Iron deficiency anaemia (IDA) is one of the most common forms of anaemia globally, affecting millions of people, particularly women and children. Understanding it's causes, clinical features and effective management strategies is crucial for improving health outcomes.
This blog post delves into the latest information about Iron deficiency anaemia (IDA), exploring it's intricacies and providing a detailed overview of it's management including iron therapy and guidelines from the World Health Organization (WHO).
Let's discuss about what Iron Deficiency Anaemia is.
Iron deficiency anemia is a form of microcytic hypochromic anaemia that occurs when the body lacks sufficient iron to produce adequate amounts of hemoglobin (the protein in red blood cells responsible for transporting oxygen). This deficiency can result from inadequate iron intake, increased requirements or loss of blood. The condition can lead to various health issues including fatigue, weakness and impaired cognitive function, underscoring the importance of timely diagnosis and treatment.
Do you know the causes of Iron Deficiency Anaemia?
The etiology of iron deficiency anemia can be multifactorial. Here are the common causes:
1. Inadequate Dietary Intake
A diet low in iron-rich foods can lead to iron deficiency. Populations at risk include:
- Vegetarians and Vegans: Individuals not consuming meat may have lower iron intake, as plant-based sources contain non-heme iron (which is less bioavailable).
- Poor Dietary Habits: High consumption of processed foods and low intake of fruits, vegetables and whole grains can contribute to deficiencies.
2. Increased Physiological Demands
Certain life stages require more iron due to physiological changes:
- Pregnancy: The growing fetus demands additional iron, often surpassing maternal stores.
- Infancy and Childhood: Rapid growth in children requires sufficient iron for development.
3. Chronic Blood Loss
Chronic blood loss is a significant contributor to Iron Deficiency Anaemia, often due to:
- Menorrhagia (heavy menstrual period)
- Haemorrhoids
- Anal fissure
- Bleeding peptic ulcer disease
- Anorectal polyps
- Gastric & colorectal malignancy
- Hookworm infestation
4. Malabsorption
Certain gastrointestinal conditions can impair iron absorption:
- Celiac Disease: An autoimmune disorder that affects nutrient absorption.
- Inflammatory Bowel Disease: Conditions like Crohn's disease can lead to malabsorption of iron.
5. Chronic Diseases
Chronic illnesses can influence iron metabolism, leading to deficiency:
- Kidney Disease: Reduced erythropoietin production in chronic kidney disease can decrease red blood cell production.
- Malignancy: Tumors can lead to anaemia through various mechanisms including blood loss and altered iron metabolism.
6. Other Contributing Factors
- Certain Medications: Medications that affect stomach acidity (like proton pump inhibitors) can hinder iron absorption.
- Age: Elderly individuals may have higher susceptibility due to chronic diseases or inadequate dietary intake.
Clinical Features of Iron Deficiency Anemia
When Iron Deficiency Anaemia develops, you'll notice certain characteristics. Recognizing the clinical manifestations of Iron Deficiency Anaemia is essential for prompt diagnosis and treatment.
Symptoms that an anaemic individual may observe:
- Fatigue
- Weakness
- Tiredness
- Effort dyspnoea
- Effort angina
- Headache
- Dysphagia (in Plummer-vinson syndrome or Paterson-Brown-Kelly syndrome)
Signs that an physician will get:
- Pallor
- Angular stomatitis
- Atrophic glossitis
- Koilonychia (spoon-shaped nails)
- Brittle nails
- Brittle hair
- Paraesthesia
Diagnosing Iron Deficiency Anaemia typically involves a combination of clinical evaluation and laboratory tests.
Medical History and Physical Examination
A thorough medical history, including dietary habits, menstrual history, and any underlying health conditions, is essential. A physical examination may reveal signs such as pallor and tachycardia.
Laboratory Diagnosis of A Case of Iron Deficiency Anaemia
1. Blood picture:
- Hb% - Reduced
- Peripheral blood film -Microcytic, hypochromic RBC with anisocytosis & poikilocytosis. Target cells, pencil cells etc. may be found in severe cases.
2. Serum Iron Profile:
- Serum iron - Reduced (2.5-10 μmol/L)
- Serum ferritin - Reduced (less than 12 μgm/L)
- Percent saturation - Decreased (less than 16%)
- Total iron binding capacity (TIBC) - Increased (upto 100 μmol/L)
3. Investigation of the cause: This will depend upon the age & sex of the patient as well as the history & clinical findings.
