Iron deficiency anaemia is one of the most common types of anaemia worldwide. It occurs when the body does not have enough iron to produce adequate amounts of haemoglobin, the protein in red blood cells responsible for carrying oxygen throughout the body. Without sufficient haemoglobin, tissues and organs receive less oxygen, leading to fatigue, weakness, and a range of systemic complications if untreated.
Causes of Iron Deficiency Anaemia
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Dietary deficiency: Insufficient intake of iron-rich foods, common in strict vegetarians or individuals with poor diets.
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Increased requirements: Pregnancy, breastfeeding, or periods of rapid growth (infancy, adolescence).
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Blood loss: Heavy menstrual periods, gastrointestinal bleeding (peptic ulcers, colon cancer, haemorrhoids, inflammatory bowel disease), frequent blood donation, or trauma.
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Malabsorption: Conditions such as celiac disease, atrophic gastritis, Crohn’s disease, or after bariatric surgery can impair iron absorption.
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Parasitic infections: Hookworm or schistosomiasis may cause chronic intestinal blood loss in endemic areas.
Symptoms
Iron deficiency anaemia may develop slowly and can be asymptomatic in early stages. As it progresses, symptoms become more evident:
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Fatigue and weakness
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Shortness of breath, especially on exertion
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Pale or sallow skin
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Dizziness or light-headedness
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Cold hands and feet
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Brittle nails or spoon-shaped nails (koilonychia)
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Sore tongue (glossitis)
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Craving for non-food items (pica), such as ice, dirt, or starch
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Restless legs syndrome
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Poor concentration and irritability
Diagnosis
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Complete blood count (CBC): Shows low haemoglobin and haematocrit, with microcytic (small) and hypochromic (pale) red blood cells.
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Serum ferritin: Low ferritin indicates reduced iron stores.
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Serum iron and transferrin saturation: Both are typically reduced.
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Total iron-binding capacity (TIBC): Elevated, reflecting increased capacity to bind iron due to deficiency.
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Peripheral smear: Microcytic, hypochromic anaemia.
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Investigations for underlying cause: Endoscopy, colonoscopy, stool occult blood testing, or gynaecological evaluation depending on risk factors.
Treatment
The goals of treatment are to correct anaemia, replenish iron stores, and address the underlying cause.
1. Oral Iron Therapy
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First-line treatment for most patients.
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Ferrous sulfate 200 mg (providing ~65 mg elemental iron) taken once to three times daily.
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Alternatives: Ferrous fumarate 300 mg (~100 mg elemental iron) once or twice daily, or Ferrous gluconate 300 mg (~35 mg elemental iron) two to three times daily.
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Duration: Typically 3–6 months after haemoglobin normalises, to replenish body stores.
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Side effects: Constipation, nausea, abdominal discomfort, dark stools. These may be minimised by taking iron with meals, though absorption is reduced. Slow-release formulations can help but may be less effective.
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Enhancers of absorption: Vitamin C (ascorbic acid) 250–500 mg with iron improves absorption.
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Avoid with tea, coffee, dairy products, or antacids within 2 hours of dosing, as they reduce absorption.
2. Intravenous Iron Therapy
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Indicated if:
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Oral iron is ineffective or poorly tolerated
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Rapid correction is needed (severe anaemia, preoperative state)
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Malabsorption syndromes (e.g., celiac disease, IBD, post-gastric bypass)
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Iron sucrose: 200 mg IV every 2–3 days until total required dose is given.
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Ferric carboxymaltose: Up to 1,000 mg IV per session, may be repeated after 1 week.
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Iron dextran: Less commonly used due to higher risk of anaphylaxis.
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Risks: Infusion reactions, hypophosphatemia, rare anaphylaxis.
3. Blood Transfusion
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Reserved for severe symptomatic anaemia (e.g., haemoglobin <7 g/dL with cardiovascular compromise).
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Not a routine treatment for iron deficiency as it does not correct the underlying deficiency.
Addressing the Underlying Cause
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Menorrhagia: Managed with hormonal therapy, antifibrinolytics, or surgical options.
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Gastrointestinal bleeding: Investigation and treatment of ulcers, polyps, haemorrhoids, or malignancy.
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Nutritional deficiency: Improved diet with iron-rich foods (red meat, poultry, fish, legumes, fortified cereals, leafy green vegetables).
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Parasitic infections: Antiparasitic medications where relevant.
Prevention
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Balanced diet: Including both heme iron (animal sources) and non-heme iron (plant sources).
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Iron supplementation: Recommended in pregnancy (30–60 mg elemental iron daily, as per WHO guidelines).
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Monitoring at-risk populations: Infants, menstruating women, frequent blood donors, and patients with chronic diseases.
Complications if Untreated
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Severe anaemia leading to heart failure, angina, or arrhythmias.
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Impaired cognitive function and reduced work capacity.
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In children: Developmental delays, behavioural problems, and impaired school performance.
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Pregnancy complications: Preterm birth, low birth weight, increased maternal mortality.
Iron deficiency anaemia is highly treatable, but identifying and addressing the underlying cause is crucial to prevent recurrence and serious complications.
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