Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. There are many types of anemia. Iron deficiency anemia occurs when the body does not have enough iron. Iron helps make red blood cells.
Iron is very important in maintaining many body functions, including the production of hemoglobin, the molecule in the blood that carries oxygen. Iron is also necessary to maintain healthy cells, skin, hair, and nails.
Iron from the food that people eat is absorbed into the body by the cells that line the gastrointestinal tract; the body only absorbs a small fraction of the iron the ingest. The iron is then released into the blood stream, where a protein called transferrin attaches to it and delivers the iron to the liver. Iron is stored in the liver as ferritin and released as needed to make new red blood cells in the bone marrow. When red blood cells are no longer able to function (after about 120 days in circulation), they are re-absorbed by the spleen. Iron from these old cells can also be recycled by the body.
Causes
Iron-deficiency anemia may be caused by the following –
- Diets low in iron – Iron is obtained from foods in our diet; however, only 1 mg of iron is absorbed for every 10 to 20 mg of iron ingested. A person unable to have a balanced iron-rich diet may suffer from some degree of iron-deficiency anemia.
- Body changes – An increased iron requirement and increased red blood cell production is required when the body is going through changes, such as growth spurts in children and adolescents, or during pregnancy and lactation.
- Gastrointestinal tract abnormalities – Malabsorption of iron is common after some forms of gastrointestinal surgeries. Most of the iron taken in by foods is absorbed in the upper small intestine. Any abnormalities in the gastrointestinal (GI) tract could alter iron absorption and result in iron-deficiency anemia. Surgery or medications that stop stomach acid production will also decrease iron absorption.
- Blood loss – Loss of blood can cause a decrease of iron and result in iron-deficiency anemia. Sources of blood loss may include GI bleeding, menstrual bleeding, or injury.
- Intravascular hemolysis, a condition in which red blood cells break down in the blood stream, releasing iron that is then lost in the urine. This sometimes occurs in people who engage in vigorous exercise, particularly jogging. This can cause trauma to small blood vessels in the feet, so called “march hematuria.” Intravascular hemolysis can also be seen in other conditions including damaged heart valves or rare disorders such as thrombotic thrombocytopenia purpura (TTP) or diffuse intravascular hemolysis (DIC).
Risk Factors
- Women who menstruate, particularly if menstrual periods are heavy
- Women who are pregnant or breastfeeding or those who have recently given birth
- People who have undergone major surgery or physical trauma
- People with gastrointestinal diseases such as celiac disease (sprue), inflammatory bowel diseases such as ulcerative colitis, or Crohn disease
- People with peptic ulcer disease
- People who have undergone bariatric procedures, especially gastric bypass operations
- Vegetarians, vegans, and other people whose diets do not include iron-rich foods (Iron from vegetables, even those that are iron-rich, is not absorbed as well as iron from meat, poultry, and fish.)
- Children who drink more than 16 to 24 ounces a day of cow’s milk (Cow’s milk not only contains little iron, but it can also decrease absorption of iron and irritate the intestinal lining causing chronic blood loss.)
Symptoms
Most of the time, symptoms are mild at first and develop slowly. Symptoms may include:
- Feeling grumpy
- Feeling weak or tired more often than usual, or with exercise
- Headaches
- Problems concentrating or thinking
As the anemia gets worse, symptoms may include –
- Blue color to the whites of the eyes
- Brittle nails
- Desire to eat ice or other non-food things (pica)
- Feeling lightheaded when you stand up
- Pale skin color
- Shortness of breath
- Sore tongue
Symptoms of the conditions that cause iron deficiency anemia include –
- Dark, tar-colored stools or blood in the stool
- Heavy menstrual bleeding (women)
- Pain in the upper belly (from ulcers)
- Weight loss (in people with cancer)
Complications
- Heart problems – Iron deficiency anemia may lead to a rapid or irregular heartbeat
- Problems during pregnancy – In pregnant women, severe iron deficiency anemia has been linked to premature births and low birth weight babies.
- Growth problems – In infants and children, severe iron deficiency can lead to anemia as well as delayed growth and development.
Treatment
Iron supplements – Iron supplements can be taken over several months to increase iron levels in the blood. Iron supplements can cause irritation of the stomach and discoloration of bowel movements. They should be taken on an empty stomach, or with orange juice, to increase absorption. They are much more effective than dietary interventions alone. In cases of malabsorption or intolerance, IV iron may be needed.
Evaluation for a source of blood loss – This may include upper endoscopy or colonoscopy.
Intravenous Iron – In some cases the doctor may recommend intravenous (IV) iron. IV iron may be necessary to treat iron deficiency in patients who do not absorb iron well in the gastrointestinal tract, patients with severe iron deficiency or chronic blood loss, patients who are receiving supplemental erythropoietin, a hormone that stimulates blood production, or patients who cannot tolerate oral iron. IV iron comes in different preparations:
- Iron dextran
- Iron sucrose
- Ferric gluconate
Blood Transfusions – Red blood cell transfusions may be given to patients with severe iron-deficiency anemia who are actively bleeding or have significant symptoms such as chest pain, shortness of breath, or weakness. Transfusions are given to replace deficient red blood cells and will not completely correct the iron deficiency. Red blood cell transfusions will only provide temporary improvement.
Iron-rich diet – Eating a diet with iron-rich foods can help treat iron-deficiency anemia. Good sources of iron include the following –
- Meats, such as beef, pork, lamb, liver, and other organ meats
- Poultry, such as chicken, duck, turkey, (especially dark meat), liver
- Fish, such as shellfish, including clams, mussels, and oysters, sardines, anchovies
- Leafy greens of the cabbage family, such as broccoli, kale, turnip greens, and collards
- Legumes, such as lima beans and green peas; dry beans and peas, such as pinto beans, black-eyed peas, and canned baked beans
- Yeast-leavened whole-wheat bread and rolls
- Iron-enriched white bread, pasta, rice, and cereals
Digestive Enzymes – Take digestive enzymes. To maximize the benefit of an iron supplement, you may need a digestive enzyme.
Supplements – Folic acid, Vitamin B-12, Extra pantothenic acid (vitamin B-5), Copper, Zinc, Raw spleen glandular, Vitamin A, Natural Beta Carotene and Vitamin E.
Chlorophyll is almost an exact match of the red blood cells or hemoglobin in the human body. With such a unique composition, chlorophyll can serve as a substitute for red blood cells until the body is able to replenish the healthy red blood cell count.
Dong quai – This herb is rich in vitamins and minerals.
Chive – This vegetable is rich in vitamin C and iron – eat fresh chives.
Quinoa – This is a grain rich in all eight essential amino acids that form a complete protein.
Gentian – The bitter herb gentian is popular in England for the treatment of anemia. Gentian can be brewed into a tea or you can take a commercially available extract.
Dandelion is also believed to help people with anemia. It is very rich in vitamins and minerals.
Other herbs that are of interest to those suffering from anemia include alfalfa, bilberry, burdock root, cherry, goldenseal, grape skins, hawthorn berry, horsetail, mullein, parsley, nettle, Oregon grape root, pau d’arco, red raspberry, shepherd’s purse, watercress, and yellow dock root.
Reference –
http://www.irondisorders.org/iron-deficiency-anemia
http://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf
http://www.health.com/health/gallery/0,,20798655,00.html
http://www.hematology.org/Patients/Anemia/Iron-Deficiency.aspx
http://patient.info/health/iron-deficiency-anaemia-leaflet
https://umm.edu/health/medical/ency/articles/iron-deficiency-anemia