 11 [cited 2023 Jan 18]. Available from: https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360
2. Government of India. Ministry of Health and Family Welfare. National Family Health Survey (NFHS-5) 2019-2021 India Report. [Internet] 2022 March [cited 2023 Jan 19]. Available from: https://dhsprogram.com/pubs/pdf/FR375/FR375.pdf
3. Petranovic D, Batinac T, Petranovic D, et al. Iron deficiency anaemia influences cognitive functions. Med Hypotheses. 2008;70(1):70-2.
4. Johnson-Wimbley TD, Graham DY. Diagnosis and management of iron deficiency anemia in the 21st century. Therap Adv Gastroenterol. 2011;4(3):177-84.
5. Drugs.com. Iron rich diet. [Internet] 2023 Jan 15 [cited 2023 Jan 18]. Available from: https://www.drugs.com/cg/iron-rich-diet.html
6. National Health Service. Red blood cell count. [Internet] 2022 Jul 06 [cited 2023 Feb 10]. Available from: https://www.nhs.uk/conditions/red-blood-count/
7. WebMD. Iron deficiency anemia. [Internet] 2022 Aug 08 [cited 2023 Jan 18]. Available from: https://www.webmd.com/a-to-z-guides/iron-deficiency-anemia

Signs and Symptoms of Iron Deficiency Anaemia

Breathing-Pattern

Breathing pattern

You might experience shortness
of breath.1,2

Heartbeat

Heartbeat

You may experience fast or irregular heartbeat.1

skin-color

Skin colour

Your skin might become
pale or yellow.1,2

tongue

Changes in the tongue

You may experience swelling or soreness (pain) of the tongue.1,2

Hair-Volume

Hair volume

You may experience hair loss.1

Change-Nails

Changes in your nails

Your nails may become brittle (fragile), cracked, spoon-shaped.1,2

abnormal

Abnormal cravings

You may experience cravings for things that are not food, like dirt, starch, clay, ice, etc.1,2

If you suffer from any of the above-mentioned signs and symptoms,
it is advisable to talk to your doctor.

References:
1. WebMD. Iron deficiency anemia. [Internet] 2022 Aug 08 [cited 2023 Jan 19] Available from: https://www.webmd.com/a-to-z-guides/iron-deficiency-anemia
2. Mayo Clinic. Iron deficiency anemia. [Internet] 2022 Jan 04 [cited 2022 Dec 26]. Available from: https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/symptoms-causes/syc-20355034

Causes of Iron Deficiency Anaemia

low-iron-Diet

Low iron in diet

Iron is a mineral that our bodies need to function properly.1,2 We get iron from the food we eat, but our bodies only absorb a small amount of it (e.g. only 1 mg is absorbed for every 10-20 mg of iron consumed). If you don’t eat a balanced iron-rich diet, you may develop some degree of iron deficiency anaemia.3

Change-in-your-Body

Changes in your
body

Your body needs more iron and red blood cells when it undergoes through changes, such as children and adolescents going through growth spurts (short periods of time when a child or adolescent experiences rapid growth in height and weight), or during pregnancy and breastfeeding.3

Digestive-Tract

Digestive tract
abnormalities

The upper small intestine (a part of the digestive system) absorbs most of the iron consumed by food. Any digestive tract abnormalities could change iron absorption and cause iron deficiency anaemia. Medications or surgery that stop stomach acid production also decrease iron absorption.3

Heavy-Periods

Heavy periods

Iron levels can decrease in women who experience heavy bleeding during periods.2

Injuries

Injuries

Any injury that results in blood loss may lead to iron deficiency anaemia.2

Pregnancy

Pregnancy

In case of pregnancy, you need an extra amount of iron to nourish your growing baby. You can become iron deficient if you do not take enough iron through diet or supplements.2

Medicines

Medicines

Medicines that treat inflammation can cause bleeding in the digestive tract. Also, medicines that treat acidity can prevent your body from absorbing enough iron.2

References:

1. WebMD. Dietary iron and iron supplements. [Internet] 2021 Nov 06 [cited 2023 Feb 07]. Available from: https://www.webmd.com/diet/supplement-guide-iron#:~:text=Iron%20is%20a%20mineral%20that’s,level%20of%20red%20blood%20cells
2. WebMD. Iron deficiency anemia. [Internet] 2022 Aug 08 [cited 2022 Dec 26]. Available from: https://www.webmd.com/a-to-z-guides/iron-deficiency-anemia
3. Johns Hopkins Medicine. Iron-deficiency anemia. [Internet] [cited 2023 Jan 19]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/irondeficiency-anemia

How is Iron Deficiency Anaemia Diagnosed?

