What anemia means?

In simple words, anemia is a condition where carriers of oxygen namely the red blood cells delivers less required oxygen to the body cells. The red blood cells are one components of the blood, it carries oxygen from the lungs to the body tissues. Hemoglobin is contained in the Red Blood Cells (RBC) made of protein and Iron and is the carrying vehicle of Oxygen Anemia will occur if the RBC number falls; quaintly of Hemoglobin falls or size of the RBC gets smaller. There are other causes of anemia which includes inability of the body cells to absorbs the oxygen or when the delivered Iron is trapped in the body.

What are the types of anemia?

Anemia can be classified in many different ways; one way of classification consider evaluating production, destruction and loss of RBC and the other approach consider  grouping anemia by RBC size. The second approach uses a quickly available and cheap lab test. On the other hand, evaluating production, destruction and loss of RBC may allow doctors to rapidly identify cases where multiple causes of anemia coexist.

Iron deficiency anemia is a type of anemia usually referred to as microcytic hypochromic anemia; microcytic is abnormally small RBC and hypochromic is reduced hemoglobin level.

Iron deficiency anemia

Iron Deficiency Anemia (IDA) is considered the most common cause of anemia, it is a global health problem affecting both developed and developing countries it  occurs at all stages of the life cycle, but is more prevalent in pregnant women and young children.

In the Americas the WHO estimated the prevalence of anemia in preschool age children at 29.3%, among pregnant women the prevalence is 24.1% and 17.8% in non pregnant women. In Europe the prevalence is 21.7%, 25.1% and 19% respectively.

Iron is distributed in certain locations in the body; over two third of iron is in the hemoglobin, the rest are distributed in the muscles (Myoglobin), tissue enzymes, transport compartment and tissue storage (ferritin and hemosiderin).

Iron needs are supplied through diet, but when supply is not enough or demands are increased, Iron available for the production of hemoglobin will not be sufficient, consequently Hemoglobin will decrease and ultimately the oxygen level delivered to the body cells will decrease. This condition describes the Iron Deficiency Anemia.

Conditions that may lead to decrease Iron level may include inadequate intake of Iron containing food, increase demand such as in pregnancy, postpartum infancy and adolescence or inadequate absorption that may occurs in diseases such as  malabsorption syndrome or blood loss due to any cause.

What are the symptoms of Iron Deficiency Anemia?

The usual presenting symptoms in adults with iron deficiency include weakness, headache, irritability and varying degrees of fatigue and exercise intolerance. However, many patients may not feel any symptoms and may recognize that they had fatigue, weakness, and exercise intolerance after successful treatment with iron.

How do I know that I have Iron Deficiency anemia?

If you are suffering from the above symptoms, your doctor can perform a simple blood test to check your Complete Blood Count (CBC) and check the state of your Iron storage.

What is the treatment of Iron deficiency anemia?

Treatment of Iron deficiency anemia must be under physician supervision; depending on the cause and severity of anemia treatment may vary, but in the majority of cases oral Iron supplement in suitable dose to correct the hemoglobin level and replenish the Iron stores is indicated.

Oral Iron Tablets

Iron exists in many forms; Ferrous Fumarate, Ferrous Gluconate, Ferrous Sulfate and Carbonyl iron which is a highly pure form of iron. The Recommended Daily Allowance (RDA) is usually expressed in elemental Iron 

        Age <5 month                  5 mg Elemental Iron

        5 mo to 10 y                   10 mg Elemental Iron

        Male              

        11-18 y                           12 mg Elemental Iron

        >18 y                              10 mg Elemental Iron

        Female         

        11-50 y                           15 mg Elemental Iron

        >50 y                              10 mg Elemental Iron

 

Daily Iron dose is determined and supervised by a physician, in general; 

For premature neonates: 2-4 mg elemental iron/kg/day divided every 12-24 hours (maximum dose: 15 mg/day).

Infants and Children:

Severe iron deficiency anemia: 4-6 mg elemental iron/kg/day in 3 divided doses.

Mild to moderate iron deficiency anemia: 3 mg elemental iron/kg/day in 1-2 divided doses.

Prophylaxis: 1-2 mg elemental iron/kg/day up to a maximum of 15 mg elemental iron/day.

Adults:

Iron deficiency: 2-3 mg/kg/day or 60-100 mg elemental iron twice daily up to 60 mg elemental iron 4 times/day, or 50 mg elemental iron (extended release) 1-2 times/day.

Prophylaxis: 60-100 mg elemental iron/day; see table:

Elemental Iron Content of Iron Salts
Iron Salt	Elemental Iron Content (% of salt form)	Approximate Equivalent Doses (mg of iron salt)
Ferrous fumarate	33	197
Ferrous gluconate	11.6	560
Ferrous sulfate	20	324
Ferrous sulfate, exsiccated	30	217

What are the side effects?

Apart from the rare hypersensitivity, the main side effects are gastric pain, nausea, constipation or even diarrhea. Dark stools may occur which results from   excretion of the unused Iron.

How about Contraindications?

Hypersensitivity or allergy to iron salts, some products contain sulfites and/or tartrazine which may cause allergic reactions in susceptible individuals.

  Drug Interactions?

Absorption of oral preparation of iron and antibiotics containing tetracyclines are decreased when both of these drugs are given together; concurrent administration of antacids and drugs containing cimetidine (antiacid) may decrease iron absorption; iron may decrease absorption of penicillamine (antibiotic); response to iron therapy may be delayed in patients receiving chloramphenicol; (antibiotic) absorption of quinolones (antibiotic) may be decreased due to formation of a ferric ion-quinolone complex.

Food Interactions?

Milk, cereals, dietary fiber, tea, coffee, or eggs decrease absorption of iron.

* Data in file