Iron Deficiency Anemia, the most common anemia

Hello guys, as I said before, I’m going to write something about health topic. Today I will explain about a problem with iron in blood. It is Iron-Deficiency Anemia (IDA).

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Definition
Iron-deficiency anemia is a common type of anemia that occurs if you do not have enough iron in your body. People with mild or moderate iron-deficiency anemia may not have any signs or symptoms. More severe iron-deficiency anemia may cause fatigue or tiredness, shortness of breath, or chest pain. Iron Deficiency Anemia is the most common anemia in daily life. Iron deficiency anemia (IDA) is a certain anaemic condition arising due to the inadequate iron to form normal Red Blood Cell (RBCs). IDA is usually caused by insufficient iron intake, chronic blood loss, and increased iron demand.

Epidemiology
The prevalence of iron deficiency varies greatly according to host factors: age, gender, physiological, pathological, environmental, and socio-economic conditions. A study of national primary care database for Italy, Belgium, Germany, and Spain determined that annual incidence rates of iron deficiency anemiaI ranged from 7.2 to 13.96 per 1,000 person-years. Higher rates were found in females, younger and older persons, patients with gastrointestinal diseases, pregnant women and women with a history of menometrorrhagia, and users of aspirin and/or antacids.
In countries where little meat is in the diet, iron deficiency anemia is 6-8 times more prevalent than in North America and Europe. This occurs despite consumption of a diet that contains an equivalent amount of total dietary iron; the reason is that heme iron is absorbed better from the diet than nonheme iron. In studies of children and adolescents from Sudan and Nepal, iron deficiency anemia was found in as many as two thirds of subjects.
Anaemia is particularly prominent in south Asia. In India, for example, up to 88% of pregnant and 74% of non-pregnant women are affected. Throughout Africa, about 50% of pregnant and 40% of non-pregnant women are anaemic. West Africa is the most affected, and southern Africa the least. In Latin America and the Caribbean, prevalences of anaemia in pregnant and non-pregnant women are about 40% and 30% respectively. The highest levels are in the Caribbean, reaching 60% in pregnant women on some islands.

