Overview

More than one-quarter of the world's population is anaemic, with approximately one-half of the burden from iron deficiency. The prevention and treatment of iron deficiency is a major public health goal, especially in women, children, and individuals in low-income countries.

Causes

• Decreased dietary intake

• Reduced absorption

• Blood loss

Blood Loss

• Overt bleeding is obvious

  • Trauma

  • Haematemesis (Vomiting blood)

  • Melaena or Haemachezia (passing blood per rectum)

  • Haemoptysis (Coughing up blood)

  • Heavy menstruation

  • Pregnancy and delivery

  • Haematuria (Passing blood in the urine)

• Overlooked causes of blood loss

  • Frequent blood donation

  • Excessive blood tests

  • Underestimating degree of menstruation

  • Occult bleeding (usually from the gut but sometimes from urine)

  • Exercise-induced blood loss from the gut

  • Gut parasites such as hookworm

Reduce Absorption

• Coeliac

• Autoimmune gastritis

• Helicobacter Pylori infection

• Bariatric surgery

Diet

• Rare to develop significant iron deficiency solely because of the dietary restriction

• At least in adults in resource-rich countries

• May contribute to deficiency in addition to reduced absorption or blood loss

Symptoms

The usual symptoms of adults with iron deficiency are primarily due to anaemia

• Fatigue

• Pica (pagophagia, ice craving)

• Restless Legs Syndrome

• Headache

• Exercise Intolerance

• Exertional Dyspnoea

• Weakness

• Neurodevelopmental delay (children)

• Beeturia (reddish urine after eating beets)

Examination

• Pallor

• Dry or rough skin

• Atrophic glossitis (pale tongue without bumps)

• Angular cheilitis (painful cracked sores at the corner of the mouth)

• Koilonychia (spoon nails)

Diagnosis

• Serum ferritin <30 ng/mL

• Transferrin saturation ≤19%

• Anaemia that resolves upon iron administration

• Absence of stainable iron in the bone marrow

Management

Obviously depends on the severity of the iron deficiency, associated anaemia, cause of the deficiency and other compounding factors like pregnancy and age.

Role of diet — Individuals may ask about the role of diet in preventing or treating iron deficiency.

• Prevention – A normal healthy diet has sufficient iron to meet normal requirements. While strict vegetarian diets contain less iron than those containing meat, the fortification of flour with iron usually mitigates iron deficiency, unless there are losses through bleeding. An iron-containing multivitamin is usually adequate to maintain iron losses through normal menstruation.

• Treatment – The iron content of foods is unlikely to be sufficient to replete iron stores in an individual with iron deficiency. Even foods high in iron, such as fortified cereals and organ meats, contain only a few milligrams of iron. In contrast, oral and intravenous iron formulations will provide a full replacement when administered as described below.

Iron Replacement Products

Oral replacement should be initially used for uncomplicated iron deficiency anaemia. However, this depends on the severity, ongoing losses, tolerance of oral products and imminent surgical procedures.

• Oral

  • May be the only option, especially in under-resourced areas.

  • Cheap

  • Eliminates the need for IV and associated risks

  • Generally used for kids through to adolescents

  • Numerous options, all essentially equally effective. The most appropriate is liquid or ferrous salts.

• Intravenous (IV)

  • Appropriate if oral therapy fails due to side effects or lack of efficacy

  • Useful if malabsorption is a cause or ongoing factor

  • Quicker and more useful if severe acute blood loss

References

Treatment of Iron Deficiency - Up To Date