From the Guidelines
Sickle cell trait and iron deficiency can coexist, but individuals with sickle cell trait are not at a higher risk for iron deficiency compared to the general population. In fact, some research suggests that sickle cell trait carriers might have slightly higher iron stores than non-carriers 1. However, when iron deficiency does occur in sickle cell trait carriers, it can potentially reduce the likelihood of sickling events since fewer abnormal hemoglobin molecules are produced when iron is limited.
Key Considerations
- Iron deficiency in sickle cell trait carriers should be treated with standard iron supplementation, typically ferrous sulfate 325mg daily or ferrous gluconate 300mg daily, until iron stores normalize 2.
- Treatment duration typically ranges from 3-6 months, with follow-up testing to confirm resolution.
- Regular health monitoring for sickle cell trait carriers should include periodic complete blood counts and iron studies, especially if they have risk factors for iron deficiency such as heavy menstruation, gastrointestinal blood loss, or poor dietary iron intake.
Important Notes
- Sickle cell trait carriers experiencing symptoms like fatigue should not assume it's related to their trait status, as iron deficiency or other conditions may be the actual cause and require specific treatment.
- If after 4 weeks the anemia does not respond to iron treatment, further evaluation of the anemia is necessary using other laboratory tests, including MCV, RDW, and serum ferritin concentration 1, 2.
From the Research
Relationship between Sickle Cell Trait and Iron Deficiency
- The relationship between sickle cell trait and iron deficiency is complex, with some studies suggesting that individuals with sickle cell trait may have a lower risk of iron deficiency anemia 3.
- A study published in the Scandinavian journal of haematology found that the prevalence of iron deficiency anemia was significantly lower in individuals with sickle cell trait compared to those without the trait 3.
- Another study published in the Archives of internal medicine found that iron deficiency in a patient with sickle cell anemia was accompanied by a decrease in sickled erythrocytes and an improvement in symptoms 4.
- The mechanism behind this relationship is not fully understood, but it may be related to increased iron absorption or reduced iron requirements in individuals with sickle cell trait 3.
- Some studies suggest that iron deficiency may actually be beneficial for individuals with sickle cell disease, as it can reduce the severity of hemolysis and improve symptoms 5, 6.
Iron Deficiency and Sickle Cell Disease
- Iron deficiency anemia is a potential problem in young non-transfused sickle cell patients, and serum ferritin below 25 ng/ml and low MCV are the most useful screening tests 7.
- A study published in the American journal of hematology found that iron restriction may have therapeutic potential in sickle cell disease, as it can reduce the concentration of hemoglobin S and decrease polymerization 5.
- Another study published in the American journal of hematology found that iron deficiency may be more common than suspected in sickle cell anemia, especially in men, and that absence of bone marrow iron remains a gold standard for diagnosis 6.
- The kinetics of sickling is strongly concentration dependent, and small decreases in the mean corpuscular deoxyhemoglobin-S concentration can cause a substantial delay in sickle hemoglobin polymerization 6.