Causes of Iron Deficiency Anemia

Written by He Li Fang
Hematology
Updated on September 09, 2024
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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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Treatment of Iron Deficiency Anemia

The treatment principles for iron deficiency anemia mainly involve two aspects. One is to identify the cause of the iron deficiency anemia. Once the cause is confirmed, fundamental treatment of the cause should be conducted to restore the body's normal iron stores. The second aspect is iron supplementation, which is recommended to be administered orally. The daily supplemental iron dose is approximately 150 to 200 milligrams, typically using ferrous preparations such as ferrous succinate, ferrous fumarate, ferrous gluconate, and iron dextran. It is suggested that iron supplements be taken with meals or after meals to reduce gastrointestinal irritation caused by the medication. Additionally, it is advised to avoid consuming tea, coffee, and other substances that could interfere with iron absorption during the treatment period.

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Characteristics of iron deficiency anemia blood picture

The clinical manifestations of iron deficiency anemia are due to the specific characteristics of anemia caused by iron deficiency and the underlying disease causing the iron deficiency. Its hematological characteristics present as typical microcytic hypochromic anemia. What does this concept mean? It refers to the values in a complete blood count where MCV is less than 80 femtoliters, MCH is less than 27 picograms, and MCHC is less than 30%. MCV refers to the average red blood cell volume, MCH refers to the mean corpuscular hemoglobin concentration, and MCHC refers to the mean corpuscular hemoglobin concentration of red blood cells. The extent of changes in red blood cell indices correlates with the duration and severity of anemia. The blood smear typically shows pale-stained red blood cells with an enlarged central pallor and varying sizes. Platelet count often tends to be high when there is concurrent bleeding and generally tends to be low in infants and children. White blood cell count is usually normal or slightly reduced, with normal differential. These are the hematological characteristics of iron deficiency anemia.

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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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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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What are the symptoms of iron deficiency anemia?

Iron deficiency anemia is a type of anemia that exhibits common symptoms found in all anemia patients. It is characterized by a range of clinical symptoms caused by oxygen deficiency in tissue organs due to a lack of blood in the body. Common symptoms include dizziness, headaches, fatigue, shortness of breath and palpitations after activity, easy fatigability, difficulty concentrating, and decreased memory. Some patients may also experience blurred vision, ringing in the ears, and in severe cases, fainting, transient darkening of vision, and even arrhythmias. Because iron deficiency anemia is also accompanied by iron deficiency, it presents a range of clinical symptoms specific to iron deficiency, including pica, angular cheilitis, glossitis, unusual tongue conditions, decreased appetite, and even constipation among other symptoms.