Iron Deficiency Anemia

PATHOGENESIS
Iron (Fe) is a component of red blood cells and the muscles that assist in the
transportation of oxygen throughout the body .Iron deficiency anemia occurs
when the body doesn't have enough iron to produce hemoglobin.
Hemoglobin is the part of red blood cells that gives blood its red color and
enables the red blood cells to carry oxygenated blood throughout the body. If
a person isnt consuming enough iron, or if a person is losing too much iron,
the body can't produce enough hemoglobin, and iron deficiency anemia will
eventually develop.
Causes of iron deficiency anemia include:

Blood loss. Blood contains iron within red blood cells. So if a person
lose blood, he also loses some iron. Women with heavy periods are at risk of
iron deficiency anemia because they lose blood during menstruation. Slow,
chronic blood loss within the body such as from a peptic ulcer, a hiatal
hernia, a colon polyp or colorectal cancer can cause iron deficiency
anemia. Gastrointestinal bleeding can result from regular use of some overthe-counter pain relievers, especially aspirin.

A lack of iron in your diet. The body regularly gets iron from the food. If
consumption of iron is too little, over time the body can become iron
deficient. Examples of iron-rich foods include meat, eggs, leafy green
vegetables and iron-fortified foods. For proper growth and development,
infants and children need iron from their diet, too.

An inability to absorb iron. Iron from food is absorbed into the

bloodstream in the small intestine. An intestinal disorder, such as celiac
disease, which affects the intestine's ability to absorb nutrients from
digested food, can lead to iron deficiency anemia. If part of the small
intestine has been bypassed or removed surgically, that may affect the
ability to absorb iron and other nutrients.

Pregnancy. Without iron supplementation, iron deficiency anemia

occurs in many pregnant women because their iron stores need to serve
their own increased blood volume as well as be a source of hemoglobin for
the growing fetus.
An iron deficiency disrupts hemoglobin function, causing iron-deficiency
anemia. Since each hemoglobin molecule contains four heme groups -- a

molecular complex that contains one atom of iron. This iron can bind to
oxygen molecules, and therefore carries out hemoglobin's primary function
of oxygen transport. Failure to consume enough iron can disrupt hemoglobin
production, leading to the presence fewer active heme groups in the
bloodstream, a subsequent decrease in oxygen transport, and anemia.
Diagnostic Tests and Procedures for Iron Deficiency Anemia
Many tests and procedures are used to diagnose iron-deficiency anemia.
They can help confirm a diagnosis.
1.
Complete Blood Count
Often, the first test used to diagnose anemia is a complete blood count
(CBC). The CBC measures many parts of your blood.
This test checks your hemoglobin and hematocrit levels. Hemoglobin is an
iron-rich protein in red blood cells that carries oxygen to the body.
Hematocrit is a measure of how much space red blood cells take up in your
blood. A low level of hemoglobin or hematocrit is a sign of anemia.
The CBC also checks the number of red blood cells, white blood cells, and
platelets in your blood. Abnormal results may be a sign of infection, a blood
disorder, or another condition.
Finally, the CBC looks at mean corpuscular volume (MCV). MCV is a measure
of the average size of your red blood cells. The results may be a clue as to
the cause of your anemia. In iron-deficiency anemia, for example, red blood
cells usually are smaller than normal.
2.
Other Blood Tests
If the CBC results confirm you have anemia, you may need other blood tests
to find out what's causing the condition, how severe it is, and the best way to
treat it.
a.
Reticulocyte count. This test measures the number of reticulocytes in
your blood. Reticulocytes are young, immature red blood cells. Over time,
reticulocytes become mature red blood cells that carry oxygen throughout
your body.
A reticulocyte count shows whether your bone marrow is making red blood
cells at the correct rate.
b.
Peripheral smear. For this test, a sample of your blood is examined
under a microscope. If you have iron-deficiency anemia, your red blood cells
will look smaller and paler than normal.

