Iron deficiency anemia

What is iron deficiency anemia?

Cells require the supply of oxygen for their proper functioning. Those responsible for carrying oxygen to the tissues are the red blood cells, also called erythrocytes or red blood cells. Inside it is a complex protein, hemoglobin, which is the one that carries oxygen and carbon dioxide that are exchanged in the pulmonary alveoli. Part of this protein is the heme group, formed by an iron nucleus, which has the ability to reversibly bind oxygen.

If, for whatever reason, there is a deficit of iron availability in the body, reduces the production of red blood cells, a situation that is called anemia due to lack of iron or iron deficiency.

What are your causes?

Lack of iron is the most common cause of iron deficiency anemia.

The normal levels of iron in the body are about 50-55 mg per kg of weight in men and about 35-40 mg per kg of weight in women. The daily iron intake is usually between 10 and 30 mg, of which only 1 mg is absorbed from the duodenum and the proximal and middle jejunum.

Once absorbed, it passes into the blood mostly bound to a transporter protein, transferrin, although a smaller portion is bound to another protein called ferritin, which allows the body's iron stores to be assessed. Iron reaches the precursors of red blood cells in the bone marrow and becomes part of the heme group, which then binds to proteins to form hemoglobin. Iron that is not used will be deposited in macrophages in the form of ferritin and hemosiderin.

Iron deficiency anemia can be due to three Causes mainly:

• A decline of the contribution iron in the diet. For example diets rich in carbohydrates to the detriment of proteins of animal origin, in the case of.
• A decreased iron absorption at the level of the digestive system for different reasons, such as a lower production of gastric juices (which favor the absorption of iron at the intestinal level), absorption diseases such as celiac disease, or surgeries that affect the stomach.
• A increased blood lossSuch as chronic gastrointestinal bleeding, heavy menstruation, other gynecological losses or pregnancy, since the fetus uses 2/3 of the iron absorbed by the mother.

Symptoms

The symptoms of iron deficiency anemia are the classic ones of an anemic syndrome: pallor skin and mucous membranes, asthenia, dyspnoea, palpitations, headache, lack of concentrationirritability insomnia or decreased libido. These are all consequences of poor oxygenation of the tissues.

In addition, there may be some alterations that are also other symptoms of iron deficiency anemia, such as:

• Angular stomatitis (mouth sores)
• glossitis (inflammation of the tongue)
• ocena (atrophy of the anterior nasal mucosa)
• koilonychia (spoon-shaped nail deformation)
• dysphagia (known as Plummer-Vinson syndrome)
• neuralgia
• paresthesia
• formation of an esophageal ring that makes feeding difficult (Chaski's ring)

Depending on whether the anemia has occurred quickly, due to acute bleeding, or more overlapping, due to a lack of absorption or chronic bleeding, the symptoms will be more or less apparent and will be better or worse tolerated, as the body becomes habituates to work at lower levels of oxygenation.

Diagnosis: high HDI and higher

The diagnosis will be based on the patient questioning and analytical data. It is convenient to detect symptoms of tiredness, paleness, dyspnea, headache or other neurological disorders. Likewise, the presence of chronic digestive, gynecological or urological bleeding that can cause iron deficiency anemia should be investigated. In the same way, an assessment will be made of the patient's diet and their intestinal rhythm.

If anemia is suspected, one will be performed, which must include a complete blood count, basic biochemistry, and the proteins involved in iron metabolism, that is, transferrin, ferritin, and the iron itself in the blood. In case of suspecting hidden blood loss, digestive, urological or gynecological bleeding screening tests should be performed.

The analysis of iron deficiency anemia will show a decrease in normal hemoglobin levels. Characteristically, the red cells of iron deficiency anemia become smaller and contain less hemoglobin; This is valued with specific parameters, which are the mean corpuscular volume (MCV), which assesses the mean size of the red blood cells, and the mean corpuscular hemoglobin (HCM), which measures the average amount of hemoglobin per red cell. Since there is a decrease in both MCV and HCM, iron deficiency anemia is classified as microcytic anemia (smaller cells) and hypochromia (less hemoglobin).

Iron levels in the blood, which is known as sideremia, will be low, less than 100 mg / dl, as well as serum ferritin, which is in fact the first parameter to be altered and which allows assessing the levels of iron stores in the body. Serum transferrin is elevated, above 300 mg / dl, since it is increased to try to compensate for the lack of iron, but its ability to bind to it is diminished.

The reticulocytes in the blood will also be assessed, that is, the young forms of red blood cells in the blood, which in this case will be elevated, as well as a parameter called the index of red blood cell distribution (HDI), which quantifies the difference in size between red blood cells, which is known as anisocytosis. In the case of iron deficiency anemia, the HDI in the blood will be high.

It is appropriate to carry out a blood smears peripheral to be able to study the possible alterations in the shape of the red blood cells, which in the case of iron deficiency anemia will appear small, as already mentioned.

The confirmatory test for iron deficiency anemia would be given by a bone marrow biopsy, which would allow studying red blood cells in formation, but this test is almost never performed, since laboratory findings allow a precise diagnosis of iron deficiency anemia.

Treatment

The treatment will consist of two approaches: on the one hand to supply the lack of iron that the patient suffers and on the other to solve, if possible, the cause that originates it.

Treatment with ferrous salts will be administered orally for a long time, until the body's reserves can be normalized, which will be assessed by determining ferritin. The treatment should be maintained for two or three months. Iron can be administered intramuscularly or intravenously in case of intolerance to the oral route, or chronic inflammatory bowel disease.

In case of severe anemia, with a lot of symptoms or very low hemoglobin levels, below 7, the patient should be transfused.

An attempt should be made to determine the cause of the anemia and correct it. If there is a lack of contribution in the diet, the intake of red meat should be reinforced. In case of chronic digestive, gynecological or urological losses, a specialist should be consulted to try to solve them.

General Medicine Specialist