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Iron Deficiency Anemia


OVERVIEW OF Iron Deficiency Anemia :

 Iron deficiency  anemia is termed as the reduced iron content of the RBC and hemoglobulin levels.


EPIDEMIOLOGY :

An iron deficiency anemia affects 8.8% of the population world wide.It is slighltly more common among females than males.

Normal volume of Hb-13.5-17.5gm/dl in men

                                          12-15gm/dl in women


CAUSES :

Bleeding-it may occur due to injury to the vessel wall, coagulation factor deficiency

Reduced intake of iron supplements in food

Internal bleeding

Endometriosis

Inability to absorb the iron

Lead poisoning

Chronic kidney diseases and enlarged spleen

Hypothyroidism

Cancer

Post operative to major or minor surgeries

 


PATHOPHYSIOLOGY :

Subnormal levels of hemoglobin causes lower oxygen carrying capacity of the blood.  This ,in turn initiates compensatory physiologic adaptation as follows.

Increased release of oxygen from blood

Increased blood flow to the tissues

Maintenance of the volume of blood

Redistribution of blood flow to maintain the cerebral supply

Tissue hypoxia leads to the impaired function of the organs.

 


COMMON CLINICAL SIGNS AND SYMPTOMS :

Tiredness

Lightheadeness

Breathlessness

Ischaemic symptoms

Signs:

Mucous membrane pallor,conjunctiva

Faintness giddiness ,tinnitus,numbness might be seen

Dyspnoea occurs

Retinal haemorrhage is seen if there is any associated visual illnessa or bleeding diathesis

Tachypnoea

Raised jugular venous pressure

Flow murmurs

Ankle edema

Amenorrhoea and loss of libido might be seen.

Postural hypotension

Anorexia,flatulence and weight loss might occur.

 


DIAGNOSTIC :

  • Complete blood count (CBC):
  •  A CBC is used to count the number of blood cells in a sample of your blood. For anemia, your doctor will be interested in the levels of the red blood cells contained in your blood (hematocrit) and the hemoglobin in your blood.

Normal adult hematocrit values vary among medical practices but are generally between 40% and 52% for men and 35% and 47% for women. Normal adult hemoglobin values are generally 14 to 18 grams per deciliter for men and 12 to 16 grams per deciliter for women.

  • A test to determine the size and shape of your red blood cells(Peripheral blood smear)Some of your red blood cells might also be examined for unusual size, shape and color.
  • Serum iron and ferritin test-to check the amount of iron in blood and body
  • Reticulocyte test:to check that the bone marrow is functioning in an accelerated level
  • Haemoglobin electrophoresis:to check the abnormality of haemoglobin as seen in the sickle cell iron deficiency iron deficiency anaemia and thalassemia.
  • Osmotic fragility test: to check if the red blood cells are more fragile than usual
  • Endoscopy:to check for internal bleeding
  • Colonoscopy:to check for bleeding from tumour in the intestine
  • Ultrasound:to check for enlarged spleen
  • Doppler ultrasound:it detect the circulatory anomalies that is suggestive of iron deficiency iron deficiency anaemia  in new borns
  • Body Magnetic resonance imaging:It is used to reveal the functions of bone marrow and also it is used to find the deposition of iron in heart,liver and other vital organs.

 


TREATMENT AND PROGNOSIS :

Oral iron

Nutritional iron deficiency is common in developing nations. An estimated two-thirds of children and of women of childbearing age in most developing nations are estimated to have iron deficiency without anemia; one-third of them have iron deficiency with anemia.[72] Iron deficiency due to inadequate dietary iron intake is rare in men and postmenopausal women. The diagnosis of iron deficiency mandates a search for potential sources of blood loss, such as gastrointestinal bleeding from ulcers or colon cancer.

Mild to moderate iron-deficiency anemia is treated can be treated by intake of oral supplements with ferrous sulfateferrous fumarate, or ferrous gluconate. Routine intake of Iron supplement is indicated in women with child bearing age and also in pregnant women.Large amount of intake of iron might results in darkening of the faecal matter.  Vitamin C promotes the absorption of an iron hence while taking the iron supplements one can take vitamin c as an adjuvant.If the iron deficiency iron deficiency anaemia occurs in chronic kidney disease recombinant erythropoietin is recommended.

Injectable iron:

Parenteral Iron is given when iron is not taken by the oral route and the patient feel difficulty in taking iron supplemets orally.It is very much useful in patients with postpartum haemorrhage,longtime kidney diseases and inflammamtory bowel syndrome. The body is capable of absorbing 6mg of iron daily from the gastrointestinal tract. In chroic cases erythropeitin can be used as the supplements to restore the Iron.

Blood transfusions:

Blood transfusion is mainly indicated in the patients who  are symptomatic and the haemoglobin level is below 6-8gm/dl.In cardiac patients who are actively bleeding and the Hb level is below 8 should undrgo blood transfusion.

In cancer patients before the transfusion of the blood other strategies should be checked in them.if anyoter alternatives is possible it can be opted in them.

Erythropoiesis-stimulating agents:

 The main aim of Erythropoiesis stimulating agents is to minimize the transfusion reactions and it is not recommended in peoples with mild to moderate symptoms.It is contraindicated in people with chronic kidney disease unless their Hb level is maintained at less than 10. They should be used in adjunct to the oral iron.

Hyperbaric oxygen:

Treatment of exceptional blood loss (anemia) is recognized as an indication for hyperbaric oxygen (HBO) The use of HBO is indicated when oxyhen delivery to tissue is not sufficient in patients who cannot be given blood transeasons. HBO may be used for medical reasons when threat of blood product incompatibility or concern for transmissible disease are factors. The beliefs of some religions (ex: Jehova's witnesses
) may require they use the HBO method.

Pre-operative anemia:

An estimated 30% of adults who require non-cardiac surgery have anemia. In order to determine an appropriate pre-operative treatment, it is suggested that the cause of anemia be first determined. There is moderate level medical evidence that supports a combination of iron supplementation and erythropoietin treatment to help reduce the requirement for red blood cell transfusions after surgery in those who have pre-operative anemia.

Iron deficiency iron deficiency anaemia due to bone marrow dysfunction is treated  by:Medication,chemotherapy and bone marrow transplant.


PREVENTION :

Dietary intake of Iron

Arrest bleeding when ever it is necessary

Take adequate amount of vitamin C since it helps in the absorption of the Iron.


REFERENCE :

https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/symptoms-causes/syc-20355034#:~:text=Iron%20deficiency%20anemia%20is%20a,is%20due%20to%20insufficient%20iron.

https://emedicine.medscape.com/article/202333-overview

https://www.webmd.com/a-to-z-guides/iron-deficiency-anemia

https://kidshealth.org/en/parents/ida.html