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Name: Iron-deficiency anemia

Description: NHLBI

Creator: DrOptra

This casebook is published and has been read 1620 times.

The author of this casebook has identified the following medical topics as being highly relevant to this casebook.

  • Iron deficiency anemia -- Anemia characterized by decreased or absent iron stores, low serum iron concentration, low transferrin saturation, and low hemoglobin concentration or hematocrit value. The erythrocytes are hypochromic and microcytic and the iron binding capacity is increased.
Notes

What Is Iron-Deficiency Anemia?

Iron-deficiency anemia is a common, easily treated condition that occurs when you don't have enough iron in your body.

Low iron levels usually are due to blood loss, poor diet, or an inability to absorb enough iron from foods.

Overview

Iron-deficiency anemia is a common type of anemia. The term "anemia" usually refers to a condition in which your blood has a lower than normal number of red blood cells. Red blood cells carry oxygen and remove carbon dioxide (a waste product) from your body.

Anemia also can occur if your red blood cells don’t contain enough hemoglobin (HEE-muh-glow-bin). Hemoglobin is an iron-rich protein that helps carry oxygen to your body.

Iron-deficiency anemia usually develops over time if your body doesn’t have enough iron to build healthy red blood cells. Without enough iron, your body starts using the iron it has stored. Soon, the stored iron gets used up.

After the stored iron is gone, your body makes fewer red blood cells. The red blood cells it does make will have less hemoglobin than normal.

Iron-deficiency anemia can cause fatigue (tiredness), shortness of breath, chest pain, and other symptoms. Severe iron-deficiency anemia can lead to heart problems, infections, problems with growth and development in children, and other complications.

People at highest risk for iron-deficiency anemia include infants and young children, women, and adults who have internal bleeding.

Outlook

Iron-deficiency anemia usually can be successfully treated. Treatment will depend on the cause and severity of the condition. Treatments may include changes to your diet, medicines, and surgery.

Severe iron-deficiency anemia may require treatment in a hospital, blood transfusions, iron injections, or intravenous iron therapy.

What Causes Iron-Deficiency Anemia?

Not having enough iron in your body causes iron-deficiency anemia. Lack of iron usually is due to blood loss, poor diet, or an inability to absorb enough iron from the foods you eat.

Blood Loss

When you lose blood, you lose iron. If you don’t have enough iron stored in your body to make up for the iron loss, you’ll develop iron-deficiency anemia.

In women, low iron levels may be due to blood loss from long or heavy menstrual periods or bleeding fibroids in the uterus. Blood loss that occurs during childbirth is another cause for low iron levels in women.

Internal bleeding (bleeding inside the body) also may lead to iron-deficiency anemia. This type of blood loss isn’t always obvious, and it may occur slowly. Some causes of internal bleeding are:

  • A bleeding ulcer, colon polyp, or colon cancer
  • Regular use of aspirin or other pain medicines, such as nonsteroidal anti-inflammatory drugs (for example, ibuprofen and naproxen)
  • Urinary tract bleeding

Blood loss from severe injuries, surgery, or frequent blood drawings also can cause iron-deficiency anemia.

Poor Diet

The best sources of iron are meat, poultry, fish, eggs, and iron-fortified foods (foods that have iron added). If you don’t eat these foods regularly, or if you don’t take an iron supplement, you’re more likely to get iron-deficiency anemia.

Vegetarian diets can provide enough iron if the right foods are eaten. For example, good nonmeat sources of iron include spinach and other dark green leafy vegetables, certain types of beans, dried fruits, and iron-fortified breads and cereals.

During some stages of life, such as pregnancy and childhood, it may be hard to get enough iron in your diet. This is because your need for iron increases during these times of growth and development.

Inability To Absorb Enough Iron

Even if there's enough iron in your diet, your body may not be able to absorb it. This may be due to intestinal surgery or diseases of the intestine, such as Crohn’s disease or celiac disease.

Prescription medicines that reduce acid in the stomach also can interfere with iron absorption.

Who Is At Risk for Iron-Deficiency Anemia?

Infants and young children, women, and adults who have internal bleeding are at highest risk for iron-deficiency anemia.

Infants and Young Children

Infants and young children need a lot of iron to grow and develop. The iron that full-term infants have stored in their bodies is used up in the first 4 to 6 months of life.

Premature and low-birth-weight babies are at even greater risk for iron-deficiency anemia. These babies don’t have as much iron stored in their bodies as other babies do.

Iron-fortified foods for babies or iron supplements, when used properly, can help prevent iron-deficiency anemia in infants and young children. Talk to your child's doctor about your child's diet.

Young children who drink large amounts of cow's milk may be at risk for iron-deficiency anemia. Milk is low in iron, and too much milk may take the place of iron-rich foods in the diet. Too much milk also may prevent children’s bodies from absorbing iron from other foods.

