Iron-deficiency anemia is the most frequent type of anemia. It mainly affects women of childbearing age, although there are other risk factors. It is due to a lack of iron necessary for the synthesis of hemoglobin in red blood cells.
During inspiration, the air that enters the lungs passes into the blood and binds to the hemoglobin to be distributed throughout the body. If iron is deficient, so will hemoglobin, so that oxygen transport is less and leads to a lack of it in the tissues, which is manifested by what is known as anemic syndrome.
Anemia is not due solely to the lack of iron . The definition of anemia includes a group of clinical entities that have hemoglobin levels of less than 13g / dL in men and less than 12g / dL in women, accompanied by symptoms, which will be discussed below.
The levels of hemoglobin can decrease due to different causes besides the lack of iron , such as the alteration of the molecules responsible for its synthesis or an accelerated destruction of red blood cells (this process is called hemolysis). In this article we are going to limit ourselves to talk about anemia due to iron deficiency or iron-deficiency anemia.
Our body does not use iron only for the synthesis of hemoglobin, but also is part of many molecules and enzymes necessary for proper functioning of our body. Therefore, an adult needs to take 10 mg of iron a day. Women of childbearing age should increase the dose to 11.5-12 mg per day due to menstrual losses.
Iron rich foods
Foods rich in iron can be differentiated into two large groups:
- Foods of animal origin: mainly in red meat, liver and sausage. They contain iron in the form of heme iron, with a rapid absorption by simple diffusion in the intestinal mucosa.
- Foods of vegetable origin: examples are spinach, chard and some nuts. In this case, non-heme iron is ingested, whose absorption is slower and by active transport (requires molecules and energy that facilitate absorption).
Causes of iron deficiency anemia
The iron deficit may be due to a decrease in intake or an increase in losses or needs:
- Decrease in intake : it is more frequent in underdeveloped countries.
- Decreased intestinal absorption: it is due to digestive diseases that alter the digestive tract and with it, the absorption of iron and other nutrients. Occurs after stomach resections (gastrectomies), in malabsorption disease or in some parasitosis.
- Increased needs: we have already said that the daily needs of an adult are around 10 mg of iron, but there are moments in the development in which they increase:
- Pregnancy, since iron is used to form placental structures. For this reason, iron is sometimes administered preventively or prophylactically during pregnancy. It may also be necessary in premature infants, who lack iron from natural deposits.
- Increase in losses: it is the most frequent cause in Western countries. Is due to:
- Blood loss due to chronic or genitourinary digestive hemorrhages such as excessive menstruation. In fact, in women of childbearing age this is the most frequent etiology.
- It also occurs in the context of other pathologies such as pulmonary hemosiderosis or accumulation of blood in the lungs.
- For an excessive blood donation.
Clinic of iron-deficiency anemia
In patients with iron deficiency anemia, we must also highlight the anemic symptoms (anemic syndrome), those symptoms that are due to lack of iron (ferropenic syndrome). In addition, we must bear in mind that in the body there are deposits of iron that will begin to decrease before symptoms of anemia appear . Then, we can differentiate three stages:
- Latent anemia: The synthesis of red blood cells is with insufficient iron (this is what is known as ineffective erythropoiesis ), so the red blood cells are smaller.
- Frank anemia: accompanied by symptoms of anemia and low hemoglobin levels.
The deficit of hemoglobin will cause mainly symptoms that affect the head, heart and muscles:
- Head: typically characterized by dizziness, headache, dizziness and irritability . Sometimes flies may appear (black dots that move in the visual field) or tinnitus (hear sounds that do not exist).
- Heart: the anemia will occur with the presence of palpitations, murmurs, dyspnea and fatigue.
- Muscles and other tissues: muscle cramps, fatigue, asthenia and skin pallor may appear .
The iron deficiency will have different symptoms:
- Changes in the epithelia (skin and mucous membranes):
- Hair loss
- Nails concave and brittle, is called coilonychia.
- In the mouth they will see wounds in the corners of the mouth that are known as ragades.
- Dysphagia or difficulty swallowing, due to alterations in the esophagus.
- Gastritis or inflammation of the stomach mucosa.
- Neurological alterations :
- Pica syndrome: it is characterized by the tendency to ingest non-nutritive substances, such as earth (geophagia), ice (pagofagia), lime, gypsum, etc.
- Alterations of conduct
- If it appears during the development stage it can cause a growth retardation .
Diagnosis of iron deficiency anemia
Anemia is suspected due to the clinical manifestations just mentioned and is confirmed by a conventional analysis that shows low levels of hemoglobin. Once the anemia is diagnosed, look for what is causing it, in this case an iron deficit is manifested by low ferritin levels.
The decrease in hemoglobin and ferritin are the main parameters, although there are other markers that can help in doubtful cases. Some of these parameters are red blood cells of small size and with lower hemoglobin, which can be determined by making a blood smear. It is also important to find out what the iron deficit is producing, such as hemorrhages or intestinal diseases, in which case the symptoms derived from these pathologies will also appear.
The treatment of iron deficiency anemia consists in correcting the cause of anemia and in facilitating iron deficiency. It is mainly done in the form of ferrous sulfate that is administered orally on an empty stomach, maintaining the treatment between 3 and 6 months depending on the severity of the anemia.