Iron Deficiency Anemia
Anemia - you may have heard this word before. You know it's something
medical dealing with the blood, but do you really know what is means?
Here is a brief rundown.
Cells need oxygen
The human body is made up of billions of small cells
which are grouped together in the various specialized organs such as the
lungs, heart, liver, etc. These cells work behind the scenes 24/7 to
keep you healthy and active. Day and night, they quietly perform many
functions such as growth and repair of tissues, production of heat,
motion, circulation, digestion, and so forth. Individually, each small
cell is much like a tiny machine which requires many things to do its
job - including oxygen The oxygen obviously comes from the air that you
breathe. The problem is: How do you deliver oxygen down to each and
every cell?
Your bloodstream
The answer lies in your circulatory system, or
bloodstream. Your blood stream is a river of fluid called plasma. It is
in constant motion pulsing forward within your arteries and veins with
each beat of your heart. Floating within this river are three types of
living cells each with a specific job.
| CELL TYPE | ABBREV | FUNCTION |
| Red blood cells | RBC | Carry oxygen to all parts of
the body |
| White blood cells | WBC | Fight infection |
| Platelets | PLT | Clot your blood when injured |
Red Blood Cells
RBCs are produced in the bone marrow and make up the
majority of the cells in your blood. As your blood constantly
circulates, these red blood cells act like "oxygen delivery boys"
picking up a load of oxygen as they travel through your lungs and
dropping off the oxygen when they travel past the cells. They repeat
this journey over and over thousands of times each day. It is amazing to
realize that your heart only pumps about 3 ounces of blood with each
beat, but over 24 hours moves about 3000 gallons of blood.
Hemoglobin
Red blood cells excel at oxygen delivery because they are
made of a special red-colored pigment called hemoglobin which
selectively grabs oxygen molecules. Each red blood cell contains several
hundred hemoglobin molecules. Hemoglobin is mostly made of iron, a
natural mineral. Just like a factory needs steel to make cars, your bone
marrow needs iron to create hemoglobin and new red blood cells. But you
need just the right amount. Too much iron is toxic to the body and can
lead to organ damage. However, if iron levels are too low, hemoglobin
production drops and fewer red blood cells are created.
Iron Deficiency Anemia
When the number of red blood cells falls below
normal, this is called anemia. There are many types of anemia, but that
due to insufficient iron is, of course, called iron deficiency anemia.
It has nothing to do with leukemia or cancer of the bone marrow. Iron
deficiency anemia is universally the most common form of anemia
affecting about 5% of American women and 2% of men. It is nothing new
for its manifestations have been found described in manuscripts that are
more than 3,000 years old.
What is normal?
Your bloodstream needs a certain number of red blood
cells, white blood cells and platelets to function properly. Your doctor
can order blood tests to measure the number of each cell type in your
blood and compare it to the normal levels. This blood test is a called
a Complete Blood Count, or CBC. One common way to estimate the number of red blood cells is to measure the amount of hemoglobin present in the
blood - expressed in grams of hemoglobin per 100 cc of blood. A low
Hemoglobin is another sign of anemia. Men with Hemoglobin measurements
less than 14 and less than 12 for women are considered anemic.
What are the symptoms of iron deficiency anemia?
One problem is that
iron deficiency anemia is very sneaky. It usually develops very slowly
over a period of many months or even years. There are no symptoms in the
early stages. By the time you do have symptoms, the anemia may be
severe. When present, symptoms of iron deficiency include fatigue,
muscle weakness, rapid heartbeat, and shortness of breath. It can cause
chest pain, as the heart is forced to work harder and faster to
compensate. Other signs of iron deficiency anemia are a pale complexion
and hair loss. Some patients report a sore red tongue and brittle
fingernails. There is one symptom of iron deficiency anemia that is
quite unusual. When specifically questioned, some patients report odd
food cravings, a condition called pica. These individuals may find
themselves uncontrollably eating large amounts of ice, starch, and even
dirt and clay. When the anemia is treated, these odd cravings disappear.
The cause is not known.
What causes iron deficiency?
It's all based on a delicate balance
between how much iron enters your body and how much you lose daily. Iron
is normally obtained through the food in your diet and by the recycling
of iron from old red blood cells. Each day, you absorb about 1 mg of
iron from your diet and lose about an equal amount in the stool and
sweat. If you don't absorb enough iron from your diet, the iron level
will slowly drop and you will eventually become anemic. On the other
hand, if you lose more iron than you absorb, the iron level will also
drop causing anemia. Common causes of excessive iron loss are pregnancy,
breast feeding, heavy menstrual periods. Another less common cause is frequent blood donation. This can sometimes deplete the body's iron stores and lead to mild anemia.
