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Introduction
Anaemia, which is a condition that describes a low concentration of red blood cells, is a significant issue acknowledged by scholars and healthcare professionals globally. According to World Health Organization (WHO, n.d.), anemia mostly affects women of reproductive age and children less than five years old, with a global prevalence of 42% and 40%, respectively, in these two populations. The common causes of anemia include malnutrition, iron deficiency, and insufficient vitamins B12 and A (WHO, n.d.). This paper aims to describe iron deficiency anemia, its clinical symptoms, and strategies for treating the condition.
Iron Absorption, Distribution and Metabolism
To acquire a better understanding of the problem of iron deficiency anemia, it is crucial to understand the mechanism of iron absorption, distribution, and metabolism. There are two types of absorbable iron, including heme and non-heme iron (Ems, St Lucia, Huecker, 2021). Heme iron is received from hemoglobin and myoglobin in animal foods. The absorption level of such hemoglobin is between 15% and 35%, which is a very high proportion (Ems, St Lucia, Huecker, 2021). Non-heme iron is received from plants, and its absorption is more difficult for the human body. Even though daily iron requirements are low and the abundance of iron is high, insufficient iron intake is the most common cause of anemia.
Absorption of iron on a cellular level requires ferric atoms to be Fe+2, while it is more common in Fe+3 form. Absorption happens in the duodenum and proximal jejunum, where gastric acid transforms unabsorbable iron into absorbable iron due to its low pH (Ems, St Lucia, Huecker, 2021). When iron gets inside the erythrocyte, it can be stored as ferritin or transported into circulation bound to ferroportin. The ferritin molecule has ferroxidase activity, which transforms from Fe+2 to Fe+3 ions and vice versa (Ems, St Lucia, Huecker, 2021). The levels of iron are regulated with the help of hepcidin. Thus, illnesses that affect the mucosa of the duodenum may decrease the absorption of iron. Some of these conditions include celiac disease, Crohns disease, duodenal cancer, and duodenal ulcers.
An adult human body contains between three and five grams of iron distributed in different parts of the body (Zhang and Enns, 2009). The majority (6575%) are stored inside the hemoglobin of erythrocytes, and around 10%-20% are stored in the form of ferritin inside the liver (Zhang and Enns, 2009). In case of iron insufficiency, the liver releases the iron ions to restore balance. Inflammations can cause hepcidin expression in the liver, which causes decreased absorption and release of iron from the liver, causing iron deficiency anemia (Ems, St Lucia, Huecker, 2021).
Clinical Presentation
The primary functions of iron are building hemoglobin and transferring it to all parts of the body through the bloodstream. Thus, the lack of absorbable iron may lead to decreased concertation of blood cells. Iron deficiency anemia has a similar clinical presentation to other types of anemia. The common symptoms include being pale, increased unexplained fatigue, chest pains, shortness of breath, and rapid heartbeat (Espanel et al., 2007). Other symptoms include pounding in the ears, headache with activity, hair loss, brittle nails, and sore tongue (Lopez et al., 2016). In rare cases, anemia may lead to pagophagia, which is a craving for ice and clay. While the symptoms are numerous, they can be observed in different patterns depending on the specific case and patient.
Since symptoms of different types of anemia are similar, additional tests are required to establish the origin of the cause of anemia. Lopez (2016) insists on including a complete blood count (CBC) as the primary diagnostic method for iron deficiency anemia. While CBC alone is sufficient in the majority of anemia cases, additional tests may be required to determine the levels of serum ferritin, iron, total iron-binding capacity, and transferrin. These tests are expected to show some or all of the following results. First, iron deficiency anemia leads to low levels of hemoglobin and hematocrit (Cappellini, Musallam, and Taher, 2020). Second, the results may show low mean cellular volume, low ferritin, or low serum iron (Cappellini, Musallam, and Taher, 2020). The results of the tests may also show high transferrin or total iron-binding capacity and low iron saturation (Cappellini, Musallam, and Taher, 2020). Thus, iron deficiency anemia is usually diagnosed using blood tests.
Other supplementary methods for diagnoses can detect clinical representations of the condition. First, a fecal occult blood test may be taken to determine if there is any blood in the stool (Lopez, 2016). Anaemia may be caused by abnormalities in the gastrointestinal tract, which may require endoscopy, capsule enteroscopy, or even small bowel biopsy (Cappellini, Musallam, and Taher, 2020). Urine samples may also be taken to search for blood in them (Lopez, 2016). Finally, since women may experience increased menstrual blood loss, gynecologic evaluation may be needed. While these tests are possible, they are not commonly used for anemia.
Treatment Strategies
Diet
One of the most common strategies for treating iron deficiency is the correction of the diet. This strategy is used when iron absorption is not the cause of iron deficiency (Auerbach, 2022). The recommendations for the diet include increased consumption of meat, especially organ meat, poultry, fish, leafy green vegetables, legumes, and iron-rich pasta (Auerbach, 2022). It should be noticed, however, that this treatment strategy is appropriate only in light cases of anemia.
Medical Iron
One of the most common treatments for iron deficiency is medical iron in the form of capsules for oral administration. Adults usually require between 150 and 200 mg of iron, which is 2-5 mg of iron for every kilogram of weight (Auerbach, 2022). The dosage and the regimen are usually determined based on the examination of the patient. However, it is recommended that iron capsules are administered two hours before or four hours after antacids since iron is absorbed in the small intestine (Auerbach, 2022). Additionally, Vitamin C can help to absorb medical iron.
Intravenous Iron and Blood Transfusion
Intravenous iron is used in rare cases when the patients have a low ability to absorb iron, experience severe blood loss or iron deficiency, or patients with oral iron intolerance (Auerbach, 2022). Iron infusion is usually administered with iron dextran, iron sucrose, or ferric gluconate (Auerbach, 2022). While this strategy can help in some cases of anemia, it is associated with significant side effects, such as allergic reactions, urticaria, pruritus, and pain in the muscles and joints (Auerbach, 2022). In severe cases, a blood transfusion may be used to treat anemia short-term in case of blood loss or intense chest pain, shortness of breath, or weakness. However, blood transfusion does not treat the condition and only provides a temporary improvement (Auerbach, 2022).
Conclusion
Iron deficiency anemia is a common condition among women and children younger than five years old. The condition has similar symptoms as all the other anemias, which include paleness, increased unexplained fatigue, chest pains, shortness of breath, rapid heartbeat, and others. Treatment strategy depends on the severity of symptoms. While most of the cases can be treated with diet correction and medical iron administration, severe cases are treated with blood transfusion and intravenous iron.
Reference List
Auerbach, M. (2022) Treatment of iron deficiency anemia in adults. Web.
Cappellini, M. D., Musallam, K. M., and Taher, A. T. (2020) Iron deficiency anaemia revisited, Journal of Internal Medicine, 287(2), pp. 153-170.
Ems T, St Lucia, K., Huecker, M.R. (2021) Biochemistry, Iron Absorption. Web.
Espanel, C. et al. (2007) Iron deficiency anaemia: Clinical presentation, biological diagnosis and management, Transfusion clinique et Biologique: journal de la Societe Francaise de transfusion sanguine, 14(1), pp. 21-24.
Lopez, A. et al. (2016) Iron deficiency anaemia, The Lancet, 387(10021), pp. 907-916.
World Health Organization (n.d.) Anaemia. Web.
Zhang, A. S., and Enns, C. A. (2009) Iron homeostasis: recently identified proteins provide insight into novel control mechanisms, Journal of Biological Chemistry, 284(2), pp. 711-715.
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