Iron deficiency anemia, iron deficiency anemia causes, laboratory evaluation

Iron plays a vital role in red blood cell production, and deficiency is the most common cause of anemia. As many as 20 per cent of women in general and 80 per cent of those who exercise may be iron-deficient. Severe deficiency leads to anemia as hemoglobin concentration falls below the normal range and red blood cells become small and pale. The prevalence of iron deficiency anemia in the USA is about 2 to 5 per cent and it is also a major problem in developing countries.

Iron deficiency anemiaAs well as the symptoms of anemia described above, someone suffering from severe iron deficiency anemia may crave dirt or paint; a condition known as pica.

Causes of iron deficiency anemia

Iron deficiency anemia can be due to increased iron losses and/or inadequate intake. As iron is poorly absorbed, many people find it difficult to meet their daily needs. For those whose needs are higher or whose absorption is poor, the risk of iron deficiency anemia increases. This is particularly the case in infants under 2 years old, pregnant women, teenage girls, and elderly people. Women are more likely to suffer from iron deficiency as they store less iron than men and lose iron monthly in menstrual blood. Iron deficiency anemia is relatively common in elderly people, particularly those who are in hospital.

There are many other factors which put someone at risk of iron deficiency, with multiple risk factors increasing the likelihood. These include an increased rate of body growth, excessive menstrual blood loss, regular blood donation, intensive exercise, a vegetarian diet, chronic aspirin use, low iron intake, low vitamin C intake, excess tea and coffee, fad diets, poverty, alcohol abuse, depression and gastrointestinal disease such as celiac disease. If several of these factors are present, the risk is obviously greater. In the absence of these risk factors, a careful search for gastrointestinal blood loss is necessary.

Anemia is the final stage of iron deficiency. Before the red blood cells are affected, iron stores are reduced but there are no clinical effects. The next stage is biochemical deficiency without symptoms; and as depletion continues, iron-dependent enzymes are affected, and immune functions requiring iron may be affected. Symptoms of anemia can develop gradually and may continue without being recognized for some time.

Laboratory evaluation of iron deficiency anemia

In addition to the laboratory measures described above, there are specific tests which can help to diagnose iron deficiency anemia. These tests, which include serum ferritin and TIBC (total iron-binding capacity) measures are more sensitive predictors of iron deficiency. Iron levels may fluctuate throughout the menstrual cycle in women and the average values from multiple tests may provide the best readings.

Serum ferritin measurement accurately reflects body stores and this is usually the earliest laboratory measure to reflect iron deficiency. It is a sensitive test and is not affected by day-to-day fluctuations in intake. Normal serum ferritin levels are 40 to 160 mcg per liter, with iron deficiency anemia indicated by a level of 12 mcg per liter. However, a normal serum ferritin does not rule out iron deficiency as certain conditions such as infection, inflammation, liver disease, some cancers and recent strenuous exercise can raise serum ferritin levels.

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