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Defeating anemia: The power of iron

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UTG Medical Students’ Association

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Sharon Praise C. Uyamadu
6th year medical student (UTG)

Anemia is a medical condition characterized by insufficient red blood cells or hemoglobin to effectively transport oxygen to the body’s tissues and organs. It is a significant global public health concern, with a particular impact on certain vulnerable groups such as young children, menstruating adolescent girls and women, and pregnant and postpartum women. The World Health Organisation (WHO) estimates that approximately 40% of children aged 6-59 months, 37% of pregnant women, and 30% of women aged 15-49 worldwide suffer from anemia.

There are a variety of causes for anemia, the most prevalent of which is iron deficiency anemia, which we will now explore.

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What is iron deficiency anemia?

Iron deficiency anemia is a common type of anemia that occurs as a result of low iron levels in the body. Iron is a mineral that plays a vital role in the production of healthy red blood cells in the bone marrow and a key protein in red blood cells called hemoglobin. Hemoglobin is responsible for carrying oxygen to various tissues and organs in the body.

When the body does not have enough iron, the production of healthy blood cells and hemoglobin decreases, leading to the development of iron deficiency anemia.

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Since the body’s iron reserves may take several months to deplete, iron deficiency anemia often develops gradually. As a result, the bone marrow generates fewer red blood cells as iron stores are depleted, and when the stores are all gone, the red blood cells not only become reduced but also abnormally small.

What are some causes/risk factors of iron deficiency anemia?

Different causes of iron deficiency anemia can be linked to a delicate balance between insufficient iron intake/absorption and excessive iron loss. Here are some reasons.

1.         Inadequate dietary intake: Not consuming enough iron-rich foods such as green leafy vegetables, poultry, red meat, and other fortified iron foods leads to iron deficiency anemia over time.

2.         Increased iron requirements: Certain stages of life or circumstances can heighten the body’s need for iron, such as pregnancy and breastfeeding, as well as periods of rapid growth in infancy and adolescence.

3.         Chronic blood loss: Persistent or repeated loss of blood depletes the body’s iron reserves. This happens during heavy menstrual periods in women (thus, menstruating women are prone to iron deficiency anemia), gastrointestinal bleeding (such as from peptic ulcers, hemorrhoids, or colorectal cancer), and frequent blood donation, all of which are common sources of blood loss.

4.         Poor iron absorption: Some disorders or factors can hinder the absorption of iron from dietary sources. Digestive system conditions like celiac disease, Crohn’s disease, and gastric bypass surgery are instances of such disorders. Moreover, substances like tannins found in teabags and coffee, along with calcium supplements, can restrict the absorption of iron.

5.         Inherited or acquired disorders: Some illnesses, whether inherited or acquired, can disrupt how the body handles iron. For instance, conditions like hemochromatosis can cause too much iron absorption initially, leading to excess iron followed by iron deficiency. Similarly, chronic kidney disease can result in iron deficiency anemia due to decreased production of a hormone necessary for red blood cell development.

6.         Medications: Certain medications like proton pump inhibitors (PPIs) used for acid reflux and anticoagulants like aspirin can cause gastrointestinal bleeding, which can contribute to iron deficiency anemia.

7.         Strict vegetarians or vegans have a higher risk of iron deficiency anemia because the body finds it harder to absorb iron from plant-based sources (non-heme iron) compared to animal-based sources (heme iron). However, following a well-planned vegetarian or vegan diet that includes iron-rich plant foods and considering iron supplementation when needed can help prevent deficiency.

8.         Hookworm infections: Hookworm are parasites that can infest the intestines and cause repeated intestinal bleeding. This blood loss can lead to iron deficiency anemia, especially in regions where hookworm infections are prevalent and sanitation conditions are poor.

9.         Pregnancy complications: Some complications during pregnancy, like multiple pregnancies (such as twins or triplets), excessive vomiting (hyperemesis gravidarum), or uterine fibroids, can increase the likelihood of iron deficiency anemia due to higher iron requirements or blood loss.

10.       Chronic diseases like chronic heart failure, chronic kidney disease, and autoimmune disorders such as rheumatoid arthritis or lupus can all contribute to iron deficiency anemia through different mechanisms, including inflammation, inefficient iron utilization, or blood loss associated with the disease.

What are some signs and symptoms?

At first, iron deficiency anemia may be so subtle that it escapes notice. However, as the body’s iron levels continue to decline and anemia worsens, the signs and symptoms become more apparent.

1.         Fatigue and weakness: Feeling constantly tired, lacking energy, and experiencing general body weakness.

2.         Skin and nail beds may appear pale and the color of the inside of the lower eyelids may be noticeably lighter than usual.

3.         Shortness of breath: Difficulty breathing or feeling breathless, especially during exertion.

4.         Frequent headaches, dizziness, and lightheadedness may occur.

5.         Palpitations, a racing heart, or irregular heartbeat.

6.         Nails may become brittle and prone to breakage, and hair may become thin or fall out more easily.

7.         Pica: Unusual cravings for non-food substances, such as ice, dirt, or clay.

8.         Cold hands and feet.

9.         Poor appetite, especially in infants and children with iron deficiency anemia.

10.       Restless legs syndrome: An uncomfortable sensation in the legs, often described as a “creepy-crawly” or “itchy” feeling, leading to an urge to move them.

11.       Soreness or swelling of the tongue and mouth: The tongue may become inflamed, sore, or swollen, and mouth ulcers can occur.

12.       Poor immune function: Increased susceptibility to infections and a weakened immune system.

It is important to note that these signs and symptoms can also be caused by other health conditions and are similar to symptoms produced by other types of anemia. If you experience these symptoms, it’s advisable to consult a doctor or healthcare professional for a proper diagnosis.

