How is iron deficiency anemia diagnosed?

Written by He Li Fang
Hematology
Updated on September 15, 2024
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The diagnosis of iron deficiency anemia includes two aspects: one is to establish whether there is anemia caused by iron deficiency, and the other is to clarify the cause of the iron deficiency. First, we need to carefully inquire and analyze the medical history, combined with the patient's physical examination, which can provide a series of clues for diagnosing iron deficiency anemia. A definitive diagnosis also requires laboratory evidence. Clinically, we can divide iron deficiency and iron deficiency anemia into three stages: iron deficiency, iron-deficient erythropoiesis, and iron deficiency anemia. The following describes the diagnostic criteria for iron deficiency anemia specifically. Iron deficiency anemia is characterized by a significant reduction in hemoglobin in red blood cells, presenting as microcytic hypochromic anemia. Its diagnostic basis includes three aspects: first, conforming to the diagnosis of iron deficiency and iron-deficient erythropoiesis; second, having microcytic hypochromic anemia; and third, effective treatment with iron supplements. These three factors together can confirm the diagnosis of this disease.

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Symptoms of iron deficiency anemia

The clinical manifestations of iron deficiency anemia consist of symptoms due to the anemia itself, specific manifestations of iron deficiency, and the underlying diseases causing the iron deficiency. The onset of anemia is often insidious, with some patients progressing very slowly. Initially, patients can adapt well to daily life and continue with their work, making it difficult to detect. It is usually not until the anemia becomes moderate to severe and symptoms become apparent that it is discovered. Common symptoms of anemia include dizziness, headaches, weakness, easy fatigue, palpitations, and shortness of breath after activity. Some patients might also experience a decline in memory and suffer from tinnitus and blurred vision. Some affected children may exhibit delayed growth and development or even abnormal behaviors, which can manifest as irritability, restlessness, inattention in class, and declining academic performance. A few patients may develop pica, a specific manifestation of iron deficiency anemia. Additionally, some patients might suffer from angular cheilitis, glossitis, and even atrophy of the tongue papillae. Severe cases can experience transient blindness and fainting, hence it is crucial to seek medical attention for iron deficiency anemia at the earliest.

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Hematology
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How long does iron deficiency anemia need to be treated?

Patients with iron deficiency anemia typically need several months of iron supplementation treatment. The specific reason is that after taking iron supplements, patients' subjective symptoms can recover quickly. The count of reticulocytes generally begins to rise within three to four days after starting the medication, reaching a peak around seven days. Hemoglobin levels notably increase within two weeks of treatment, and generally return to normal around two months. After correcting anemia, it is necessary to continue treatment for at least another three months because the body's iron stores need further supplementation. It is necessary to restore serum ferritin levels to fifty micrograms per liter to replenish these stores fully. This is required to achieve a true cure of iron deficiency anemia, as without this, patients are prone to relapse. Therefore, regular and long-term effective use of iron supplements is an essential basis for ensuring the treatment effectiveness of iron deficiency anemia.

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Pediatrics
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Symptoms of iron deficiency anemia in babies

Any age can develop the disease, but it is most commonly seen between six months and two years old, with a relatively slow onset. Generally, there is a gradual pallor of the skin and mucous membranes, most notably in the eyes, lips, oral mucosa, and nail beds. Affected children tend to be fatigued and less active, and older children may experience symptoms such as dizziness and darkening before the eyes. Physical examination may reveal enlargement of the liver, spleen, and lymph nodes; the more severe the anemia, the more pronounced the enlargement. Anemia can lead to a decreased appetite, and in some cases, pica, such as a craving to eat non-food items like soil or walls, may occur. Symptoms may also include vomiting, diarrhea, glossitis, and stomatitis. There is a general listlessness, lack of concentration, impaired memory, and intelligence that may be lower than peers of the same age. Iron deficiency anemia can also lead to decreased cellular immune function, making infections more likely.

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Causes of Iron Deficiency Anemia

There are many reasons for iron deficiency anemia, which we can categorize into several aspects. The first aspect is a decrease in iron intake, including diet, meaning insufficient dietary intake. The second aspect is decreased absorption, such as the absence of a target organ for absorption or the lack of stomach acid affecting its absorption efficacy. The second aspect refers to excessive loss, most commonly chronic gastrointestinal bleeding, such as in patients with tumors, duodenal ulcers, gastric ulcers, gastritis, ulcerative colitis, a parasitic infection with hookworms, as well as hemorrhoids, and arteriovenous malformations, all of which can cause gastrointestinal bleeding leading to increased iron loss. Excessive menstrual flow in female patients, multiple blood donations, and multiple pregnancies can all lead to iron deficiency. These are the various causes related to iron deficiency.

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What are the symptoms of iron deficiency anemia in children?

Iron deficiency anemia can manifest as: 1. Gradual pallor of the skin and mucous membranes, especially noticeable on the lips, oral mucosa, and nail beds. Older children may experience dizziness, darkening before the eyes, and tinnitus. Additionally, anemia can lead to extramedullary hematopoiesis, and enlargement of the liver, spleen, and lymph nodes can occur. The younger the age and the longer the duration of the disease, the more severe the anemia and the more prominent the enlargement of the liver and spleen. 2. In terms of gastrointestinal tract: reduced appetite, pica, vomiting, diarrhea, and stomatitis may occur. 3. Nervous system manifestations include: restlessness or lethargy, lack of concentration, reduced memory, and intelligence often lower than peers of the same age. 4. Cardiovascular system: an increased heart rate may be observed, and in severe cases, cardiac enlargement and even heart failure can occur. 5. Immune system: Iron deficiency can affect hematopoietic function, often leading to reduced cell-mediated immune function and combined infections.