Etiology and Risk Factors

• Dietary factors
  Meat provides a source of heme iron, which is less affected by the dietary constituents that markedly diminish bioavailability than nonheme iron is. The prevalence of iron deficiency anemia is low in geographic areas where meat is an important constituent of the diet. In areas where meat is sparse, iron deficiency is commonplace.
• Hemorrhage
  Bleeding for any reason produces iron depletion. If sufficient blood loss occurs, iron deficiency anemia ensues. A single sudden loss of blood produces a posthemorrhagic anemia that is normocytic. The bone marrow is stimulated to increase production of hemoglobin, thereby depleting iron in body stores. Once they are depleted, hemoglobin synthesis is impaired and microcytic hypochromic erythrocytes are produced.
• Hemosiderinuria (Brown urine), hemoglobinuria (excretion of free hemoglobin in the urine), and pulmonary hemosiderosis (alveolar capillary bleeding and accumulation of haemosiderin in the lungs)
• Malabsorption of iron
  Malabsorption is a disorder of the gastrointestinal tract that leads to defective digestion, absorption and transport of important nutrients across the intestinal wall. Disorders of malabsorption lead to decreased iron absorption and produce iron deficiency anemia.
• Iron-refractory iron deficiency
  Iron-refractory iron deficiency anemia (IRIDA) is a hereditary disorder marked by with iron deficiency anemia that is typically unresponsive to oral iron supplementation and may be only partially responsive to parenteral iron therapy.
  Risk factors :
• Age
  You may be at increased risk for iron deficiency at certain ages:
  • Infants between 6 and 12 months, especially if they are fed only breast milk or are fed formula that is not fortified with iron. The iron that full-term infants have stored in their bodies is used up in the first 4 to 6 months of life. Babies who were born prematurely may be at an even higher risk, as most of a newborn’s iron stores are developed during the third trimester of pregnancy.
  • Children between ages 1 and 2, especially if they drink a lot of cow’s milk. Cow’s milk is low in iron.
  • Teens, who have increased need for iron during growth spurts.
  • Older adults, especially those over age 65.
• Unhealthy environments
  Children who have lead in their blood from their environment or water. Lead interferes with the body’s ability to make hemoglobin.
• Family history and genetics
  Von Willebrand disease is an inherited bleeding disorder that affects the blood’s ability to clot. This makes it harder to stop bleeding and can increase the risk of iron-deficiency anemia from trauma, surgery, or heavy menstrual periods.
  Individuals with a gene for hemophilia, including symptomatic female carriers who have heavy menstrual periods, may be at risk for iron-deficiency anemia.
• Lifestyle habits
  Certain lifestyle habits may increase your risk for iron-deficiency anemia, including:
  • Vegetarian or vegan eating patterns. Not eating enough iron-rich foods, such as meat and fish, may result in you getting less than the recommended daily amount of iron.
  • Frequent blood donation. Individuals who donate blood often may be at risk for iron-deficiency anemia.
  • Endurance activities and athletes. Athletes, especially young females, are at risk for iron deficiency. Endurance athletes lose iron through their gastrointestinal tracts. They also lose iron through the breakdown of red blood cells, called hemolysis. Hemolysis, in this case, is caused by strong muscle contractions and the impact of feet repeatedly striking the ground, such as with marathon runners.
• Sex
  Girls and women between the ages of 14 and 50 years need more iron than boys and men of the same age. Women are at higher risk for iron-deficiency anemia under some circumstances, including:
  • During menstruation, especially if you experience heavy periods.
  • During pregnancy, after delivery, or when breastfeeding you may be consuming less than the recommended daily amount of iron. This is because your need for iron increases during these periods of growth and development, and it may be hard to get the recommended amount from food alone. Pregnant women need more iron to support the growth of their unborn babies, so their bodies produce more blood. With more red blood cells on hand, their bodies can store iron to prepare for blood loss during delivery.

Signs and Symptoms

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• Very frequent
  • Dimness or Paleness
  • Exhaustion and tiredness
  • Dyspnoea
  • Headache
• Frequent
  • Diffuse and moderate alopecia
  • Atrophic glossitis
  • Restless legs syndrome
  • Dry and rough skin
  • Dry and damaged hair
  • Cardiac murmur
  • Tachycardia
  • Neurocognitive dysfunction
  • Angina pectoris
  • Vertigo
• Rare
  • Haemodynamic instability
  • Syncope
  • Koilonychia
  • Plummer-Vinson syndrome

Diagnostic
IDA diagnosis necessitates the laboratory investigation. IDA should not be presumed unless confirmed by laboratory testing in addition to evidence of low iron stores. The evaluation of the primary reason for anaemia includes a complete blood count (CBC), peripheral blood smear, reticulocyte count, and serum iron indices. A CBC can be helpful in determining the mean corpuscular volume (MCV), which measures the average size of RBCs, and mean corpuscular haemoglobin concentration, which measures the concentration of haemoglobin in a given amount of packed RBCs.
Patients suspected to have IDA should undergo iron studies test. The results determined from this test should be correlated with the red cell indices. The serum ferritin level is the most commonly available and useful index of iron deficiency. Iron studies diagnostic for IDA consists of low haemoglobin (<13 g/dL and <12 g/dl in women), low transferrin saturation (<15%), a low serum ferritin (<30 μg/L), and high total iron-binding capacity (>13.1 μmol/l)

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Complications
Undiagnosed or untreated iron-deficiency anemia may cause the following complications:

• Depression
• Heart problems. If you do not have enough hemoglobin-carrying red blood cells, your heart has to work harder to move oxygen-rich blood through your body. Cells in tissues need a steady supply of oxygen to work well. Normally, hemoglobin in red blood cells takes up oxygen in the lungs and carries it to all the tissues of the body. When your heart has to work harder, this can lead to several conditions: irregular heartbeats called arrhythmias, a heart murmur, an enlarged heart, or even heart failure.
• Increased risk of infections
• Motor or cognitive development delays in children
• Pregnancy complications, such as preterm delivery or giving birth to a baby with low birth weight
  In people with chronic conditions, iron-deficiency anemia can make their condition worse or result in treatments not working as well.

