Iron deficiency anemia, the most common anemia

What is anemia?

Anemia is defined as a decrease in the amount of hemoglobin and, consequently, a decrease in the ability to supply oxygen to tissues and organs.

There are many types of anemia and for very diverse causes, from a lack of iron or certain vitamins, to the destruction of red blood cells by antibodies. An exhaustive review of the different anemias is a highly specialized and tedious subject for anyone without medical training. However, the most common anemias are:

  • Iron deficiency anemia: caused by iron deficiency.
  • Inflammatory anemia: causes chronic inflammatory disorders.
  • Anemia due to lack of vitamin B 12 and folic acid.

Other anemias, such as those caused by congenital defects affecting the formation of red blood cells or hemoglobin, such as thalassemias, are relatively numerous but generally clinically irrelevant.

Even more distant are anemias due to red cell destruction such as autoimmune hemolytic anemias or anemias due to mechanical destruction, etc. Fortunately these are very rare, but it is interesting to mention them so that it is understood that the correct diagnosis of the causes of anemia can be very complex.

What are the symptoms of anemia?

The symptoms of any anemia are:

  • Tiredness
  • Loss of appetite
  • Pallor
  • Sleepiness
  • Irritability

These symptoms will be more or less intense depending on the amount of hemoglobin. And so we classify as:

  • Mild anemia: when the hemoglobin is between 12 and 10 g.
  • Moderate anemia: between 10 and 8 grams.
  • Severe anemia: below 8g

Likewise, symptoms vary from one individual to another and according to the speed at which the anemia has occurred.

When anemia sets in slowly, the degree of habituation and tolerance to iron deficiency anemia is striking. It is not uncommon to find young women with very severe anemia of 6 g of hemoglobin who report feeling only slightly tired (figures of 4 g begin to be incompatible with life).

Iron deficiency anemia

One of the most common anemias is iron deficiency anemia, i.e. anemia due to iron deficiency. This anemia can reach a high prevalence in young women as a result of menstruation, in Europe, depending on the level of development, it can be around 5%. The prevalence is much lower in post-menopausal women and in men, around 0.1%.

But it is important to know that prior to anemia there is a status of iron deficiency, which also causes pathology, and can be up to 15% in European women of childbearing age.

Diagnosis and treatment of iron deficiency anemia

One of the most common tasks undertaken by the hematology specialist is the correct diagnosis and treatment of anemias. Initiating treatment blindly and without having carried out a study of the causes can lead to and cover up the true origin, to therapeutic failure and, eventually, to damage that may be irreparable.

The diagnosis of iron deficiency anemia is relatively simple:

  • In the laboratory, the amount of hemoglobin, circulating iron and, above all, iron deposits (called ferritin and which are a much more stable and reliable measure) are assessed.
  • In the study of the causes, the type of patient must be taken into account:
    • If the patient is female, young, and does not manifest digestive symptoms and no occult or obvious blood is found in the stool examination, it is assumed to be due to an imbalance between iron intake and menstrual losses.
    • If the patient is a man or a menopausal woman things are different. In this case a study should be made of possible losses through the digestive tract, which may be due to relatively trivial causes such as a diverticulum or as serious as colon cancer.
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Much less frequently we find an absorption disorder. This occurs mainly in patients with celiac disease (mainly gluten intolerance), which sometimes does not manifest itself in any other way. An analysis as simple as the fecal occult blood test should be performed preventively at least once a year.

What is the treatment of iron deficiency anemia?

Once it has been clearly diagnosed that the anemia is due to iron deficiency and that there are no other reasons, the causes must be sought and confirmed, which will be digestive losses or gynecological losses and, very rarely, an absorption defect.

The problem behind the anemia must be studied, whether it is a myoma, hormonal dysregulation, digestive cancer, celiac disease, etc., because it is not only a question of resolving the anemia, but also the underlying cause, which is the real problem and which can be very serious. In no case should treatment be started and the study of the causes be ignored.

In iron deficiency anemia the treatment will always be iron replacement, unless it is very serious, for example, less than 6 g of hemoglobin and with hemodynamic repercussions, in which case transfusion is mandatory. This iron can be administered orally in tablets or in suspension.

The treatment usually causes digestive problems of intolerance and, very often, constipation. I personally recommend taking it with a meal or after a meal. It will be absorbed somewhat less, but will do less damage to the digestive tract and improves compliance with treatment.

When the results are not optimal or the patient does not tolerate oral iron (intolerable constipation, non-specific digestive discomfort…) the correct thing to do is to proceed with intravenous iron infusion. The current intravenous iron preparations are very convenient to administer, very safe and a few doses resolve a situation that would take months to resolve with oral iron, but without any discomfort and allowing the physician a fairly certain estimate of the patient’s needs. This is a huge step forward.

Can there be iron deficiency without anemia?

This situation prior to iron deficiency anemia is suffered by 14% of women of childbearing age in advanced countries and 90% in underdeveloped countries.

Without reaching the severe symptoms of anemia, a patient may suffer from

  • A certain degree of muscular fatigue
  • Irritability
  • Depression
  • Hair loss
  • Fragile nails
  • Oddly smooth tongue
  • Collarbones
  • Pagophagia, a rare symptom, which is a compulsive desire to eat unusual things such as chewing ice, chewing coffee beans, ingesting large amounts of ice-cold Coca-Cola, eating dirt, etc. They occur in a small percentage and very often patients do not report it because they believe it is a mental disorder.

Also iron deficiency, even if there is no anemia as such, affects the heart muscle and can contribute to heart failure. For all these reasons, it is recommended that even in women, iron deposits (ferritin) should not be less than 50 mgs.

What products should a patient eat to improve anemia?

In the case of iron deficiency anemia it is absolutely useless to undertake a specific diet, which in any case would be based on huge amounts of meat. Other widespread beliefs such as taking lentils are even more absurd. Just so we understand that a single tablet of ferrous sulfate from a pharmacy containing 100 mg of iron is equivalent to the iron contained in six kilos of lentils. So the way to cure is through the treatments I have exposed.