ANEMIA, IRON DEFICIENCY

Iron deficiency anemia occurs when your body does not have enough iron to produce red blood cells. Iron is an essential component of red blood cells. Most of your iron comes from food, but you may lose iron if you lose a large amount of blood. In developing countries, inadequate nutrition is the principal cause of iron deficiency anemia. In Europe and the United States, chronic blood loss is more frequently responsible for the iron deficiency.

The body has many ways of conserving iron. When red blood cells are destroyed, the iron inside them is reused in the production of new red blood cells. However, there is a daily iron loss that should be replenished with nutrition. Foods that have a high amount of iron are animal products such as meat, milk, and eggs. Vegetables such as spinach and broccoli have a large amount of iron, but the intestine is not able to absorb it.

Patients at risk for iron deficiency anemia are strict vegetarians (those who do not consume any animal products), those who eat an inadequate diet, and those who require large amounts of iron, such as pregnant or lactating women or women with heavy menstrual losses. Also at risk are patients with chronic blood losses caused by conditions such as gastric ulcers or intestinal tumors. Many times the first sign of a malignant intestinal tumor is iron deficiency anemia.

You may feel fatigued or unable to perform your normal daily activities. In severe cases, you may have shortness of breath, palpitations, and even chest pain. If you have an iron deficiency for a long period of time, other symptoms such as sore mouth, difficulty swallowing, or a tendency for your nails to soften and curl, sometimes taking the shape of a spoon, may occur.

A simple blood test is the most common method of diagnosis. The blood is examined with a microscope, and the red blood cells show a characteristic shape. Sometimes the diagnosis is not clear, and a bone marrow examination is necessary. This is performed at the doctor's office under local anesthesia, and the results usually are available in 2 to 3 days.

Determination of the cause of iron loss is essential to the diagnosis of iron deficiency anemia. Because the cause is most often chronic blood loss, signs of abnormal bleeding are sought.

The tenuous nature of iron balance among infants, adolescents, and pregnant women make evaluation unnecessary in most instances of iron deficiency anemia. A trial with iron supplementation is usually sufficient. However, any abnormality among men or postmenopausal women necessitates prompt investigation.

The immediate treatment of patients with iron deficiency anemia depends on the severity of the condition. In the worse cases, blood transfusion may be necessary. All other cases can be managed with an iron tablet taken three to four times a day. A typical regimen is one tablet after each meal and at bedtime. As many as 25% of patients have some nausea and upper abdominal pain; diarrhea and constipation may occur. If that is the case, a physician should be told, and the dose of iron will be reduced. After any surgical procedure, especially a gastric operation, the body absorbs less iron than normal. In that case a liquid iron preparation is usually prescribed.

• Undergo a screening blood test if you are at risk for iron deficiency anemia.
• Participate in your prenatal care, and take your prenatal vitamins. Continue to take your prenatal vitamins if you are lactating.
• Eat a well-balanced diet to maintain your iron balance.

• Avoid overexertion.

• If you experience severe fatigue, dizziness, chest pain, or shortness of breath.
• If you have bleeding or if chronic bleeding increases.
• If you have abdominal pain from the iron supplement pill. This is a side effect of some formulations of iron and usually resolves or improves with lowering of the dose or changing to a different iron formulation.

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