- Upper GI endoscopy (if bleeding peptic ulcer is suspected)
- Stool examination for occult blood & ova of hookworm
- Urine examination for microscopic haematuria
How will you manage a case of Iron Deficiency Anaemia?
Managing Iron Deficiency Anaemia involves addressing the underlying cause, restoring iron levels and monitoring response to treatment. Here are the key strategie:
1. Dietary Changes: Encouraging dietary modifications is the first step in managing mild cases:
- Iron-Rich Foods: Incorporate sources of heme iron (meat, fish, poultry) and non-heme iron (beans, lentils, fortified cereals, dark leafy greens).
- Vitamin C Intake: Consuming vitamin C-rich foods (oranges, strawberries, bell peppers) alongside iron sources can enhance non-heme iron absorption.
2. Treatment:
Oral Iron Supplementation
Unless the patient has angina, heart failure or evidence of cerebral hypoxia, transfusion is not necessary and oral iron supplementation is appropriate.
- Ferrous sulfate is the most commonly prescribed form, typically taken in doses of 200 mg 8 hourly (195 mg of elemental iron per day) for 3-6 months to replete iron stores.
- If intolerant of ferrous sulphate (dyspepsia & altered bowel habit), a reduction in dose to 200 mg 12 hourly or a switch to ferrus gluconate 300 mg 12 hourly (70 mg of elemental iron per day) is given.
Common side effects of oral iron supplementation include gastrointestinal discomfort, constipation or diarrhoea. These can often be managed by adjusting the dose or changing the formulation (e.g. ferrous gluconate or ferrous fumarate).
Duration of Treatment: Iron therapy usually continues for 3-6 months after hemoglobin levels normalize to replenish iron stores.
The Hb should rise by 1gm/dl (10gm/L) every 7-10 days.
Reticulocyte response will be evident by 1 week.
Parenteral Iron therapy
In cases where oral iron is not tolerated, ineffective or when rapid correction is necessary (such as in patients with severe anaemia or chronic kidney disease), intravenous iron therapy is given. Parenteral iron allows for higher doses to be delivered quickly, reducing the need for frequent dosing.
- Common options include iron dextran, iron sucrose, iron isomaltose and iron carboxymaltose.
- Doses required can be calculated based on the patient's starting Hb and body weight.
- Observation for anaphylaxis following an initial test dose is recommended.
3. Treating Underlying Causes:
Identifying and managing underlying conditions contributing to iron deficiency is crucial:
- Addressing Menorrhagia: Options may include hormonal therapies or surgical interventions to manage heavy menstrual bleeding.
- Gastrointestinal Disorders: Treatment of conditions like peptic ulcers or inflammatory bowel disease can improve absorption and reduce blood loss.
4. Monitoring and Follow-Up
Regular follow-up is essential to assess treatment effectiveness and adjust as needed:
- Laboratory Monitoring: Repeated CBC and iron studies should be performed 1-2 months after starting treatment to evaluate hemoglobin levels and iron status.
- Symptom Assessment: Monitor the resolution of symptoms to gauge improvement.
WHO Guidelines on Iron Deficiency Anaemia
The World Health Organization (WHO) has established guidelines to combat iron deficiency anaemia, emphasizing preventive measures, education and treatment:
1. Universal Iron Supplementation
WHO recommends iron supplementation for:
- Pregnant Women: Daily supplementation of 30–60 mg of iron to prevent deficiency during pregnancy.
- Young Children: Iron supplements for infants and young children, especially in regions with high prevalence.
2. Dietary Education
WHO highlights the importance of nutrition education in preventing Iron Deficiency Anaemia. Promoting awareness about iron-rich foods and the benefits of a balanced diet can significantly reduce deficiency rates.
3. Screening and Diagnosis
Routine screening for anemia in at-risk populations is essential. The WHO advises regular hemoglobin testing for pregnant women and young children to facilitate early detection and treatment.
4. Integrated Health Programs
WHO encourages the integration of anemia prevention strategies into broader health programs, focusing on improving overall maternal and child health, nutrition, and chronic disease management.
Iron deficiency anaemia is a widespread health concern with significant implications for overall well-being. Understanding its causes, symptoms and effective management strategies is vital for healthcare professionals and patients alike. Through a combination of dietary interventions, iron supplementation and addressing underlying conditions, Iron Deficiency Anaemia can be effectively managed. Adhering to WHO guidelines can further enhance efforts to prevent and treat this condition, ultimately improving health outcomes for vulnerable populations. If you suspect you or someone you know may be experiencing symptoms of iron deficiency anaemia, consult a healthcare provider for proper evaluation and management.
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