Children who have lead in their blood also may be at risk for iron-deficiency anemia. Lead can interfere with the body’s ability to make hemoglobin. Lead may get into the body from breathing in lead dust, eating lead in paint or soil, or drinking water that contains lead.

Women

Women of childbearing age are at increased risk for iron-deficiency anemia because of blood loss during their monthly periods. About 1 in 5 women of childbearing age has iron-deficiency anemia.

Pregnant women also are at higher risk for the condition because they need twice as much iron as usual. The extra iron is needed for increased blood volume and for the fetus' growth.

About half of all pregnant women develop iron-deficiency anemia. The condition can increase a pregnant woman's risk for a premature or low-birth-weight baby.

Adults Who Have Internal Bleeding

Adults who have internal bleeding, such as intestinal bleeding, can develop iron-deficiency anemia due to blood loss. Certain conditions, such as colon cancer and bleeding ulcers, can cause blood loss. Certain medicines, such as aspirin, also can cause internal bleeding.

Other At-Risk Groups

People who get kidney dialysis treatment may develop iron-deficiency anemia. This is because blood is lost during dialysis. Also, the kidneys are no longer able to make enough of a hormone needed to make red blood cells.

Certain eating patterns or habits can put you at higher risk for iron-deficiency anemia. This can happen if you:

  • Follow a diet that excludes meat and fish, which are the best sources of iron. However, vegetarian diets can provide enough iron if the right foods are eaten. For example, good nonmeat sources of iron include spinach and other dark green leafy vegetables, certain types of beans, dried fruits, and iron-fortified breads and cereals.
  • Eat poorly due to money, social, health, or other problems.
  • Follow a very low-fat diet over a long period. Some higher fat foods, like meat, are some of the best sources of iron.
  • Follow a high-fiber diet. Large amounts of fiber can slow the absorption of iron.

 

What Are the Signs and Symptoms of Iron-Deficiency Anemia?

The signs and symptoms of iron-deficiency anemia depend on how serious the condition is. Mild to moderate iron-deficiency anemia may have no signs or symptoms.

When signs and symptoms do occur, they can range from mild to severe. Many of the signs and symptoms of iron-deficiency anemia apply to all types of anemia.

Signs and Symptoms of Anemia

The most common symptom of all types of anemia is fatigue (tiredness). Not having enough hemoglobin in the blood causes fatigue. Hemoglobin is an iron-rich protein in red blood cells that carries oxygen to the body.

Anemia also can cause shortness of breath; dizziness, especially when standing up; headache; coldness in your hands or feet; pale skin, gums, and nail beds; and chest pain.

If you don't have enough hemoglobin-carrying red blood cells, your heart has to work harder to circulate the reduced amount of oxygen in your blood. This can lead to arrhythmia, heart murmur, an enlarged heart, or even heart failure.

In infants and young children, signs of anemia include poor appetite, slowed growth and development, and behavioral problems.

Signs and Symptoms of Iron-Deficiency Anemia

Signs and symptoms of iron-deficiency anemia may include brittle nails, swelling or soreness of the tongue, cracks in the sides of the mouth, an enlarged spleen, and frequent infections.

People who have iron-deficiency anemia may have unusual cravings for nonfood items such as ice, dirt, paint, or starch. This craving is called pica (PI-ka or PE-ka).

Some people who have iron-deficiency anemia develop restless legs syndrome (RLS). RLS is a disorder that causes a strong urge to move your legs. This urge to move often occurs with strange and unpleasant feelings in your legs. People who have RLS often have a hard time sleeping.

Iron-deficiency anemia can put children at greater risk for lead poisoning and infections.

Some signs and symptoms of iron-deficiency anemia are related to the condition's causes. For example, a sign of intestinal bleeding can be bright red blood in the stools or black, tarry-looking stools.

Very heavy menstrual bleeding, long periods, or other vaginal bleeding may suggest that a woman is at risk for iron-deficiency anemia.

How Is Iron-Deficiency Anemia Diagnosed?

Your doctor will diagnose iron-deficiency anemia based on your medical history, a physical exam, and the results from tests and procedures.

Once your doctor knows the cause and severity of the condition, he or she can create a treatment plan for you.

Mild to moderate iron-deficiency anemia may have no signs or symptoms. Thus, you may not know you have it unless your doctor discovers it from a screening test or while checking for other problems.

Specialists Involved

Primary care doctors often diagnose and treat iron-deficiency anemia. These doctors include pediatricians, family doctors, gynecologists/obstetricians, and internal medicine specialists.

A hematologist (a blood disease specialist), a gastroenterologist (a digestive system specialist), and other specialists also may help treat iron-deficiency anemia.

Medical History

To learn about your medical history, your doctor will ask about your signs and symptoms and any past problems you’ve had with anemia or low iron.

