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Anemia (Iron deficiency): Overview
Iron deficiency anemia is the most common form of anemia. Iron is an essential component of the hemoglobin molecule: without iron the bone marrow is unable to produce hemoglobin. The red cell count falls and those which do enter circulation are smaller than normal (microcytic) and lacking in hemoglobin, hence they are pale (hypochromic).
The deficiency of iron may be absolute (there is no iron available for the production of hemoglobin - this is true iron deficiency anemia) or relative (the iron is present in storage in the marrow but other reasons prevent its incorporation into red blood cells).
Causes and Development
The average amount of iron in the average adult male is 4gm and in the average adult female 2.5gm. The normal North American diet contains approximately 15-20mg of iron per day. Most is present in meat and green vegetables; approximately 1.0mg is absorbed each day and just about an equal amount is lost in feces and sweat. As a result, the average adult's iron intake is in delicate balance, but is of little consequence as there is slightly more iron absorbed than lost and a store of iron is gradually accumulated. If, for some reason, the rate of iron loss increases, these stores can be depleted and an absolute iron deficiency develops. Such a deficiency requires large doses of supplemental iron to resupply the body stores and sufficient monitoring to prevent iron overload.
Causes of iron deficiency include:- Diet - uncommon except in children
- Failure to absorb
- Increased utilization (for example pregnancy, adolescent growth)
- Atransferrinemia
- Failure to utilize (for example lead poisoning, chronic diseases)
- Blood loss.
Chronic blood loss is the most common cause of iron deficiency anemia. It must be remembered that anemia in iron deficiency develops slowly. The type and severity of the anemia varies with time. The development stages are:- Depletion of iron stores, decreased ferritin levels, no anemia
- Increased transferrin levels, no anemia
- Fall in serum iron, no anemia
- Development of normocytic, normochromic anemia
- Development of microcytic, hypochromic anemia.
Signs and Symptoms
Along with those mentioned below, symptoms often include malaise (a vague feeling of physical discomfort or uneasiness).
Diagnosis and Tests
Laboratory Diagnosis of Iron Deficiency
Routine procedures. Hgb, Hct and RBC count are all decreased. The degree of decrease depends upon the length of time the marrow has been without sufficient supplies of iron. Because marrow can continue to produce empty cells, the red cell number will not be proportionately as low as the Hgb and Hct values. Serum ferritin is a better measure of body iron stores than any value in the complete blood count, as it will begin dropping long before other signs appear in the blood.
Indices. MCV - decreased, MCH - decreased, MCHC - decreased. The MCHC is the last to become lowered because as the marrow becomes more and more depleted of iron it produces smaller cells with a smaller amount of hemoglobin in each in an attempt to keep the concentration of hemoglobin in each normal. The RDW is increased, reflecting the anisocytosis characteristic of iron deficiency.
Treatment and Prevention
Treatment depends on the underlying cause. Iron deficiency anemia is usually easy to resolve; an anemia that does not respond as expected may require the help of a hematologist and additional testing.
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Signs, symptoms & indicators of Anemia (Iron deficiency):
Conditions that suggest Anemia (Iron deficiency):
Risk factors for Anemia (Iron deficiency): | | | | | Autoimmune |  Gluten Sensitivity / Celiac Disease | Anemia is a frequent presentation of celiac disease. In one study, 200 consecutive patients of a hematology clinic were screened for antigliadin and antiendomysial antibodies. Patients with both positive titers underwent intestinal biopsy, and in 10 patients (5%), results were positive for celiac disease. The prevalence increased to 8.5% if the patients with macrocytic anemia and the patients with bleeding who responded to iron therapy were excluded. |
 Crohn's Disease |
Digestion |
Gastrointestinal Bleeding | People with long-term bleeding that tends to occur in small amounts or intermittently may develop symptoms of anemia, such as tiring easily and looking unnaturally pale. |
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Nutrients |
Copper Deficiency | Copper deficiency, due to its effects on ceruloplasmin, may cause an iron-deficiency anemia which can only be corrected with copper supplementation as it impairs iron absorption, reduces heme synthesis and increases iron accumulation in storage tissues. [J Orthomol Med 4( 2): pp.99-108, 1989] |
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Organ Health |
Chronic Renal Insufficiency | Patients with CRF often suffer from complications such as anemia, which occurs when failing kidneys no longer produce sufficient erythropoietin, a hormone that stimulates the production of oxygen-carrying red blood cells (RBCs). In addition to decreased levels of RBCs, patients often begin to accumulate toxic metabolites, which shorten the lifespan of existing RBCs. |
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Symptoms - Reproductive - General |
(Much) recent breastfeeding | Breast-feeding a baby can deplete iron stores. |
Being in late/being in mid-/being in early pregnancy | Pregnancy can deplete iron stores. |
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Tumors, Malignant |
Non-Hodgkin's Lymphoma |
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Anemia (Iron deficiency) suggests the following may be present: | | | | | Hormones | Counter-indicators:
 Hypothyroidism | If anemia is identified as a problem then the likelihood of Hypothyroidism is reduced. Therefore, it is wise to rule out anemia first, because both can contribute to similar symptomology. Of course, it is not impossible for both to occur simultaneously, but this is less likely. |
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Immunity |
Counter-indicators:
Chronic Fatigue / Fibromyalgia Syndrome | If anemia is identified as a problem then the likelihood of CFS is reduced. Therefore, it is wise to rule out anemia first, because both can contribute to similar symptomology. Of course, it is not impossible for both to occur simultaneously, but this is less likely. |
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Nutrients |
 Iron Requirement (confirmed) |
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Recommendations and treatments for Anemia (Iron deficiency): | | | | | Botanical |  Chlorella |
Diet |
 Caffeine/Coffee Avoidance | Research has shown that drinking coffee causes a significant loss of several vitamins and minerals, including vitamins B and C, calcium, iron, and zinc. |
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Homeopathy |
Ferrum phosphoricum Cell Salt |
Lab Tests/Rule-Outs |
 CBC (Complete Blood Count) Test
Test Iron Stores (Ferritin) |
Mineral |
Iron | Iron supplementation, with as much as 200mg of elemental iron per day, is the obvious therapy for treating and preventing the recurrence of iron deficiency anemia. |
Molybdenum | Molybdenum may help prevent anemia by helping mobilize iron, provided there are sufficient iron stores. |
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Vitamins |
Vitamin C (Ascorbic Acid) | It has been well established that better iron absorption occurs from both plant and animal sources when vitamin C is taken at the same time, whether from foods or as a supplement. 75mg of vitamin C in a meal will cause about a six-fold increase in the absorption of heme iron. It appears that vitamin C enhances non-heme iron absorption in individuals with low iron status, but does not increase iron status unnecessarily in iron-replete individuals. [Effect of ascorbic acid on iron absorption from different types of meals. Hum Nutr: Appl Nutr,1986 40A: pp.97-113] |
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KEY | Weak or unproven link: may be a sign or symptom of; may suggest; may increase risk of | | Strong or generally accepted link: is often a sign or symptom of; often increases risk of | | Definite or direct link: is a sign or symptom of; strongly suggests | | Strong counter-indication: often contraindicates; often reduces the likelihood of |  | Definitely or absolutely counter-indicates: strongly contraindicates | | May be useful: may help with | | Moderately useful: often helps with | | Very useful: is highly recommended for |
Last updated: Apr 08, 2012
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