September 22, 2017
Iron Deficiency and Anemia
For this post, we’ll do a shallow dive into the facts on iron deficiency and anemia. We’ll take about prevalence, leading causes and signs/symptoms to watch out for.
Iron deficiency is incredibly common world wide, affecting approximately 12% of the global population. The numbers are highest in women of child-bearing age and people living in lower-income countries. In North America 10% of women of child-bearing age are believed to be iron deficient and 3-5% have iron deficiency anemia. An astounding 25% of pregnant women are thought to be iron deficient.
Obstetric and gynecologic causes are most common in pre-menopausal women. While iron deficiency is much less common in men, the presence of iron deficiency +/- anemia in a male must prompt an investigation for possible underlying cancer or GI condition like inflammatory bowel disease or ulcer. In addition to blood loss, poor iron intake from restrictive diets can also exacerbate or even lead to iron deficiency.
Patients with iron deficiency and normal blood counts or mild anemia often will have generalized symptoms such as fatigue, mild weakness and headaches. If iron and blood loss has happened over a long-period of time these symptoms can occur gradually such that patients are only aware they had them once things have improved post treatment. Other symptoms one can experience are increased irritability and weird dietary cravings. Ice-craving (pagophagia) is quite specific to iron deficiency and can be common in pregnant women. A certain percentage of patients with iron deficiency will also notice red urine after eating beets (beeturia) and restless legs, particularly at night. If anemia becomes more severe, symptoms can progress to include significant exercise intolerance (shortness of breath going up a single flight of stairs), dizziness or vertigo, and even chest pain.
The most sensitive test for iron deficiency is a low serum ferritin. A low ferritin is the first indicator of dropping iron and should be the initial test of choice for physicians suspecting iron deficiency in most of their patients. It should be noted that serum ferritin is an “acute phase reactant” and levels can be abnormally elevated when a patient is experiencing acute inflammation. This can be the result of an active infection or a chronic inflammatory condition like Crohn’s disease or Rheumatoid Arthritis. Serum ferritin values are not accurate in these patients and other iron tests like Transferrin Saturation and TIBC (Total Iron Binding Capacity) are the tests of choice.
A great blog-site dedicated to iron deficiency and anemia can be found here: http://theironmaiden.ca/