Your doctor also may ask about your diet and whether you’re taking any medicines. If you're a woman, your doctor may ask whether you could be pregnant.

Physical Exam

Your doctor will do a physical exam to look for signs of iron-deficiency anemia. He or she may:

  • Look at your skin, gums, and nail beds to see whether they're pale or yellowish
  • Listen to your heart for a rapid or irregular heartbeat
  • Listen to your lungs for rapid or uneven breathing
  • Feel your abdomen to check the size of your liver and spleen
  • Do a pelvic and rectal exam to check for internal bleeding

Diagnostic Tests and Procedures

A number of tests and procedures are used to diagnose iron-deficiency anemia. They can help confirm a diagnosis, look for a cause, and find out how severe the condition is.

Complete Blood Count

Often, the first test used to diagnose anemia is a complete blood count (CBC). The CBC measures many different parts of your blood.

This test checks your hemoglobin and hematocrit (hee-MAT-oh-crit) levels. Hemoglobin is the 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 normal range of these levels varies in certain racial and ethnic populations. Your doctor can explain your test results to you.

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 (kor-PUS-kyu-lar) 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.

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 (re-TIK-u-lo-site) count measures the number of young red blood cells in your blood. The test shows whether your bone marrow is making red blood cells at the correct rate.

Your doctor also may order a peripheral smear. For this test, a sample of your blood is examined under a microscope. In people who have iron-deficiency anemia, the red blood cells will look smaller and paler than normal.

Your doctor may recommend tests to measure iron levels in your blood and body. These tests can show how much iron has been used from your body's stored iron. These tests include:

  • 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.
  • 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 up.
  • 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.

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.

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, and colon or pelvic organs.

How Is Iron-Deficiency Anemia Treated?

Treatment for iron-deficiency anemia will depend on the cause and severity of the condition. Treatments may include dietary changes and supplements, medicines, and surgery.

Severe iron-deficiency anemia may require treatment in a hospital, blood transfusions, iron injections, or intravenous (IV) iron therapy.

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 Changes and Supplements

Iron

You may need iron supplements to build up your iron levels as quickly as possible. Iron supplements can correct low iron levels within months. Supplements come in pill form or in drops for children.

Large amounts of iron can be harmful. Thus, you should take iron supplements only as your doctor prescribes. Keep iron supplements out of reach from children. This will prevent them from taking an overdose of iron.

Iron supplements can cause side effects, such as dark stools, stomach irritation, and heartburn. Iron also can cause constipation, so your doctor may suggest that you use a stool softener.

Your doctor may advise you to eat more foods that are rich in iron. The best source of iron is red meat, especially beef and liver. Chicken, turkey, pork, fish, and shellfish also are good sources of iron.

The body tends to absorb the iron from meat better than iron in other foods. However, other foods also can help you raise your iron levels.

Nonmeat foods that are good sources of iron include:

  • Spinach and other dark green leafy vegetables
  • Peanuts, peanut butter, and almonds
  • Eggs
  • Peas; lentils; and white, red, and baked beans
  • Dried fruits, such as raisins, apricots, and peaches
  • Prune juice

Iron is added to some foods, such as cereal, bread, and pasta. You can look at the Nutrition Facts label on a food to find out how much iron it contains. The amount is given as a percentage of the total amount of iron you need every day.

Vitamin C

Vitamin C helps the body absorb iron. Good sources of vitamin C are fruits and vegetables, especially guava, red sweet pepper, kiwi, oranges and orange juice, green pepper, and grapefruit juice.

If you're taking medicines, ask your doctor or pharmacist whether you can eat grapefruit or drink grapefruit juice. This fruit can affect the strength of a few medicines and how well they work.

Other fruits rich in vitamin C are strawberries, cantaloupe, papaya, pineapple, and mango. Vegetables high in vitamin C include vegetable and tomato juices, Brussels sprouts, kohlrabi, broccoli, sweet potato, cauliflower, and kale.

Fresh and frozen fruits, vegetables, and juices usually have more vitamin C than canned ones.

Treatment To Stop Bleeding

If blood loss is causing iron-deficiency anemia, treatment will depend on the cause of the bleeding. For example, if you have a bleeding ulcer, your doctor may prescribe antibiotics and other medicines to treat the ulcer.

If your blood loss is due to a polyp or a cancerous tumor in your intestine, you may need surgery to remove the growth.

If blood loss is due to heavy menstrual flow, your doctor may prescribe oral contraceptives to help reduce your monthly blood flow. In some cases, surgery may be advised.

Treatments for Severe Iron-Deficiency Anemia

If your iron-deficiency anemia is severe, you may get a transfusion of red blood cells. A blood transfusion is a safe, common procedure in which blood is given to you through an IV line in one of your blood vessels. Transfusions require 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, transfusions are only a short-term treatment. Your doctor will need to find and treat the cause of your anemia.

