http://www.nlm.nih.gov/medlineplus/ency/article/000584.htm

Iron deficiency anemia

Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. There are many types of anemia. Iron deficiency anemia is a decrease in the number of red cells in the blood caused by too little iron.

See also: Iron deficiency anemia - children

CausesIron deficiency anemia is the most common form of anemia. About 20% of women, 50% of pregnant women, and 3% of men do not have enough iron in their body.

Iron is a key part of hemoglobin, the oxygen-carrying protein in the blood. Your body normally gets iron through diet and by recycling iron from old red blood cells. Without iron, the blood cannot carry oxygen effectively. Oxygen is needed for every cell in the body to function normally.

The causes of iron deficiency are:

Blood loss Poor absorption of iron by the body Too little iron in the diet

It can also be related to lead poisoning in children.

Anemia develops slowly after the normal iron stores in the body and bone marrow have run out. In general, women have smaller stores of iron than men because they lose more through menstruation. They are at higher risk for anemia than men.

In men and postmenopausal women, anemia is usually caused by gastrointestinal bleeding due to:

Certain types of cancer (esophagus, stomach, colon) Esophageal varices Long-term use of aspirin or nonsteroidal anti-inflammatory medications (NSAIDS) Peptic ulcer disease

Iron deficiency anemia may also be caused by poor absorption of iron in the diet, due to:

Celiac disease Crohn's disease Gastric bypass surgery Taking antacids

Other causes of iron deficiency anemia include:

Heavy, long, or frequent menstrual bleeding Not receiving enough iron in the diet (for example, if you are a strict vegetarian)

Adults at high-risk for anemia include:

Those who use aspirin, ibuprofen, or arthritis medicines for a long time Women who are pregnant or breastfeeding who have low iron levels Seniors Women of child-bearing age

Symptoms Blue color to whites of the eyes Brittle nails Decreased appetite (especially in children) Fatigue Headache Irritability Pale skin color Shortness of breath Sore tongue Unusual food cravings (called pica) Weakness

Note: There may be no symptoms if the anemia is mild.

Exams and Tests Fecal occult blood test Hematocrit and hemoglobin (red blood cell measures) Iron binding capacity (TIBC) in the blood RBC indices Serum ferritin Serum iron level

Treatment

The cause of the iron deficiency must be found, especially in older patients who face the greatest risk for gastrointestinal cancers.

Iron supplements (ferrous sulfate) are available. For the best iron absorption, take these supplements with an empty stomach. However, many people cannot tolerate this and may need to take the supplements with food.

Patients who cannot tolerate iron by mouth can take it through a vein (intravenous) or by an injection into the muscle.

Milk and antacids may interfere with the absorption of iron and should not be taken at the same time as iron supplements. Vitamin C can increase absorption and is essential in the production of hemoglobin.

Pregnant and breastfeeding women will need to take extra iron because their normal diet usually will not provide the required amount.

The hematocrit should return to normal after 2 months of iron therapy. However, iron should be continued for another 6 - 12 months to replenish the body's iron stores in the bone marrow.

Iron-rich foods include:

Eggs (yolk) Fish Legumes (peas and beans) Meats (liver is the highest source) Poultry Raisins Whole-grain bread

Outlook (Prognosis)With treatment, the outcome is likely to be good. Usually, blood counts will return to normal in 2 months.

Possible ComplicationsThere are usually no complications. However, iron deficiency anemia may come back. Get regular follow-ups with your health care provider.

Children with this disorder may be more likely to get infections.

When to Contact a Medical ProfessionalCall for an appointment with your health care provider if:

You have symptoms of this disorder You notice blood in your stool

PreventionEveryone's diet should include enough iron. Red meat, liver, and egg yolks are important sources of iron. Flour, bread, and some cereals are fortified with iron. If you aren't getting enough iron in your diet (uncommon in the United States), take iron supplements.

During periods when you need extra iron (such as pregnancy and breastfeeding), increase the amount of iron in your diet or take iron supplements.

Alternative NamesAnemia - iron deficiency

ReferencesMabry-Hernandez IR. Screening for iron deficiency anemia--including iron supplementation for children and pregnant women. Am Fam Physician. 2009 May 15;79(10):897-8.

Alleyne M, Horne MK, Miller JL. Individualized treatment for iron-deficiency anemia in adults. Am J Med. 2008;121:943-948.

Brittenham G. Disorders of Iron Metabolism: Iron Deficiency and Iron Overload. In: Hoffman R, Benz EJ, Shattil SS, et al, eds. Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 36.

Update Date: 3/21/2010Updated by: James R. Mason, MD, Oncologist, Director, Blood and Marrow Transplantation Program and Stem Cell Processing Lab, Scripps Clinic, Torrey Pines, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

http://emedicine.medscape.com/article/202333-medication#showall

Medication SummaryThe most economical and effective medication in the treatment of iron deficiency anemia is the oral administration of ferrous iron salts. Among the various iron salts, ferrous sulfate most commonly is used. Claims are made that other iron salts are absorbed better and have less morbidity. Generally, the toxicity is proportional to the amount of iron available for absorption. If the quantity of iron in the test dose is decreased, the percentage of the test dose absorbed is increased, but the quantity of iron absorbed is diminished.

There are advocates for the use of carbonyl iron because of the greater safety with children who ingest their mothers’ medication. Decreased gastric toxicity is claimed but not clearly demonstrated in human trials. Bioavailability is approximately 70% of a similar dose of ferrous sulfate.

Reserve parenteral iron for patients who are either unable to absorb oral iron or who have increasing anemia despite adequate doses of oral iron. It is expensive and has greater morbidity than oral preparations of iron.

Mineral supplementationsClass Summary

These agents are used to provide adequate iron for hemoglobin synthesis and to replenish body stores of iron. Iron is administered prophylactically during pregnancy because of anticipated requirements of the fetus and losses that occur during delivery.

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Ferrous sulfate (Feratab, Fer-Iron, Slow-FE)

Ferrous sulfate is the mainstay treatment for treating patients with iron deficiency anemia. They should be continued for about 2 months after correction of the anemia and its etiologic cause in order to replenish body stores of iron. Ferrous sulfate is the most common and cheapest form of iron utilized. Tablets contain 50-60 mg of iron salt. Other ferrous salts are used and may cause less intestinal discomfort because they contain a smaller dose of iron (25-50 mg). Oral solutions of ferrous iron salts are available for use in pediatric populations.

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Carbonyl iron (Feosol)

Carbonyl iron is used as a substitute for ferrous sulfate. It has a slower release of iron and is more expensive than ferrous sulfate. The slower release affords the agent greater safety if ingested by children. On a milligram-for-milligram basis, it is 70% as efficacious as ferrous sulfate. Claims are made that there is less gastrointestinal (GI) toxicity, prompting use when ferrous salts are producing intestinal symptoms and in patients with peptic ulcers and gastritis. Tablets are available containing 45 mg and 60 mg of iron.

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Dextran-iron (INFeD)

Dextran-iron replenishes depleted iron stores in the bone marrow, where it is incorporated into hemoglobin. Parenteral use of iron-carbohydrate complexes has caused anaphylactic reactions, and its use should be restricted to patients with an established diagnosis of iron deficiency anemia whose anemia is not corrected with oral therapy.

The required dose can be calculated (3.5 mg iron/g of hemoglobin) or obtained from tables in the Physician's Desk Reference. For intravenous (IV) use, this agent may be diluted in 0.9% sterile saline. Do not add to solutions containing medications or parenteral nutrition solutions.