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Iron-Deficiency Anaemia

Iron-deficiency anaemia (IDA), also known as Sideropenic Anaemia or FeDA, is a condition characterised by a decrease in the number of red blood cells or the amount of haemoglobin in the blood due to insufficient iron. It's a common condition that can have significant health implications if left untreated.

Red blood cells
Red blood cells

Signs and Symptoms

IDA often develops slowly, giving the body time to adapt, which can result in vague symptoms initially. Common symptoms include fatigue, weakness, dizziness, lightheadedness, poor physical exertion, headaches, and a decreased ability to concentrate. In severe cases, shortness of breath, confusion, and increased thirst may occur. Children with IDA may experience growth and developmental issues.

Additional symptoms can include irritability, angina, palpitations, breathlessness, tingling or numbness, glossitis, angular cheilitis, koilonychia, poor appetite, dysphagia, periorbital hyperpigmentation, and restless legs syndrome. Pica, particularly pagophagia (the consumption of ice), is also specific to IDA.

Causes

IDA can result from increased iron demand, increased iron loss, or decreased iron intake. Increased demand is common during periods of growth or pregnancy. Blood loss is a significant cause, occurring through heavy menstrual periods, gastrointestinal bleeding, or frequent blood donations. Poor dietary intake and malabsorption conditions like celiac disease or after gastric bypass surgery can also lead to IDA.

Parasitic Disease

In the developing world, parasitic worms like hookworms are a leading cause of IDA. They cause chronic blood loss and inflammation by attaching to the intestinal mucosa.

Menstrual Bleeding and Gastrointestinal Bleeding

Heavy menstrual bleeding can cause IDA in women of childbearing age. Gastrointestinal bleeding, often due to ulcers, cancer, or medications like NSAIDs, is a common cause in men and post-menopausal women.

Diet

Inadequate dietary intake of iron, particularly non-heme iron from plant sources, can lead to IDA. Foods rich in iron include meat, nuts, and iron-fortified products.

In many countries, wheat flour is fortified with iron.
In many countries, wheat flour is fortified with iron.

Pregnant Women and Children

Pregnancy increases iron requirements, and without supplementation, IDA is common. Children, especially infants, are at risk due to rapid growth and inadequate dietary iron.

Diagnosis

Diagnosis begins with a complete blood count (CBC) showing low haemoglobin and hematocrit levels. Further tests include serum ferritin, serum iron, total iron-binding capacity (TIBC), and transferrin saturation. A blood smear may show hypochromic, microcytic red blood cells, poikilocytosis, and anisocytosis.

Blood smear of a person with iron-deficiency anaemia at 40X enhancement
Blood smear of a person with iron-deficiency anaemia at 40X enhancement

Treatment

Treatment focuses on addressing the underlying cause and replenishing iron stores. Dietary changes to include iron-rich foods and oral iron supplements are first-line treatments. Vitamin C can enhance iron absorption. For severe cases or those not responsive to oral iron, intravenous iron or blood transfusions may be necessary.

Ascorbic acid
Ascorbic acid

Epidemiology

Globally, IDA affects approximately 1.48 billion people, with higher prevalence in women and young children. It's more common in developing countries due to factors like parasitic infections and inadequate dietary intake.

Deaths due to iron-deficiency anaemia per million persons in 2012
Deaths due to iron-deficiency anaemia per million persons in 2012
Disability-adjusted life year for iron-deficiency anaemia per 100,000 inhabitants in 2004
Disability-adjusted life year for iron-deficiency anaemia per 100,000 inhabitants in 2004

Self-assessment MCQs (single best answer)

Which of the following is not a common symptom of iron-deficiency anaemia (IDA)?



What specific condition is characterised by spoon-shaped nails and is associated with IDA?



In the developing world, what is a leading cause of IDA?



What is the primary diagnostic test to confirm iron-deficiency anaemia?



Which of the following foods is least likely to help in replenishing iron stores?



What vitamin enhances iron absorption when taken with iron-rich foods or supplements?



Which of the following is not a typical cause of iron-deficiency anaemia?



Which population group is at increased risk of IDA due to rapid growth and inadequate dietary iron?



What treatment might be necessary for severe cases of IDA unresponsive to oral iron supplements?



What is the global prevalence of iron-deficiency anaemia?



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