Iron also may be injected into a muscle or through an IV tube into a vein. However, IV iron therapy presents some safety concerns. It must be done in a hospital or clinical setting by experienced staff. This therapy usually is given to people who need iron long-term but can’t take iron supplements by mouth or who need to be treated for iron-deficiency anemia right away.

How Can Iron-Deficiency Anemia Be Prevented?

Eating a well-balanced diet that includes foods that are good sources of iron may help you prevent iron-deficiency anemia. Taking iron supplements (as your doctor prescribes) also may lower your risk for the condition if you're not able to get enough iron from food.

For more information on diet and supplements, see "How Is Iron-Deficiency Anemia Treated?"

Special measures can help prevent iron-deficiency anemia in infants and young children and women—two groups at highest risk for the condition.

Infants and Young Children

A baby's diet can affect his or her risk for iron-deficiency anemia. For example, cow's milk is low in iron. For this and other reasons, cow's milk is not recommended for babies in their first year. After the first year, you may need to limit the amount of cow's milk your baby drinks.

Also, babies need more iron as they grow and begin to eat solid foods. Talk to your child’s doctor about a healthy diet and food choices that will help your child get enough iron.

Your child's doctor may recommend iron drops. However, giving a child too much iron can be dangerous. It's important to follow the doctor's instructions and keep iron supplements and vitamins away from children. Asking for child-proof packages for supplements can help prevent overdosing in children.

Women

Women of childbearing age may be tested for iron-deficiency anemia, especially if they have:

  • A history of iron-deficiency anemia
  • Heavy blood loss during their monthly periods
  • Other risk factors for iron-deficiency anemia

For pregnant women, medical care during pregnancy usually includes screening for anemia. Also, your doctor may prescribe an iron supplement or advise you to eat more iron-rich foods.

Living With Iron-Deficiency Anemia

If you have iron-deficiency anemia, it’s important to take care of your health. See your doctor regularly to make sure your iron levels are improving. At your checkups, your doctor may change your medicines or supplements. He or she also may suggest ways to improve your diet.

Take iron supplements only with your doctor's approval, and only as he or she prescribes. It’s possible to have too much iron in your body (a condition called iron overload). Too much iron in your body can damage your organs.

You may have fatigue (tiredness) and other symptoms of iron-deficiency anemia until your iron levels return to normal. This can take months. Tell your doctor if you get any new symptoms or if your symptoms get worse.

Key Points

  • Iron-deficiency anemia is a common, easily treated condition that occurs when you don't have enough iron in your body.
  • Low iron levels usually are due to blood loss, poor diet, or an inability to absorb enough iron from the foods you eat.
  • Iron-deficiency anemia usually develops over time if your body doesn't have enough iron to build healthy red blood cells. Without enough iron, your body starts using the iron it has stored. After the stored iron is gone, your body makes fewer red blood cells. The red blood cells it does make will have less hemoglobin than normal. Hemoglobin is a protein that helps carry oxygen to your body.
  • People at highest risk for iron-deficiency anemia include infants and young children, women of childbearing age, and adults who have internal bleeding.
  • The signs and symptoms of iron-deficiency anemia depend on how serious the condition is. Mild to moderate iron-deficiency anemia may have no signs or symptoms. Many of the signs and symptoms of iron-deficiency anemia, such as fatigue (tiredness), apply to all types of anemia.
  • Your doctor will diagnose iron-deficiency anemia based on your medical history, a physical exam, and the results from tests and procedures.
  • Treatment for iron-deficiency anemia will depend on the cause and severity of the condition. Treatments may include dietary changes and supplements, medicines, and surgery. Severe iron-deficiency anemia may require treatment in a hospital, blood transfusions, iron injections, or intravenous iron therapy.
  • Eating a well-balanced diet that includes foods that are good sources of iron may help you prevent iron-deficiency anemia. Taking iron supplements (as your doctor prescribes) also may lower your risk for the condition if you're not able to get enough iron from food.
  • If you have iron-deficiency anemia, it's important to take care of your health. See your doctor regularly, take iron supplements only as your doctor prescribes, and tell your doctor if you have any new symptoms or if your symptoms get worse.
  • Iron-deficiency anemia usually can be successfully treated.

 

Bookmarks The following information, which has been distilled by the casebook author from this and other websites is particularly relevant to this casebook.
Bookmarks - Web
Web Page Notes Concepts
 What is iron-deficiency anemia? National Heart, Lung and Blood Institute
 
 Anemia: MedlinePlus U.S. National Library of Medicine (Iron deficiency anemia)
 
 Dietary Supplement Fact Sheet: Iron NIH Office of Dietary Supplements (Iron deficiency anemia)
 

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