The most common type of anemia is iron deficiency anemia. It has a huge disease burden, affecting almost one-fourth of the world’s population.
Prevention of iron deficiency anemia is crucial due to several reasons.
- Anemia in pregnancy is very dangerous as it is associated with low birth weight and prematurity
- Children with Iron deficiency anemia are shown to have impaired learning abilities
- Iron deficiency anemia patients have reduced work capacity, which ultimately affects negatively to the country’s productivity and economy
Etiology
Causes for Iron deficiency anemia divides into four categories. They are; decreased intake, decreased absorption, increased demand, and increased loss.
Decreased intake is usually due to nutritional deficiencies.
This is more commonly seen in poorer countries.
The vegetarians are also at risk as their only source of iron is non-haem iron, which is harder to absorb.
Decreased absorption can be due to diseases like coeliac disease, or surgical removal of the stomach known as a gastrectomy.
The demand for iron increases in childhood and pregnancy, which makes them prone to iron deficiency.
Blood loss is the most common cause of iron deficiency anemia in developed countries.
In males, it can be GI bleeding from gastric ulcers or colon cancers.
In females, it is the heavy menstrual bleeding that causes increased iron loss from the body.
Parasites like hookworm also can cause chronic blood loss.
Pathophysiology
All of these causes lead to inadequate iron for the needs of the body.
Iron is essential for the division of cells in the red cell generation process as it is a major component of haemoglobin.
When there is not enough iron for hemoglobin production, the bone marrow will release small-sized cells known as microcytic red cells.
They also contain less hemoglobin, and therefore appear pale in colour.
The cells cannot transport oxygen effectively, thus causing tissue hypoxia.
This stimulates the bone marrow to increase erythropoiesis.
But when even increased production could not compensate for the deficit, bone marrow starts to release poorly formed erythrocytes of various shapes and sizes.
This is called poikilocytosis and anisocytosis.
Also, iron is an essential component of myoglobin, an oxygen storing protein seen in muscles, and cytochrome oxidase, a mitochondrial enzyme.
Cytochrome oxidase deficiency first becomes evident in rapidly dividing tissues like in the hair and nails.
Lack of iron, therefore can manifest through several clinical features.
Clinical features
The most common clinical features of iron deficiency anemia are pallor, tiredness, shortness of breath, and exercise intolerance.
Sometimes the patients may have glossitis, which is an inflamed tongue, and cheilitis, which is inflammation of the lips.
But all these symptoms are vague and non-specific.
The specific symptoms and signs include spoon-shaped nails, which is known as koilonychia, craving for unusual substances like clay or ice, which is called pica, and hair loss.
Laboratory Investigations
The usual investigations done to diagnose iron deficiency anemia are;
– Full blood count
– Peripheral blood smear
– Iron studies
– and, bone marrow biopsy for definitive diagnosis.
A full blood count will show decreased hemoglobin, decreased hematocrit, low MCV, MCH, and MCHC.
In the blood picture we will be able to see hypochromic microcytic cells.
If the central pale area of erythrocytes is bigger than one third of the cells, they are named hypochromic. And if the erythrocytes are smaller than small lymphocytes, they are called microcytic.
The other features evident in the blood picture are anisocytosis, and poikilocytosis, which will be evident by the presence of pencil cells, tear drop cells and target cells.
The iron studies will exhibit low serum iron, low ferritin, and increased total iron-binding capacity (TIBC) soluble transferrin receptors (STfR) levels.
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