3.
Tests to measure iron levels. These tests can show how much iron has
been used from your body's stored iron. Tests to measure iron levels include:
a. Serum iron. This test measures the amount of iron in your blood. The level
of iron in your blood may be normal even if the total amount of iron in your
body is low. For this reason, other iron tests also are done.
b. Serum ferritin. Ferritin is a protein that helps store iron in your body. A
measure of this protein helps your doctor find out how much of your body's
stored iron has been used.
c. Transferrin level, or total iron-binding capacity. Transferrin is a protein that
carries iron in your blood. Total iron-binding capacity measures how much of
the transferrin in your blood isn't carrying iron. If you have iron-deficiency
anemia, you'll have a high level of transferrin that has no iron.
4. Other tests. Your doctor also may recommend tests to check your
hormone levels, especially your thyroid hormone. You also may have a blood
test for a chemical called erythrocyte protoporphyrin. This chemical is a
building block for hemoglobin.
Children also may be tested for the level of lead in their blood. Lead can
make it hard for the body to produce hemoglobin.
5. Tests and Procedures for Gastrointestinal Blood Loss
To check whether internal bleeding is causing your iron-deficiency anemia,
your doctor may suggest a fecal occult blood test. This test looks for blood in
the stools and can detect bleeding in the intestines.
If the test finds blood, you may have other tests and procedures to find the
exact spot of the bleeding. These tests and procedures may look for bleeding
in the stomach, upper intestines, colon, or pelvic organs.
TREATMENT:
Treating iron-deficiency anemia will depend on the cause and severity.
Treatments may include dietary changes and supplements, medicines, and
surgery. The goals of treating iron-deficiency anemia are to treat its
underlying cause and restore normal levels of red blood cells, hemoglobin,
and iron.

Dietary Approach and Supplements:

Iron supplements- iron supplements are needed to build up the
iron stores in your body, and this may have a significant
contribution in the immediate rise in the iron levels. Iron
supplements can correct low iron levels within months. Dose may

be based on the doctors prescription. Upon the intake of this

iron supplements, it must be taken note that side effects include:
dark stools, stomach irritation, constipation and heartburn.
Iron rich foods- this is an important step in treating iron
deficiency anemia. Food high in iron includes:
Chicken
Dried peas, and beans
Eggs (yolk)
Fish
Meats (liver is the highest source)
Peanut butter
Soybeans
Whole-grain bread
Oatmeal
Raisins and prunes
Spinach and other greens
Vitamin C- C helps the body absorb iron. Good sources of
vitamin C are vegetables and fruits, especially citrus fruits.
Treatment to stop bleeding
If blood loss is resulting to iron-deficiency anemia, the physician
may treat it depending on the cause of bleeding.
For example:

If there is a presence bleeding ulcer, the physician

may prescribe antibiotics and other medicines to
treat the ulcer.
If a polyp or cancerous tumor in the intestine is
causing bleeding, there may be a need for surgery to
remove the growth.
In cases of severe iron deficiency anemia
Blood Transfusion- If iron-deficiency anemia is severe, there may be
a need to get a transfusion of red blood cells. It is a procedure in which
blood is given to you through an IV line in one of your blood vessels. A
transfusion requires careful matching of donated blood with the
recipient's blood.A transfusion of red blood cells will treat your anemia
right away. The red blood cells also give a source of iron that your body
can reuse. However, a blood transfusion is only a short-term treatment.
Iron Therapy- For this treatment, iron is injected into a muscle or an
IV line in one of your blood vessels. Iron therapy usually is given to
people who need iron long-term but can't take iron supplements by
mouth. This therapy also is given to people who need immediate
treatment for iron-deficiency anemia.

COMPLICATIONS:
Mild iron deficiency anemia usually doesn't cause complications.
However, left untreated, iron deficiency anemia can become severe
and lead to health problems, including the following:

Heart problems. Iron deficiency anemia may lead to a rapid or

irregular heartbeat. Your heart must pump more blood to compensate
for the lack of oxygen carried in your blood when you're anemic. This
can lead to an enlarged heart or heart failure.

Problems during pregnancy. In pregnant women, severe iron

deficiency anemia has been linked to premature births and low birth
weight babies. But the condition is easily preventable in pregnant
women who receive iron supplements as part of their prenatal care.

Growth problems. In infants and children, severe iron deficiency

can lead to anemia as well as delayed growth and development.
Additionally, iron deficiency anemia is associated with an increased
susceptibility to infections.
References:
http://www.mayoclinic.com/health/iron-deficiencyanemia/DS00323/DSECTION=complications)
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001610/
http://www.webmd.com/a-to-z-guides/iron-deficiency-anemiatreatment-overview?page=1
http://www.nhlbi.nih.gov/health//dci/Diseases/ida/ida_diagnosis.html