Iron is important in maintaining several body functions; it is required for maintaining healthy cells, skin, hair and nails.
Who are at Risk of Iron Deficiency?
Iron deficiency is very common, especially among women and in people whose diet lacks adequate iron. People at increased risk of iron deficiency include:
• Women who menstruate; heavy menstrual periods deprives the body of its iron stores.
• Pregnant women, women who have had a recent delivery or are breast feeding.
• Vegetarians, vegans, people whose diet lacks iron-rich foods. Even iron-rich vegetables are inferior to meat, poultry and fish since iron from the latter is more easily absorbed by the body.
• Children who drink excess cow’s milk. Cow’s milk is a poor source of iron; it can also decrease absorption of iron and irritate the intestinal linings causing chronic blood loss.
• People with peptic ulcer; those who have undergone major surgery or physical trauma. Bariatric surgery, especially gastric bypass operations, increases the risk.
• People with gastrointestinal diseases such as celiac disease (sprue), or inflammatory bowel diseases such as ulcerative colitis, or Crohn disease.
Other common causes include:
• Blood loss due to conditions such as gastritis (inflammation of the stomach), esophagitis (inflammation of the oesophagus), haemorrhoids, angiodysplasia (leaky blood vessels in the gastrointestinal tract), infections and tumours. Chronic nose bleeds can also cause significant loss of iron
• Blood loss from the urinary tract
• Frequent blood donations
• The breakdown of red blood cells in blood stream is called intravascular hemolysis. This can be due to damaged heart valves or rare disorders such as thrombotic thrombocytopenia purpura (TTP) or diffuse intravascular haemolysis (DIC).
• Vigorous exercise, particularly jogging, can traumatize small blood vessels in the feet. This is called “march hematuria.”
What are the Symptoms and Signs of Iron Deficiency?
Mild iron deficiency anemia often goes unnoticed because of lack of evident symptoms. With further iron depletion and worsening anemia, signs and symptoms intensify.
Common symptoms include:
• Extreme fatigue; weakness
• Hair loss
• Shortness of breath, fast heartbeat
• Dizziness or light-headedness
• Cold extremities: hands and feet get cold
• Inflammation or soreness of tongue
• Brittle nails, changes in the appearance of nails
• Pica: Unusual cravings for substances like ice, dirt or starch (non-nutritive substances). Iron deficiency is believed to be the cause of pica. Pica is more common in women (especially during pregnancy) and young children.
• Poor appetite
• Restless leg syndrome: An uncomfortable tingling or crawling feeling in legs
When to Visit a Doctor? Can I take Oral Iron Supplements on my own?
Always visit a doctor, a specialist in Internal Medicine or Pediatrics (in the case of children) preferably. Every case of anemia needs thorough work up. Iron deficiency shouldn’t be self-diagnosed or self-treated. There is every risk of acquiring an iron overload if you take unnecessary supplements. This damages your liver and can lead to many complications.
What are the Complications of Iron Deficiency?
Untreated sever iron deficiency can lead to heart problems such as enlarged heart or heart failure. Iron deficiency can also complicate pregnancy leading to premature births and low birth weight babies.
Delayed growth and development of children is linked to iron deficiency. It also increases susceptibility to infections.
What are the Tests available to Diagnose Iron Deficiency?
Iron deficiency is often evident from blood work up. Components of the work up usually involve hemoglobin, ferritin, haematocrit and parameters indicating morphology of red blood cells. Imaging modalities such as endoscopy, colonoscopy and ultrasound may also be required for further investigating the cause of iron deficiency.
How can Iron Deficiency be treated?
Oral iron supplements are commonly prescribed by doctors to replenish iron stores. Iron tablets are to be taken on an empty stomach for best results, however if gastric upset ensues (a common side effect of iron tablets), it is okay to take them with meals. These supplements (tonic, pills etc.) may be needed for long periods, since the deficiency cannot be corrected with one or two doses.
Iron tablets are better taken with a glass of orange juice or with a vitamin C supplement, since vitamin C improves iron absorption.
One frequent complaint from patients on iron supplements is darkening of stools, but this is not harmful. Constipation that arises due to iron supplements is usually combated with stool softeners.
Severe case of iron deficiency and absolute intolerance to oral supplements (metallic taste, gastric upset, nausea etc. that may prevent patients from taking pills) may be tackled by switching over to intravenous infusions of iron. Blood transfusions may be required in certain cases.
It is always important to treat the underlying cause that leaded to iron deficiency. Unless the basic cause is corrected, iron deficiency may not completely respond to supplements.
Can Iron Deficiency be Prevented?
Include iron-rich foods in your diet:
• Peas; lentils; white, red, and baked beans; soybeans; and chickpeas
• Dark green leafy vegetables, such as spinach
• Dried fruit, such as prunes, raisins and apricots
• Iron-fortified cereals, breads and pastas
• Red meat
Iron in meat is better absorbed than the iron in vegetables, this is why pure vegetarians are at increased risk of iron deficiency.
Infants should be adequately breast fed. Iron-fortified formulas are used when applicable. Iron in breast milk is readily absorbed unlike the iron found in formula. Cow’s milk is not a rich source of iron for babies.