From the Guidelines
Iron deficiency anemia develops through a progressive depletion of iron stores in the body, leading to impaired hemoglobin production and reduced oxygen-carrying capacity. This condition can be caused by various factors, including chronic blood loss, inadequate dietary intake, malabsorption, or increased requirements 1. The pathophysiology of iron deficiency anemia involves a spectrum of stages, ranging from iron depletion to iron-deficiency anemia, with the most severe form characterized by underproduction of iron-containing functional compounds, including hemoglobin 1.
Key Factors Contributing to Iron Deficiency Anemia
- Chronic blood loss, such as menstruation or gastrointestinal bleeding
- Inadequate dietary intake of iron
- Malabsorption of dietary iron, often due to conditions like celiac disease or gastric bypass
- Increased requirements for iron, as seen in pregnancy or childhood growth
Clinical Presentation and Diagnosis
Symptoms of iron deficiency anemia develop gradually and may include fatigue, weakness, pallor, headaches, and in severe cases, tachycardia and dyspnea on exertion 1. Diagnosis is typically made through blood tests, and treatment requires addressing the underlying cause and replenishing iron stores through oral supplements or intravenous iron in cases of severe deficiency or malabsorption 1.
Importance of Investigating Underlying Causes
It is crucial to investigate the underlying cause of iron deficiency anemia, especially in adults without an obvious explanation, as it may be indicative of serious gastrointestinal pathology, including cancer 1. Prompt and complete investigation is essential to ensure timely diagnosis and treatment of any underlying conditions.
From the Research
Pathophysiology of Iron Deficiency Anemia
The pathophysiology of iron deficiency anemia involves a complex interplay of factors that lead to a decrease in iron stores, resulting in a reduction in hemoglobin production and ultimately, anemia.
- Iron deficiency anemia arises when the balance of iron intake, iron stores, and the body's loss of iron are insufficient to fully support production of erythrocytes 2.
- The most common causes of iron deficiency are bleeding (menstrual, gastrointestinal), impaired iron absorption (atrophic gastritis, celiac disease, bariatric surgical procedures), inadequate dietary iron intake, and pregnancy 3.
- Iron deficiency can progress from low iron stores to iron-deficiency anemia, with individuals experiencing symptoms such as fatigue, irritability, depression, difficulty concentrating, restless legs syndrome, and dyspnea 3.
Diagnosis of Iron Deficiency Anemia
Diagnosing iron deficiency anemia can be challenging, but several tests are available to help identify the condition.
- Serum ferritin measurement is the most important analysis in the study of iron deficiency, but there is no consensus on the diagnostic cut-off 4.
- Transferrin saturation, serum iron, and soluble transferrin receptor are also used to diagnose iron deficiency, but these tests can be affected by inflammation and other factors 5, 6.
- Reticulocyte hemoglobin content (CHr) is a useful marker for diagnosing iron deficiency and monitoring iron therapy, as it is less affected by inflammation than other tests 5.
Risk Factors and Prevention
Certain individuals are at higher risk of developing iron deficiency anemia, including:
- Women of childbearing age, particularly those with heavy menstrual bleeding 3.
- Pregnant women, especially during the third trimester 3.
- Individuals with chronic inflammatory conditions, such as chronic kidney disease, heart failure, and cancer 3, 6.
- Prevention and early detection of iron deficiency anemia are crucial to reducing the impact of this condition on human health, particularly in underdeveloped countries 2.