Approximately 20 percent of women and 2 percent of men have iron deficiency anemia, notes a report in "American Family Physician." The most common nutritional deficiency worldwide, iron deficiency anemia causes severe fatigue in women and mental developmental delays in children. Iron supplementation is the mainstay of treatment for the majority of these conditions.
Causes
The causes of iron deficiency fall into four categories: increased physiological demand for iron, abnormal iron loss, decreased iron intake and reduced iron absorption. Increased iron demands occur in pregnancy and during rapid growth spurts in adolescence. Abnormal iron loss results from blood donation and chronic blood loss, with gastrointestinal blood loss being the most common cause of iron deficiency anemia in men. Decreased iron intake results from inadequate diet, while poor iron absorption occurs in Crohn's disease and other inflammatory conditions.
Features
As noted in "Hematology: Basic Principles and Practice," iron deficiency anemia is characterized by pallor, dizziness, headache, heart palpitations, ringing in the ears, weakness, shortness of breath and reduced exercise capacity. Other symptoms include a sore mouth, "spooning" of the fingernail beds and problems swallowing.
Types
The most common anemia caused by lack of iron is iron deficiency anemia. Other anemias that have related iron deficiencies or are secondary to them include anemia of chronic disease, thalassemia, anemia related to stage III chronic kidney disease and sideroblastic anemia, according to "Harrison's Principles of Internal Medicine."
Therapy
Iron replacement is the standard of care in response to anemias related to iron deficiency. Oral supplementation with iron salts, such as ferrous sulfate, ferrous fumarate and ferrous gluconate, is the most common treatment, according to "Cecil Medicine." Used to treat mild to moderate deficiencies, oral iron is accompanied with ascorbic acid to aid in absorption.
Intravenous iron therapy is given to patients who have severe forms of iron deficiency anemia or who cannot tolerate oral iron. In less than 1 percent of patients, a severe allergic reaction occurs.
Adverse Effects
Some of the most common side effects of oral iron supplementation are abdominal pain and cramps, nausea, constipation and black discoloration of stools. According to "Conn's Current Therapy 2010," less common problems side effects include acute iron poisoning, decreased absorption of prescription medications, temporary tooth discoloration and a metallic taste in the mouth.
Intravenous iron therapy side effects include severe allergic reactions, skin discoloration, increased susceptibility to Vibrio species of bacteria, iron overload, joint and bone pain, drops in blood pressure and low-grade fever.
References
- "Conn's Current Therapy 2010" 1st ed.; Edward Bope, M.D., et al.; 2010
- "Ferri's Clinical Advisor 2011" 1st ed.; Fred Ferri, M.D.; 2010
- "American Family Physician"; Shersten Killip, M.D., et al.; March 2007
- "Cecil Medicine" 23rd ed.; Lee Goldman, M.D. and Dennis Ausiello, M.D.; 2008
- "Hematology: Basic Principles and Practice" 5th ed.; Ronald Hoffman, M.D.; 2008
- "Harrison's Principles of Internal Medicine" 17th ed.; Anthony Fauci, M.D., et al., eds.; 2008
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