Iron-Deficiency Anemia

(Reduced Iron in Blood)

Definition

Anemia is a low level of healthy red blood cells (RBC). RBCs carry oxygen from the lungs to the rest of the body. Iron is needed to build healthy RBCs. Lower RBC counts mean the body is not getting enough oxygen.
Red Blood Cells
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Iron makes a critical component of red blood cells.
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Causes

Factors that play a role include:
  • Iron that is poorly absorbed in the digestive tract—may occur due to intestinal diseases or surgery
  • Chronic bleeding , such as heavy menstrual bleeding or bleeding in the gastrointestinal (GI) tract
  • Not enough iron in the diet—common cause in infants, children, and pregnant women

Risk Factors

These factors may increase your chance of developing this condition:
  • Rapid growth cycles—may occur with infancy or adolescence
  • Heavy menstrual bleeding or chronic blood loss from the GI tract
  • Pregnancy
  • Diets that contain insufficient iron—rare in the United States
  • Breastfed infants who have not started on solid food after 6 months of age
  • Babies who are given cow’s milk prior to age 12 months
  • Alcoholism

Symptoms

Most people with mild anemia have no symptoms. In those that have them, anemia may cause:
  • Fatigue
  • Pale skin
  • Fingernail changes
  • Weakness
  • Headache
  • Decreased work capacity
  • Heart palpitations
  • Infection
  • Craving to eat things that are not food (called a pica), such as ice or clay
  • Hair loss
  • Shortness of breath during or after physical activity

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.Tests may include:
  • Serum iron
  • Transferrin iron binding capacity
  • Serum ferritin level
  • Microscope examination of a blood smear
  • Fecal occult blood test —to look for hidden blood in the stool

Treatment

Treatments may include:

Iron Supplements

Iron can be taken as a supplement or as part of a multivitamin. Iron comes in many "salt" forms. Ferrous salts are better absorbed than ferric salts. Ferrous sulfate is the cheapest and most commonly used iron salt. Slow-release or coated products may cause less stomach problems. However, they may not be absorbed as well. Some products contain vitamin C to improve absorption. Talk to your doctor, though, because your iron level could get too high.

Iron-Fortified Cereal

Your doctor may recommend that you feed your baby iron-fortified cereal.

Prevention

To help reduce your chance of having anemia:
  • Eat a diet rich in iron , such as oysters, meat, poultry, or fish
  • Avoid foods that interfere with iron absorption, such as black tea
Ask your doctor if your infant is getting enough iron. General guidelines include:
  • Starting at 4 months, breastfed infants need an iron supplement until they get enough iron from other sources, like infant cereal or iron-fortified formula.
  • Bottle-fed infants should get a formula that is fortified with iron.
  • Many premature infants need extra iron starting at 1 month of age.

RESOURCES

American Congress of Obstetricians and Gynecologists
http://www.acog.org

Healthy Children—American Academy of Pediatrics
http://healthychildren.org

CANADIAN RESOURCES

Dietitians of Canada
http://www.dietitians.ca

Health Canada
http://www.hc-sc.gc.ca

References

Beers MH, Berkow R. The Merck Manual of Diagnosis and Therapy. 17th ed. Hoboken, NJ: John Wiley & Sons; 1999.

Beers MH, Berkow R. The Merck Manual of Diagnosis and Therapy. 18th ed. Hoboken, NJ: John Wiley & Sons; 2006.

Iron. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/biomedical-libraries/natural-alternative-treatments. Updated August 22, 2013. Accessed August 12, 2014.

Iron deficiency in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 4, 2014. Accessed August 12, 2014.

Iron deficiency in children (infancy through adolescence). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 7, 2014. Accessed August 12, 2014.

Iron fortification of infant formulas. Pediatrics. 1999;104:119-123.

US Preventive Services Task Force. The Guide to Clinical Preventive Services: Report of the United States Preventive Services Task Force. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002.

US Preventive Services Task Force. The Guide to Clinical Preventive Services: Report of the United States Preventive Services Task Force. AHRQ Publication No. 06-0588; Rockville, MD: 2006.

10/12/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Baker R, Greer F, et al. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics. 2010;126(5):1040-1050.

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