Iron-Deficiency

Iron is very important in maintaining many body functions, including the production of hemoglobin, the molecule in your blood that carries oxygen. Iron is also necessary to maintain healthy cells, skin, hair, and nails.

Iron from the food you eat is absorbed into the body by the cells that line the gastrointestinal tract; the body only absorbs a small fraction of the iron you ingest. The iron is then released into the blood stream, where a protein called transferrin attaches to it and delivers the iron to the liver. Iron is stored in the liver as ferritin and released as needed to make new red blood cells in the bone marrow. When red blood cells are no longer able to function (after about 120 days in circulation), they are re-absorbed by the spleen. Iron from these old cells can also be recycled by the body.

Am I at Risk?

Iron deficiency is very common, especially among women and in people who have a diet that is low in iron. The following groups of people are at highest risk for iron-deficiency anemia:

Women who menstruate, particularly if menstrual periods are heavy
Women who are pregnant or breastfeeding or those who have recently given birth
People who have undergone major surgery or physical trauma
People with gastrointestinal diseases such as celiac disease (sprue), inflammatory bowel diseases such as ulcerative colitis, or Crohn disease
People with peptic ulcer disease
People who have undergone bariatric procedures, especially gastric bypass operations
Vegetarians, vegans, and other people whose diets do not include iron-rich foods (Iron from vegetables, even those that are iron-rich, is not absorbed as well as iron from meat, poultry, and fish.)
Children who drink more than 16 to 24 ounces a day of cow's milk (Cow's milk not only contains little iron, but it can also decrease absorption of iron and irritate the intestinal lining causing chronic blood loss.)

Other less common causes of iron deficiency include:

Blood loss from the gastrointestinal tract due to gastritis (inflammation of the stomach), esophagitis (inflammation of the esophagus), ulcers in the stomach or bowel, hemorrhoids, angiodysplasia (leaky blood vessels similar to varicose veins in the gastrointestinal tract), infections such as diverticulitis, or tumors in the esophagus, stomach, small bowel, or colon
Blood loss from chronic nosebleeds
Blood loss from the kidneys or bladder
Frequent blood donations
Intravascular hemolysis, a condition in which red blood cells break down in the blood stream, releasing iron that is then lost in the urine. This sometimes occurs in people who engage in vigorous exercise, particularly jogging. This can cause trauma to small blood vessels in the feet, so called "march hematuria." Intravascular hemolysis can also be seen in other conditions including damaged heart valves or rare disorders such as thrombotic thrombocytopenia purpura (TTP) or diffuse intravascular hemolysis (DIC).

What Are the Signs and Symptoms of Iron-Deficiency Anemia?

Symptoms of iron-deficiency anemia are related to decreased oxygen delivery to the entire body and may include:

Being pale or having yellow "sallow" skin
Unexplained fatigue or lack of energy
Shortness of breath or chest pain, especially with activity
Unexplained generalized weakness
Rapid heartbeat
Pounding or "whooshing" in the ears
Headache, especially with activity
Craving for ice or clay - "picophagia"
Sore or smooth tongue
Brittle nails or hair loss

How Is Iron-Deficiency Anemia Diagnosed?

Iron-deficiency anemia is diagnosed by blood tests that should include a complete blood count (CBC). Additional tests may be ordered to evaluate the levels of serum ferritin, iron, total iron-binding capacity, and/or transferrin. In an individual who is anemic from iron deficiency, these tests usually show the following results:

Low hemoglobin (Hg) and hematocrit (Hct)
Low mean cellular volume (MCV)
Low ferritin
Low serum iron (FE)
High transferrin or total iron-binding capacity (TIBC)
Low iron saturation

The peripheral smear or blood slide may show small, oval-shaped cells with pale centers. In severe iron deficiency, the white blood count (WBC) may be low and the platelet count may be high or low.

Iron-Deficiency

Am I at Risk?

What Are the Signs and Symptoms of Iron-Deficiency Anemia?

How Is Iron-Deficiency Anemia Diagnosed?

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