Treatment

• Dietary therapy
  Increasing dietary iron consumption alone is insufficient to treat IDA and higher supplemental doses of iron are essential. However, increasing the iron intake and enhancing the absorption by minimizing the inhibitors and maximising the enhancers may be valuable for secondary prevention of iron deficiency.
• Oral iron therapy
  The dosage of iron required to treat IDA in adults is 120 mg/day for three months; the dosage for children is 3 mg/kg per day, up to 60 mg/day. In a study done by Baker et al. an increase in haemoglobin of 1 g/dL after one month on treatment showed an adequate response to treatment and confirmed the diagnosis of IDA. In adults with IDA, the treatment should be continuously undergone for three subsequent months after the anaemia is corrected for the replenishment of the iron stores.
• Parenteral iron therapy
  Parenteral treatment may be used in patients who cannot absorb or tolerate oral iron, such as those who have undergone gastrectomy, bariatric surgery, gastrojejunostomy, or other small bowel surgeries. The most adverse effect of intravenous therapy includes GI effects, worsening symptoms of inflammatory bowel disease, renal-failure-induced anaemia treated with erythropoietin, unresolved bleeding, and insufficient absorption in patients with celiac disease.
• Red cell transfusion
  Transfusion of red cells is a warranted treatment for severe anaemia. Recommendations often specify certain haemoglobin values as indications to transfuse, but the patient’s clinical condition and symptoms are critical mode of determining whether RBC transfusion should be carried out or not. Transfusion is associated with adverse consequences, including fluid overload, and a range of immunological hazards. Therefore, it should be kept for immediate, targeted management in patients with severe anaemia and end-organ function, or where IDA is complicated by series acute on-going bleeding. Iron treatment must always follow transfusion to restore iron.

Prevention
Certain populations are at sufficiently high risk for iron deficiency to warrant consideration for prophylactic iron therapy. These include pregnant women, women with menorrhagia, consumers of a strict vegetarian diet, infants, adolescent girls, and regular blood donors.
When caused by inadequate iron intake, iron deficiency anemia can be prevented by eating a diet high in iron-rich foods and vitamin C. Mothers should make sure to feed their babies breast milk or iron-fortified infant formula.
Foods high in iron include:

• meat, such as lamb, pork, chicken, and beef
• beans
• pumpkin and squash seeds
• leafy greens, such as spinach
• raisins and other dried fruit
• eggs
• seafood, such as clams, sardines, shrimp, and oysters
• iron-fortified dry and instant cereals
  Foods high in vitamin C include:
• fruits such as oranges, grapefruits, strawberries, kiwis, guavas, papayas, pineapples, melons, and mangoes
• broccoli
• red and green bell peppers
• Brussels sprouts
• cauliflower
• tomatoes
• leafy greens

Conclusion
Iron-Deficiency Anemia is a type of anemia when you don't have enough iron in your blood. The causes are increase of iron demand, loss of iron and malabsorption/decreased iron intake. The symptoms are paleness, dizziness, exhaustion, dry skin, and dyspnoea. The diagnosis based on lab findings. The treatment for Iron-Deficiency Anemia are correcting the underlying disease and iron suplementation.

References

• WHO IDA Assesment, Prevention, and Control
• IDA : Journal of Cancer Research and Immuno-Oncology
• Iron Deficiency Anemia, heartline.com
• Iron deficiency in critically ill patients: highlighting the role of hepcidin
• Disorders associated with malabsorption of iron: A critical review
• Iron Deficiency Anemia, medscape
• IDA Signs, Symptoms, and Complications : NIH
• IDA Risk Factors : NIH
• My lecturer lectures

That's all from my writting, i'm sorry if there is errors. Thank you for reading !