Iron Deficiency Anemia
Introduction
Do you feel weak and fatigued? Do you become short of breath easily during mild exercise? Do you ever feel like your heart is going to beat right out of your chest? If you answered yes to any of these questions, you may be among over 500 million people in the world that suffer from iron deficiency anemia (IDA). IDA is usually not a deadly condition, but it is associated with increased risk of infection, decreased work productivity, and developmental delays. If left untreated, anemia can progress and cause serious complications. IDA can usually be corrected by taking iron, but sometimes, additional treatments are necessary to correct the cause
It is important to keep in mind that IDA should not be self-diagnosed or self-treated. If you feel that you or your child may have IDA, you should seek the advice of a healthcare provider. Your healthcare provider can perform a blood test to determine if you have IDA.
What is it?
IDA is a condition characterized by a decrease in the ability of the blood to carry oxygen. Oxygen is carried by a portion of the blood called hemoglobin. Hemoglobin transports the oxygen from the lungs to all other areas of the body. Iron is an essential component of hemoglobin. When the amount of iron stored in the body gets too low, hemoglobin can no longer carry oxygen effectively.
What causes it?
Diets low in meat and fresh fruits and vegetables, which contain large amounts of iron, can lead to IDA. Some illnesses, such as rheumatoid arthritis, may result in IDA by decreasing the absorption of iron from the diet. Things that increase the body's demand for iron can also contribute to IDA. Some examples include frequent blood donation, endurance sports, heavy menstruation, pregnancy, and breast-feeding. IDA can also be seen in people who have conditions that lead to blood loss, such as trauma, ulcers, certain cancers (esophagus, colon, and stomach), and hemorrhoids.
Who has it?
IDA is present in over 500 million people worldwide. It most commonly occurs in women and young children.
What are the risk factors?
There are many risk factors for the development of IDA. Women of childbearing age who have blood loss during menstruation, pregnant women, women who are breastfeeding, people older than 65 years of age, vegetarians, infants and children during phases of rapid growth, and people who have a poor dietary intake of iron are all at risk for developing IDA. Some other risk factors include peptic ulcer disease, long term aspirin or non-steroidal anti-inflammatory drug (NSAID) use, and cancers of the esophagus, colon, and stomach.
What are the symptoms?
In mild cases of IDA there may be no symptoms at all. However, in moderate and severe cases the following symptoms may be present:
- Decreased exercise tolerance
- Fatigue
- Dizziness or lightheadedness
- Pale skin
- Irritability
- Weakness
- Rapid heart rate
- Shortness of breath
- Sensitivity to cold
- Headache
- Brittle nails
- Tongue pain or smooth tongue
- Decreased appetite
- Decreased saliva
- Craving dirt, clay, cornstarch, or ice
How is it treated?
• Diet
Increasing the dietary intake of iron can help prevent IDA from occurring. Iron-rich foods include meat (especially liver), raisins, fresh fruits and vegetables, fish, chicken, egg yolks, peas, beans, and whole-grain bread. However, iron is best absorbed from chicken, fish, and meat. Some beverages affect the absorption of iron. Drinking orange juice during meals can help increase the absorption of iron, while drinking tea or milk will decrease absorption of iron.
• Oral iron supplementation
Oral iron supplements can be used for treatment and prevention of IDA. The most common and cheapest form of iron available for supplementation is ferrous sulfate. Sometimes iron is used in combination with Vitamin C, as found in orange juice, to increase the absorption of iron into the body. Some foods and medications can decrease the absorption of iron into the body and should not be taken at the same time as iron supplements. Some examples include antacids and other medications to treat heartburn, milk and other dairy products, tetracycline antibiotics, and cholestyramine. The best absorption of iron supplements occurs on an empty stomach, but this can cause some stomach upset. If this occurs, it is acceptable to take the iron supplement with food. Another alternative is a product called Slow Fe. It is absorbed into the body more slowly and the manufacturer claims that it causes fewer side effects.
It is important to keep in mind that iron deficiencies cannot be corrected overnight. It usually takes several months of iron supplementation to replenish the iron that your body needs to function properly.
• IV iron supplementation
In severe IDA, IV iron may be given. IV iron may also be given to people who are unable to tolerate oral iron supplements. Some common IV iron supplements are iron dextran, iron sucrose, and sodium ferric gluconate. IV iron administration is usually associated with a higher risk of side effects and allergic reactions.
What is on the horizon?
Since IDA is caused by a deficiency of iron, it makes sense that the most effective treatment for it is iron supplementation. However, most commonly in the United States and other developed nations, the cause of IDA is not a deficiency of iron intake in the diet. Usually there is some other cause or underlying problem that is leading to a deficiency of iron and this problem needs to be corrected in order to effectively treat IDA. This is why most new treatment options for IDA are aimed at treating the underlying cause and not just the iron deficiency.
One example is oral contraceptive pills, or birth control pills, for women of childbearing age. Oral contraceptive pills usually result in a lighter menstrual flow. This decrease in blood loss can help prevent IDA from occurring. Some oral contraceptive pills also contain an iron supplement.
References
- Ieck B, Mason BJ, Thompson EG. Anemias. In: Dipiro JT, Talbert RL, Yee GC, et al. eds. Pharmacotherapy: A Pathophysiologic Approach. 6th ed. New York: McGraw-Hill; 2005:1805-1831.
- Iron Disorders Institute: Iron Deficiency Anemia. Available at: http://www.irondisorders.org/Disorders/Iron-Deficiency.asp. Accessed 08/14/2007 and 10/01/08.
- Mayo Clinic: Food and Nutrition: Iron Deficiency Anemia. Available at: http://www.mayoclinic.com/health/iron-deficiency-anemia/DS00323. Accessed 08/14/2007 and 10/01/08.
- Medline Plus: Iron Deficiency Anemia. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000584.htm. Accessed 08/14/2007 and 10/01/08.
- National Heart Lung and Blood Institute: Iron Deficiency Anemia. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/ida/ida_whatis.html. Accessed 08/14/2007 and 10/01/08.
Iron Deficiency Anemia Health Condition Last Updated: October 2008
Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It is not intended to diagnose a health condition, but it can be used as a guide to help you decide if you should seek professional treatment or to help you learn more about your condition once it has been diagnosed.