Iron Deficiency Anemia
Iron deficiency anemia is characterized by low levels of haemoglobin, low serum iron, and an increased Total Iron Binding capacity (TIBC).
The Causes of Iron Deficiency are:
- Insufficient iron in the diet,
- A chronic loss of blood, such as occurs with chronic peptic ulcers, bleeding piles, worm infestation of the intestine, menorrhagia, and hematuria,
- The enhanced demands for iron that occur in infancy and pregnancy and during lactation.
- The diminished absorption of iron in various diseases such as coeliac disease and atrophic gastritis.
Most patients develop symptoms when their haemoglobin falls to 7 g per 100 ml. They complain of fatigue, weakness, and anorexia. As the iron deficiency anemia - becomes more severe, their fingernails become thin and flat and finally become spoon-shaped: this is known as koilonychia. Their tongues become red and sore and in severe cases appear smooth, waxy, and glistening. Patients may find it difficult to swallow.
Iron deficiency anemia affects about 500 million people throughout the world. In developing countries, the common combination of an abnormal loss of blood from the intestine (for example from hookworm infestation) and a limited intake of iron in the diet means that the prevalence of iron deficiency anemia is much higher than in developed countries.
What is the form of iron most used for the treatment of deficiency anemia, and how do you calculate the dose?
The most used form of iron is ferrous sulphate and its dost is calculated in terms of the elemental iron it provides. Adults should take 100-200 mg elemental iron daily, while children may take 1.5-2 mg per kg body weight daily.
When managing iron deficiency anemia, both, its cause, and its effect need to be treated. Though at times it may be difficult to determine its cause, the replenishment of iron reserves (the depletion of which is the cause of symptoms) is rather simpler. Treatment consists of the oral administration of inorganic iron. The ferrous salts of iron are far more effective than the ferric salts, and a very satisfactory and most used preparation is ferrous sulphate, its dose calculated in terms of the elemental iron it provides. Adults should take 100-200 mg elemental iron daily and children 1.5-2 mg per kg body weight, daily. This dose may be supplemented with vitamin C, which increases the absorption of iron through its capacity to maintain iron in the reduced state. A response to iron therapy usually occurs in one to two weeks: an increase in the reticulocyte count is the first sign, then the haemoglobin rises. Iron therapy should be continued for at least three months after the haemoglobin level has been restored, to allow for the replenishment of the body's iron reserves.
Parenteral Iron therapy
Parenteral Iron therapy may be necessary for a few patients who are unable to take iron orally because of gastrointestinal symptoms, such as vomiting and diarrhoea, or who are unable to absorb iron because of some malabsorption disorder or severe anemia in the late stages of pregnancy Commonly used preparations of iron that may be injected are iron-sorbitol-citric acid complex (Jectofer) for intramuscular use and iron-dextran complex (Inferon) given intravenously. When the haemoglobin level is below 5 g per 100 ml, it is usually advisable to keep the patient in bed; depending on the patient's clinical stage, he or she may require a blood transfusion to raise the haemoglobin level.
The Role of Diet
Throughout life everyone should receive enough iron, 10 mg for men and 19 mg for women each day. Additional iron is necessary for adolescent girls and women throughout their reproductive years because of the demands of menstruation and childbearing
In addition to medicinal iron, foods that are rich in iron should be given to patients with iron deficiency anemia. The iron-rich foods are liver, beef, veal, lamb, Turkey, chicken, enriched bread and cereals, eggs. peanuts, butter, dried peas and beans, dried fruits including apricots, peaches, prunes, figs, dates and raisins and green leafy vegetables When anorexia is present, serving food attractively and considering individual preference will help to stimulate a desire for food.