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Iron Deficiency Anemia

The body needs iron to make hemoglobin, the most important component of the red blood cells. Insufficient supply of iron limits the production of hemoglobin, which in turn affects the production of red blood cells (RBCs). This decreased amount of hemoglobin and RBCs in the bloodstream is known as anemia. Since, RBCs are needed to carry oxygen throughout the body, anemia results in less oxygen reaching the cells and tissues, affecting their function (AMAG Pharmaceuticals).

Iron-deficiency anemia (IDA), often caused by inadequate iron ingestion. It is the major cause of anemia in childhood. Iron-fortified infant formulas and cereals have substituted the iron requirement in infants of United States (American Reagent).

IDA or Iron-deficiency anemia doesn't develop instantly, but, a person develops through stages of iron deficiency, beginning with iron diminution, in which the amount of iron in the body is reduced while the iron in RBCs remains constant, persistence of this leads to progression of iron deficiency, ultimately leading to IDA. This is because the red blood cells will have less hemoglobin than normal.

Causes

Iron-deficiency anemia is a resultant of several factors, encompassing- insufficient iron in the diet, poor absorption of iron by the body, ongoing blood loss, most commonly from menstruation or from gradual blood loss in the intestinal tract, episodes of rapid growth. In certain cases poverty becomes a contributing factor to IDA because families living at or below the poverty level may not be getting enough iron-rich foods.

It is manifested that Iron deficiency alters the physiological functions and IDA enables the body to absorb more lead, which enhances the risk of lead poisoning in kids, particularly those living in older homes. This leads to ill health and also children face difficulties in learning and show behavioral problems. Moreover, rapid growth demands more iron and therefore any kind of iron deficiency in nutrition leads to IDA. It is observed that, infants, discontinuing iron-fortified formula and substituted with cow's milk before 12 months can lead to IDA. Since, cow's milk is low in iron essential for infant growth and development; it often replaces the consumption of iron-rich foods. Milk reduces the absorption of iron causing irritation in the intestinal mucosa resulting in small amounts of bleeding. This slow, gradual loss of blood in the stool — combined with low iron intake — may eventually result in IDA.

Other causes of IDA encompass prematurity and low birth weight, poor iron intake in the diet for children between the ages of 1 and 3 years make them prone to IDA, high consumption of cow’s milk, during the onset of puberty, when growth is at its peak, boys are at risk of IDA. Adolescent girls are at higher risk because of menstrual blood loss and smaller iron stores than boys. Many girls also tend to consume a diet low in iron. On the contrary, multivitamins with iron aren't adequate and taking too much iron is a major cause of serious poisoning in children

Deficiency of Vitamin C also leads to poor iron absorption leading to IDA as vitamin C enhances iron absorption in the body. Inadequate daily intake of iron in pregnancy, growth spurts or blood loss due to heavy period or internal bleeding also cause IDA. This causes depletion of iron in the body and in the bone marrow. Women have less stores of iron than men because of the blood loss during menstruation (Watson Pharma).

In men and postmenopausal women, anemia is usually due to gastrointestinal blood loss associated with ulcers, the use of aspirin or nonsteroidal anti-inflammatory medications, or colon cancer. Various other ailments like Gauche Disease may also cause anemia. In some rare cases, IDA can become life-threatening resulting in hospitalization and a blood transfusion.

Symptoms of IDA

 Iron-deficiency anemia can cause fatigue (tiredness), pale skin and mucous membrane, shortness of breath, chest pain, rapid heartbeat or a new heart murmur, irritability, reduced appetite and other symptoms resulting in tiredness and dizziness. Severe iron-deficiency anemia can lead to heart problems, infections, problems with growth and development in children, and other complications. Individuals with highest risk for iron-deficiency anemia include infants and young children, women, and adults who have internal bleeding. Therefore, diet must be supplemented with nutrition rich in iron including meat, leafy green vegetables and iron-fortified grains. Under certain conditions the body does not absorb iron properly and may need a lot more iron to make enough red blood cells. Under this condition, additional iron requirement is supplemented with iron pill taken orally or an iron injection.

Rarely, a person with IDA may experience pica, a craving to eat nonfood items such as paint chips, chalk, or dirt. Pica may be caused by a lack of iron in the diet.

Diagnosis

A complete blood count (CBC) may disclose low hemoglobin levels and low Hematocrit (the percentage of the blood made up of red blood cells). The CBC also gives information about the size of the RBCs because RBCs with low hemoglobin tend to be smaller and less pigmented. The reticulocyte count measures the number of immature red blood cells being produced, due to poor dietary intake of iron the RBCs are not able to reach the complete development and hence reduced oxygen carrying capacity of RBCs is observed. In some cases serum iron is measured, but it may not give the value of iron concentrated in the body’s cells. One the other hand, serum ferritin reflects total body iron stores. It's one of the earliest indicators of depleted iron levels.

Oral Iron Supplements

 Iron pills including the three forms of ferrous iron. All iron supplements will cause stool to become dark in color.

Iron injection

 Iron injections are liquid solutions containing iron which are either injected directly into the blood stream through an IV or into the muscle (IM) – often the upper arm. They are given to the subjects who are not able to take their full dose of oral iron or their body cannot properly absorb iron through their digestive tract. They may also be given to patients who have extremely low levels of iron or who have lost a large amount of blood. Iron given by injection doesn’t follow the path of absorption through the intestines, but is delivered directly to the circulatory system; therefore, can help build red blood cells more quickly than oral iron.

Iron injections include three major types: iron dextran, ferumoxytol and carbohydrate iron, which includes the forms ferric gluconate and iron sucrose. Iron injections may show side effects like anaphylaxis, low blood pressure, flushing, headache, muscle and joint pain, dizziness, nausea, rashes, pain and inflammation at the injection site, fever, chills. Ferric gluconate and iron sucrose – These two iron solutions are known to trigger an allergic reaction to a lesser extent.

Conclusion

 Iron deficiency anemia is the most common form of anemia. About 20% of women, 50% of pregnant women, and 3% of men are iron deficient (Fishbane, 1999). Some people with iron deficiency anemia always feel cold, because iron plays a role in regulating the body's temperature. Iron can be found in red meat, liver, raisins, spinach, broccoli, andegg yolk. Even though most cases of IDA are the result of poor dietary iron intake, diet changes alone usually aren't enough to replenish depleted iron stores. Likewise, multivitamins with iron aren't adequate for kids with IDA who have such low iron stores, so a separate daily iron supplement may be required. Vitamin C enhances iron absorption and must also be supplemented in the food. Rarely, IDA is so severe and possibly life-threatening that hospitalization and a blood transfusion may be required.

Research shows that do play an imperative role in the normal progression and establishment of sleep patterning. IDA is known to show some implications in the temporal modulation and early functional integration along with brain development persistence of such condition is known to have negative implications on the development.

Looking into the prevalence of IDA it becomes imperative to understand all the aspects of iron deficiency and its relation with other implications. And therefore much research is carried out to understand the disease and its manifestations.

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Monika Nigam

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