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A lot of my patients, relatives and friends ask many questions on iron deficiency anemia. As it is a very common condition in India, I thought to compile up the frequently asked questions in order to answer them in a single post, so that it could make things easier to understand. Many of the people don’t even know they have iron deficiency in the body as some are asymptomatic.
So, let’s start with the questions.
Q. What is anemia?
A. Anaemia is defined a s a reduction in haemoglobin concentration , below the level which is expected for a healthy persons of same age and sex, and in the same environment.
Q. What is haemoglobin ?
A. Haemoglobin is a protein which is present in the red blood cells that helps in carrying oxygen to the tissues of the body.
Q. What is iron deficiency anemia?
A. Iron deficiency anemia is the commonest form of anemia worldwide caused by decrease in iron levels in the body due to various causes. It is also a serious public health problem in developing countries like India.
Q. What are the causes of iron deficiency anemia?
A. Iron deficiency anemia can be cause because of the following reasons-
1. Nutritional deficiency- due to a diet poor in iron rich food or increased requirements as seen in pregnancy, lactation or in infants.
2. Blood loss- due to menorrhagia, hookworm infestation, meckel’s diverticulum, esophageal varices, hemorrhoids (piles), peptic ulcer, colorectal polyp carcinoma of stomach, haematuria, hemoglobinuria.
3. Malabsorption- due to celiac disease, achlorhydria (gastrectomy or atrophic gastritis).
Q. What are the stages of iron deficiency anemia?
A. There are three stages-
Stage 1- iron depletion. That refers to the depletion of the storage iron in the body.
Stage 2- depletion of stored iron along with low transport iron and normal haemoglobin hevel.
Stage 3– features of stage 2 along with low haemoglobin levels, low MCVand MCH.
Q. Who is at risk ?
A. Some people are at a much higher risk than others for developing iron deficiency anaemia such as-
- Women of childbearing age
- Pregnant females
- Frequent blood donors
- People consuming a poor diet that is low in iron rich foods.
Q. What is the clinical presentation of the patient?
A. Patient may be asymptomatic or might have minor symptoms like-
- Poor Concentration.
- Pica (Eating Ice, Clay Or Starch)
- Koilonychia (Spoon Shaped Nails)
- Tongue Swelling
- Shortness Of Breath
- Fast Or Irregular Heart Beat
Q. How is iron deficiency anemia diagnosed ?
A. Complete Blood Count (CBC) is the first test that is recommended for the diagnosis of iron deficiency anemia.
Q. What are the laboratory findings?
A. The various lab findings are-
- Low haemoglobin (Hb) <12g/dl in females and <14 g/dl in males.
- Low packed cell volume (PCV) <36% in women and <41 % in men.
- Low mean corpuscular volume (MCV) <80 fl.
- Low mean cell hemoglobin (MCH) <27 pg.
- Low mean cell hemoglobin concentration (MCHC) <30 g/dl.
- Blood smear shows microcytic hypochromic cells along with pencil cells (elliptocytes).
- Reticulocyte count is low. (normal 0.5%-2%)
- Serum ferritin is <15 microgram/dl.
- Serum iron is reduced <30 microgram/dl.
- Total iron binding capacity (TIBC) is increased >400 microgram/dl.
- Transferrin saturation is <10%.
- Increased soluble transferrin receptor in serum.
- Bone marrow iron stain (gold standard test) shows lack of stainable iron in the bone marrow.
- Morphological examination of bone marrow shows- micronormoblasts. Cytoplasm lags behind the nucleus in maturation hence showing nuclear cytoplasmic asynchrony.
- Reticulocyte haemoglobin content is decreased.
- Increase in the percentage of hypochromic red cells.
- Red cell distribution width (RDW) is increased .
Q. How to know whether a person is responding to oral iron therapy or not?
A. Increase in the reticulocyte count beginning around the third day of the therapy and reaching maximum around fifth to tenth day indicates optimal response.
Q. What is the haemoglobin rise after oral iron therapy ?
A. Haemoglobin rises at the rate of 0.5-1.0 g/dl/week.
Q. What is the general treatment of iron deficiency anaemia?
A. Oral iron therapy or in occasional cases intravenous infusions.
Q. What foods are recommended in order to increase iron in the body ?
A. Some of the iron containing foods are-
- Red meat
- Iron fortified cereals
- Nuts and seeds
- Dried apricots
NOTE- It is very important to know the root cause of iron deficiency anemia as supplements or treatment won’t work until and unless the underlying condition leading to the deficiency is treated.
Hope you found this useful. ♥️