However, all men and post-menopausal women have no reason to develop
iron deficiency anemia since they do not have monthly blood loss. Iron
deficiency anemia in a man or post-menopausal woman suggests that they
are losing blood from somewhere else - most often from the digestive
system. In fact, it is quite common to acquire significant iron
deficiency anemia due to slow chronic loss of blood from the digestive
tract. It only takes about 1 to 2 teaspoons of blood loss daily to
exceed iron absorption. If the amount of blood lost each day is this
small, the blood is digested with the food, mixed with the stool, and
not readily visible. So you can be losing small amounts of blood each
day and have bowel movements that look entirely normal. This slow
invisible loss of blood is called occult bleeding. Possible causes of
occult blood loss from the digestive system include a large hiatal
hernia, acid reflux, peptic ulcers, gastritis, stomach and colon polyps,
stomach and colon cancer, Crohns disease, colitis, hemorrhoids and
others. The point is that if you are non-menstruating woman or a man and
you have iron deficiency anemia, you need to see your doctor. He will
often refer you to a digestive disease specialist, or
gastroenterologist, for further evaluation.
Treatment
After your doctor finds and treats the cause of your iron
deficiency, he can prescribe appropriate therapy to get your iron levels
back to normal and correct the anemia. Eating more iron-rich foods is
often suggested. These include raisins, meats (liver is the highest
source), fish, poultry, eggs (yolk), legumes (peas and beans), and whole
grain bread. While increasing the iron content of your diet can be
helpful, this is an inefficient way to boost your iron stores. In fact,
it takes about 11 pounds of red meat to provide the same iron content as
one high dose iron supplement. So, if you have iron deficiency anemia,
your doctor will probably also suggest an iron supplement. These come in
two basic forms.
Multivitamins with iron The most common are multivitamin supplements
that also contain a low dose of iron for daily maintenance. Many brands
are available. These are best for women who are not anemic but have
extra blood loss from monthly periods. Extra iron is also needed during
pregnancy and lactation because normal dietary intake cannot supply the
required amount. The usual dose of iron in these supplements is 10 - 20
mg of ferrous sulfate which delivers about 1 - 2 mg. of elemental iron
to your system. Anyone who donates blood on a regular basis should consider such
a low dose daily supplement.
High dose iron supplements When treating significant iron deficiency
anemia, a higher dose supplement is required to maximize iron
absorption. Many brands are available. A common one is FeoSol. Most are inexpensive, effective,
and available without a prescription. Most have about 300 mg of ferrous
iron per capsule. Milk and antacids may interfere with absorption of
iron and should not be taken at the same time as iron supplements.
Vitamin C helps your body absorb iron. Make sure to get your daily
allowance. If you eat at least three servings of vegetables and two
servings of fruit each day, especially citrus fruits, you're probably
getting enough. You can also raise your vitamin C intake with a
one-a-day multivitamin. Do not be alarmed if your bowel movements turn
dark green or black when taking high dose iron supplements. This is
normal and has no significance.
How long to take iron
When an individual with iron deficiency anemia
begins iron supplements, the bone marrow acts like a shut-down factory
going back to work on overtime. The new iron is used to make more
hemoglobin which allows red blood cell production to soar. Most patients
will see their anemia improve within a few weeks with a gradual rise in
the Hemoglobin blood test as shrunken iron deficient red blood cells
are replaced with healthy full sized cells. Within 8 weeks the anemia is
usually gone. However, treatment should continue daily until the body
iron stores are fully replenished. This may take up to six months in
severe cases. One way to see that this has been accomplished is the
ferritin (iron) level in the blood. A ferritin level over 50 usually assures that the body iron
stores have been replenished.
Prevention of iron deficiency
The daily dietary iron requirement for all
men and women after menopause is about 1.0 mg per day. The average
American diet is usually enough to meet these needs. Men do not need
extra iron supplements. If they take a multivitamin-mineral supplement,
it should not contain iron. Menstruating and lactating women, however,
need 2.0 mg of iron per day. During pregnancy, the requirement rises to
about 3.0 mg. per day. Since the intestines absorb only 10% of the iron
in the diet, an oral intake of 20 mg to 30 mg of iron is needed to meet
these requirements. You should not take doses higher than this without
talking with a doctor first. There is no normal mechanism for your body
to excrete excess iron. Taking too much iron can actually be unhealthy
and cause long-term negative effects.
Iron can be deadly
If you have iron-containing vitamins or higher dose
iron supplements, be sure to keep them out of the reach of children.
Iron is poison for small children. In fact, iron is the leading cause of
poisoning deaths in children under six.
- Keep pills in their original childproof bottle and close it tightly
right after use
- Put the bottle in an out-of-reach place right
after use.
- Keep the bottle out of sight of children at all times
Summary
Iron deficiency anemia is the most common form of anemia and may
occur due to poor iron intake or as a result of chronic blood loss. It
usually develops silently over a long period of time. It is expected in
women of childbearing age due to iron losses from menstruation,
pregnancy, and breast-feeding. However, iron deficiency anemia in a man
or a post-menopausal woman is often a sign of chronic blood loss from
the digestive tract. Even mild cases warrant careful investigation to
rule out colon cancer, peptic ulcer disease, and other causes of occult
bleeding. The underlying cause must be treated and iron stores
replenished with iron supplements. Most patients respond well to oral
iron supplements.
Iron-containing hemoglobin in your red blood cells (RBC) is what gives your skin a healthy color. Compared to normal, note how pale the red blood cells are in the patient with iron deficiency. That is why paleness of the skin is a common symptom in those with iron deficiency.
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