CBC

Complete blood count (CBC)

This blood test helps determine your red blood cell count.1

Blood-Smear

Peripheral blood smear

This test helps examine the size and shape of your red blood cells. Your red blood cells will look smaller than usual in size if you suffer from iron deficiency anaemia.1

Serum-iron-test

Serum iron test

This test shows the amount of iron in your blood.1

Ferritin-test

Ferritin test

Ferritin is a protein that helps store iron in the body. Low levels of ferritin usually mean that you have a low level of stored iron.4

Blood-Test

Faecal occult blood test

This test checks for the presence of tiny amounts of blood in your stool.1

Blood-Test

Total-iron binding capacity (TIBC)

This test evaluates the capacity of transferrin to bind to iron.2 If you have iron deficiency anaemia, your TIBC will be high.5,6

Blood-Test

Transferrin saturation

This test evaluates the percentage of total iron-binding protein saturated with iron.2 If you have iron deficiency anaemia, your transferrin saturation level will be reduced.6

Endoscopy

Endoscopy

Endoscopy is a test wherein the doctor passes a thin tube (with a camera) down your throat to your stomach to check for the source of the bleeding.7

Colonoscopy

Colonoscopy

Colonoscopy is a procedure wherein a thin tube (with a camera) is inserted into the rectum (last part of the large intestine) ) and directed to the colon (large intestine). It helps your doctor to view inside some or all of colon and rectum to look for internal bleeding. You are generally anaesthetised during the test.7

Ultrasound

Pelvic ultrasound

Pelvic ultrasound is a test that uses sound waves to create images of inside the pelvis.8 It can be used to find out the reason for heavy bleeding during periods, suchas uterine fibroids (non-cancerous growths).1,7

References:
1. WebMD. Iron deficiency anemia. [Internet] 2022 Aug 08 [cited 2022 Dec 26]. Available from: https://www.webmd.com/a-to-z-guides/iron-deficiency-anemia
2. Tietze K. Chapter 5 – Review of Laboratory and Diagnostic Tests. 2012. DOI:10.1016/B978-0-323-07738-5.10005-5.
3. WebMD. Complete blood count (CBC) test. [Internet] 2022 Mar 04 [cited 2023 Feb 10]. Available from: https://www.webmd.com/a-to-z-guides/complete-blood-count
4. Düzenli Kar Y, Özdemir ZC, Emir B, et al. Erythrocyte indices as differential diagnostic biomarkers of iron deficiency anemia and thalassemia. J Pediatr Hematol Oncol. 2020;42(3):208-13.
5. National Health Service. Total iron-binding capacity (TIBC) and transferrin test. [Internet] 2022 Jul 06 [cited 2023 Feb 15]. Available from: https://www.nhs.uk/conditions/tibc-test
6. Vishnoi V, Awasthi DK, Awasthi G. Iron deficiency anemia: A review. WJPMR. 2022;8(8),127-40.
7. Mayo Clinic. Iron deficiency anemia. [Internet] 2022 Jan 04 [cited 2022 Dec 26]. Available from: https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/diagnosis-treatment/drc-20355040
8. WebMD. What is a pelvic ultrasound? [Internet] 2021 Apr 26 [cited 2023 Feb 07]. Available from: https://www.webmd.com/women/what-is-a-pelvic-ultrasound

Treatment of Iron Deficiency Anaemia

Background
Background

Iron supplements

Your doctor may recommend iron tablets to refill iron stores in your body. Avoid taking iron supplements with antacids since it can impact the absorption of iron. Vitamin C improves iron absorption. Your doctor might recommend taking your iron tablets with a vitamin C supplement or with a glass of orange juice.1

Intravenous iron therapy

If the iron is not well absorbed by your intestine, your doctor may prescribe iron through an intravenous tube straight into your bloodstream.2

Transfusion

If supplements do not help with your symptoms of iron deficiency anaemia or if you have severe anaemia, you might require a transfusion of red blood cells.2

References:
1. Mayo Clinic. Iron deficiency anemia. [Internet] 2022 Jan 04 [cited 2022 Dec 22]. Available from: https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/diagnosis-treatment/drc-20355040
2. WebMD. Iron deficiency anemia. [Internet] 2022 Aug 08 [cited 2022 Dec 26]. Available from: https://www.webmd.com/a-to-z-guides/iron-deficiency-anemia

In-Pregnancy

Iron deficiency anaemia in pregnancy

During pregnancy, a woman’s body undergoes significant changes to nurture and accommodate the developing baby.

Pregnancy causes a two- to three-fold increase in iron requirement.1 Iron is used by the body to produce more blood to supply oxygen to the baby.2

You are at increased risk of iron deficiency anaemia if you are pregnant. Iron deficiency anaemia refers to a condition in which you have insufficient healthy red blood cells to carry sufficient oxygen to the tissues all over the body. Iron deficiency anaemia during pregnancy is associated with having a low birth weight baby and postpartum depression (depression after childbirth).2 

References:
1. Soma-Pillay P, Nelson-Piercy C, Tolppanen H, et al. Physiological changes in pregnancy. Cardiovasc J Afr. 2016;27(2):89-94.
2. Mayo Clinic. Pregnancy week by week. [Internet] 2022 Feb 09 [cited 2022 Dec 22]. Available from: https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/anemia-during-pregnancy/art-20114455

Treatment of Iron Deficiency Anaemia in Pregnancy

Background
Background

Oral iron supplement

Oral iron supplements are usually used for the treatment of iron deficiency anaemia in pregnancy.1

Intravenous iron therapy

Intravenous iron therapy is given when pregnant women do not respond well to the oral iron treatment or develop troublesome side effects.1

Blood transfusion

It is one of the effective treatments for iron deficiency anaemia. It can be considered as the final course of action if the pregnant woman is not responding to parenteral (other than oral) iron supplementation or the anaemia cannot be controlled or the pregnant woman is in a critical condition.1
References:
1. Mahayasa PD, Winata IG, Setiawan WA. Iron deficiency anemia treatment in pregnancy. European Journal of Medical and Health Sciences. 2022;4(4):36-7.