How is iron deficiency anemia diagnosed?

To diagnose iron deficiency anemia, your doctor or healthcare professional will begin by gathering your medical history to understand the symptoms you have been experiencing.

They will then conduct a blood test to assess various factors. This includes measuring your hemoglobin levels and examining the size, shape, and quantity of your red blood cells. In cases of iron deficiency, the red blood cells typically appear small and pale.

The blood test will also assess the levels of iron, transferrin (a protein that transports iron in the body), and ferritin (a protein that stores iron). Lower-than-normal levels of serum iron, transferrin, and ferritin often indicate iron deficiency anemia.

Your doctor might also investigate potential causes of iron deficiency related to blood loss. For women experiencing heavy periods, a pelvic ultrasound scan may be performed to identify the underlying cause of excessive bleeding and explore possible treatment options.

Additionally, endoscopy and colonoscopy may be conducted to detect any gastrointestinal bleeding, while examining a stool sample under a microscope can help identify potential hookworm infections.

How is it treated?

Treatment for iron-deficiency anemia depends on its cause and severity. Options include dietary changes, supplements, medications, and surgery.

In severe cases, blood transfusions or intravenous (IV) iron therapy may be needed, often administered in a hospital. For mild cases, which are common, iron supplementation and dietary adjustments are usually effective.

Iron supplementation

Iron tablets available over the counter often contain a combination of iron and folic acid (FeFa). Folic acid supports the production of healthy red blood cells, similar to iron.

Your doctor will guide you on the appropriate dosage of iron supplements based on your specific requirements and also advise you on incorporating iron-rich foods into your diet. Only take iron supplements as prescribed by your doctor to prevent any potential harm, as excessive amounts of iron can be dangerous.

Iron supplements can cause some side effects which include:

1.         Upset stomach: Iron tablets can cause stomach discomfort, including nausea, vomiting, or stomach cramps, especially when taken on an empty stomach.

2.         Constipation

3.         Diarrhea

4.         Heartburn or an uncomfortable sensation in the stomach.

It is always important to consult with your doctor before taking any medications alongside iron tablets. Some medications can potentially interfere with the absorption of iron, so your doctor’s guidance is essential to ensure the effectiveness of both the medications and the iron supplements.

Vitamin C

To enhance iron absorption, it is recommended to take iron tablets with vitamin C. Vitamin C helps improve the absorption of iron. Your doctor may suggest taking iron tablets with a glass of orange juice, a fruit, or a vitamin C supplement.

How can one prevent iron deficiency anemia?

Preventing iron deficiency anemia ensures taking steps to guarantee adequate intake of iron.

Here are some measures:

1.         Eat iron-rich foods: Iron-rich foods such as lean meats, eggs, chicken, fish, beans, lentils, spinach, kale, iron-fortified cereals and pasta, and nuts should be included in your diet. Iron absorption can be improved by combining these foods with a source of vitamin C.

2.         A well-balanced diet: Maintain balanced and diverse diet rich in fruits, vegetables, whole grains, and protein sources to ensure enough nutrition, including iron.

3.         Consider iron supplements: If you are at risk of iron deficiency or have been diagnosed with low iron levels, consult your doctor about iron supplementation.

4.         Improve iron absorption: Combine iron-rich foods with vitamin C-rich foods, such as oranges, mangoes, watermelon, apples, pineapples, bananas, tomatoes, or bell peppers, because vitamin C promotes iron absorption. Also, consume calcium-rich foods separately from iron-rich foods because calcium inhibits iron absorption.

5.         Keep iron absorption inhibitors in mind: Iron-blocking drugs, such as excessive coffee, tea, and calcium supplements, should be avoided during meals since they can impair iron absorption. Instead, eat them in between meals.

6.         Treat underlying causes: If you have conditions like gastrointestinal issues or excessive menstrual bleeding that contribute to iron deficiency anemia, engage with your healthcare professional to manage and treat these underlying causes.

7.         Schedule regular check-ups with your doctor to assess your overall health and iron levels.

What happens if Iron deficiency anemia is left untreated?

Iron deficiency anemia can cause several consequences if left untreated or uncontrolled. Some of the probable issues are as follows:

1.         Impaired cognitive function: Iron deficiency anemia, whether severe or chronic, can impair cognitive function, including concentration, memory, and overall mental functioning and performance.

2.         Delayed growth and development: Iron deficiency anemia can cause delayed growth and development in children, affecting their physical and cognitive milestones.

3.         Weakened immune system: Iron deficiency anemia affects the immune system, making people more prone to infections and diseases.

4.         Fatigue and lower productivity: Chronic fatigue and low energy levels can have a substantial influence on daily activities, work performance, and general quality of life.

5.         Heart complications: Severe or persistent iron deficiency anemia can strain the heart, increasing the risk of heart palpitations, rapid heartbeat (tachycardia), and, in severe cases, heart failure.

6.         Complications of pregnancy: Iron deficiency anemia during pregnancy raises the risk of complications such as preterm birth and low birth weight.

7.         Fertility problems: Iron deficiency anemia can impact fertility in both men and women, potentially resulting in infertility.

8.         Restless leg syndrome: Iron deficiency anemia has been linked to the development or worsening of restless legs syndrome, which causes uncomfortable sensations and an uncontrollable urge to move the legs.

In summary

Iron deficiency anemia is not a death sentence; it can be effectively treated by addressing the underlying causes. Symptoms like fatigue, pale skin, and shortness of breath can be reversed through dietary changes and iron supplementation. Remember, taking charge of your health is essential. So, when was the last time you had a blood test?

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