What is Iron deficiency ?
A deficiency of iron can result from a number of different causes. Inadequate iron in the diet, impaired absorption of iron, and excessive bleeding are all examples of conditions that can lead to iron deficiency.
The amount of iron in the body is tightly regulated by cells of the intestine that can increase or decrease iron absorption according to need. When iron deficiency becomes severe, the manufacture of red blood cells is decreased, and iron deficiency anemia results.
Causes of iron deficiency
Certain illnesses and conditions can increase the risk of iron deficiency.
Loss of iron through bleeding can occur with:
- Extremely heavy menstrual periods
- Cancer of the esophagus, bowel, stomach, or colon
- Esophageal varices
- Gastrointestinal bleeding caused by aspirin or ibuprofin
- Peptic ulcer disease
Disorders of iron absorption that cause iron deficiency include:
- Celiac disease
- Gastric bypass
- Crohn’s disease
- Excessive use of antacids
In addition, vegetarians and older adults who do not eat a balanced diet may not get enough dietary iron and are at increased risk.
Symptoms of iron deficiency
- Fatigue
- Leg cramps
- Cold intolerance
- Infections
- A craving for ice or non-food items (pica)
- Lightheaded feelings
- Shortness of breath
- Altered behavior
- Poor performance in school
- Difficulty swallowing
- Sore tongue
When examined by a physician, a patient with iron deficiency might also show the presence of
- Pallor
- Spoon-shaped nails
- A glossy tongue
- Fissures at the corners of the mouth
- Enlargement of the spleen
- In infants, growth may be impaired
Tests for iron deficiency
Iron levels are normally tested through hematocrit and hemoglobin counts. Hematocrit measures the percentage of blood that consists of red blood cells. A normal result for men is in the range of 40.7% to 50.3%. For women, the normal range is 36.1% to 44.3%.
A test for hemoglobin shows how much hemoglobin is the blood. Normal levels for men are 13.8 to 17.2 grams per decaliter (g/dL). For women, the normal range is 12.1 to 15.1 g/dL.
Additional tests that may be ordered include:
- Bone marrow biopsy
- Serum iron level
- Iron binding capacity
- RBC indices
- Serum ferritin
People at Risk of Iron Deficiency
Some people are at a higher risk of being deficient in iron, including:
- Poor or homeless people
- People with an eating disorder
- Elderly people
- Children who drink a lot of cow’s milk
- People on a diet to lose weight
- People who don’t eat fruits, vegetables and meat
- People who consume a lot of caffeine
- People who take antacids
Treatment of iron deficiency
Iron deficiency anemia is typically treated with oral supplements and a diet of iron-rich foods. Supplements may occasionally need to be given intravenously.
- Take iron tablets on an empty stomach. If possible, take your iron tablets when your stomach is empty. However, because iron tablets can upset your stomach, you may need to take your iron tablets with meals.
- Don’t take iron with antacids. Medications that immediately relieve heartburn symptoms can interfere with the absorption of iron. Take iron two hours before or four hours after you take antacids.
- Take iron tablets with vitamin C. Vitamin C improves the absorption of iron. Your doctor might recommend taking your iron tablets with a glass of orange juice or with a vitamin C supplement.
The prognosis for otherwise healthy patients is excellent. The hematocrit typically returns to normal in two months, and supplements should be continued for an additional 6 to 12 months to replenish the body’s iron stores.
