The World Health Organization estimated that over 30 per cent of the world's population is anemic, majority of them are due to lack of iron in the body.
How iron deficiency causes anemia.
Iron plays several important roles in our body. The main function is formation of hemoglobin, which carries oxygen from the lungs to other parts of the body.
Iron is a main component of the hemoglobin, which is a red colored pigment found inside the red blood cells. Hemoglobin gives red color to our blood. Four molecules of iron are found in one hemoglobin molecule.Oxygen is temporarily binds with these molecules and transported throughout the body.
Low levels of hemoglobin in the blood is called anemia.
Normal range of hemoglobin in adults are;
Males 13.5-17 g/dl
Females 12-15 g/dl
Lack of iron in the body leads to reduced production of hemoglobin in the red blood cells.
What are the causes of iron deficiency anemia?
Chronic blood loss, and improper diet are the main causes.
Iron is mainly found in the red blood cells. When we lose 1ml of blood, we lose about 1mg of Fe out of the body. Small amounts of blood loss over a long period of time can lead to low levels of iron in the body.
Chronic blood loss can be due to following reasons.
- Menstrual loss: Women lose between 30 - 80ml blood each month during their periods. Some may lose more than that amount. Because of that women are more prone to have iron deficiency symptoms.
- Hemorrhoids (piles): This is a common condition that affects more than a quarter of the adult population. Bleeding from the hemorrhoids is one of the main causes of iron loss.
- Hookworm infestation: This worms are found inside the intestine and suck our blood. This is the most common cause of fe deficiency among children, specially in the developing world.
- Cancer: Cancers in the gastro-intestinal tract, such as stomach, colon and rectum are associated with chronic blood loss. Iron deficiency anemia in a person over the age of 40 is an ominous sign, and should be taken seriously. Necessary investigations should be done to find out or exclude cancer.
- Inflammatory bowel disease: Ulcerative colitis and Crohn's disease cause bloody diarrhea and chronic blood loss.
- Peptic ulcer disease: Gastric or duodenal ulcer can cause chronic bleeding into the gastro-intestinal tract.
- Analgesic use: Long term use of non steroidal anti-inflammatory drugs (NSAID) such as Ibuprofen may cause bleeding from the gastro intestinal tract.
Anemia is more prevalent in vegetarians. Although many vegetables contain significant amounts of Fe, the absorption from these food is limited.
Poor absorption from the digestive tract may result in deficiency. People with coeliac disease, and people who have had gastric bypass surgery are at increased risk.
Increased demand during pregnancy can result in low iron level in the body. Pregnant women need extra iron for their growing babies and placentas, particularly in the later part of pregnancy.
In addition, the volume of blood in the body significantly increases during pregnancy. So more hemoglobin is needs to be produced.
Furthermore, many women start their pregnancy with low levels of iron in body stores. So they are more prone to anemia.
Symptoms and signs of iron deficiency anemia.
- Tiredness and difficulty in doing physical activities.
- Puffy face and leg swelling.
- Palpitations or awareness of heart beat.
- Shortness of breath when doing physical activity.
- Dizziness.
- Chest pain during exertion (angina).
- Pain in the legs while walking (intermittent claudication).
- Headache.
- Ringing in the ears.
- Pallor which is best seen on conjunctiva of the eyes.
- Brittle and spoon shape nails.
- Thin and brittle hair.
- Hair loss.
- Soreness of the tongue.
- Altered taste.
- Eating strange items such as mud or ice. This condition is called pica.
- Difficulty in swallowing.
- Ulcers at the corners of the mouth.
- Impaired immunity and increased susceptibility to infections.
- Impaired growth in children.
- Heart failure.
How to prevent anemia due to iron deficiency.
Eating iron rich food is the best way of preventing anemia. Foods of animal origin are the best sources.
Red meat is the number one food that provide adequate amounts of heme iron. Eating beef or lamb one or twice a week is a good way of preventing anemia.
Liver of beef, lamb, and chicken contain large amounts of iron. However, eating too much liver is not recommended because of the risk of vitamin A toxicity.
Beans and green leafy vegetables are the good plant sources. Better examples are; spinach, tofu, lentils, kidney beans, lima beans, soybeans, and dates.
However, iron from these food is poorly absorbed by our bodies. The absorption can be increased by adding vitamin C rich foods such as lemon, lime, and capsicum.
How iron deficiency anemia is diagnosed.
Estimation of hemoglobin (Hb%) in the blood is measured to diagnose anemia. An Hb level of less than 13.5g/dl in men, and less than 12g/dl in women are indicatives of anemia.
Measuring hematocrit is another test. This is the percentage of red blood cells (RBC) by volume in the blood. Normal ranges are 38-50 for males, and 35-45 for females.
These two tests can identify anemia. However, further tests are needed to demonstrate low levels of iron in the body.
Blood picture is a test used to examine the morphology of blood cells. In iron deficiency, red blood cells are smaller and paler in color than normal. This is called microcytic hypochromic anemia.
Ferritin; a protein helps store iron in the body. Estimation of ferritin is done to identify iron deficiency.
If the results indicate anemia due to lack of iron, further tests may be needed to confirm the cause of deficiency. Upper GI endoscopy, colonoscopy, and ultra sound scan are commonly performed.
Treatment of iron deficiency anemia.
Your doctor may recommend you to take iron supplements. In addition, he or she will also treat the underlying cause such as piles, peptic ulcer or menorrhagia.
When taking iron supplements consider following points.
- Always take the correct dose. Iron overdose can be dangerous.
- It is better to take it on an empty stomach. If you develop nausea, stomach upset or vomiting, take the pills with small amount of food.
- You can take the tablets in divided doses to reduce the side effects. For example; taking one tablet in the morning and one in the afternoon is better than taking two at the same time.
- Do not take iron with antacids or calcium supplements because they reduce the absorption of iron.
- Avoid tea, coffee and milk at least two hours before and after taking the tablets, because these foods reduce the absorption of iron.
- Take the tablets with plenty of water. Never swallow the tablets without water.
- Always take while you are sitting or standing. Never swallow the pills while you are lying on the bed.
- Vitamin C is an iron absorption enhancer. So, drinking orange juice may help increase the absorption of iron from the gut.
- Do not chew, crush or split extended release tablets.
- If you are using liquid form, shake well before use and measure the correct amount carefully.
- Iron supplements have many side effects, most are minor ones. However they may cause allergic reactions. If you develop symptoms of allergy such as itching, rash, swelling, dizziness and difficult breathing, stop the medicine and seek immediate medical help.
- Keep the iron and other medications away from children.
- You may stop taking the iron supplement when your body's iron stores become full. Check you blood for iron and ferritin levels and ask your doctor when to stop.
