Understanding Iron Deficiency Anemia

What is Anemia?

Anemia is a decrease in the number of Red Blood Cells (RBCs), or a decrease in their hemoglobin(hgb.) content. Hemoglobin is a component of RBCs that enables them to transpost oxygen from the lungs to all the cells of the body. Without adequate oxygen, cells can not function efficiently. Hemoatocrit describes the concenration of RBCs in a volume of blood. It is also decreaesed in anemia.

Average normal values for adults are:
	Males	females
RBC	4.6-6.2 million	4.2-5.4 million
Hemoglobin	14-18 grams	12-16 grams
Hematocrit	42-52%	37-47%

What causes Anemia?

Anemia can be caused by:

• blood loss resulting from heavy menses, gastrointestinal bleeding, or major injuries;
• impaired red blood cell production, nutritional deficiencies or bone marrow abnormalities, minor genetic abnormalities;
• excessive red blood cell destruction which can occur in autoimmune or metabolic diseases, and genetic anemias such as thalassemia or sickle cell anemia;
• or a combination of these.

Although many people believe symptoms such as fatigue, weakness, or decreased appetite are related to anemia, anemia usually occurs gradually, and has no symptoms until it is relatively severe.

Iron Deficiency Anemia is the most common Anemia

Iron is necessary for the formation of the hemoglobin molecule, so it essential for the normal Red Blood Cell production and function. Lack of iron results in RBCs that are smaller and paler than normal. These cells are less efficient in transporting oxygen.

Iron deficiency occurs when dietary intake or absorption of iron is not sufficient to meet the body's needs.

• Increased iron demand may be the result of rapid growth, pregnancy, or strenuous exercise
• Decreased absorption can result from a diet low in iron or a vegetarian diet
• Excessive amounts of iron can be lost with bleeding caused by heavy menses or gastrointestinal disease. (If abnormal bleeding is the cause of iron deficiency, it must be treated and corrected.)

• Dietary: a balanced diet contains about 10mg/day of iron. Multivitamins with iron typically contain12-18mg of iron. Only 10% (1-2mg) is actually absorbed. Women with heavy menses may lose 15-20mg of iron in a cycle. Once anemia occurs, and the body has used its stored iron, it is not possible to replace the iron that has been lost by diet or multivitamins only.
• Medication: Ferrous Sulfate 325 mg. three times a day, 30 minutes before meals. It provides the body with 10mg of absorbable iron per tablet. Unfortunately, it is common to experience diarrhea, constipation, or other gastrointestinal symptoms from iron supplements. These side effects can be reduced by starting with a reduced dose schedule, such as 1 tablet daily x 5-7 days, then one tablet twice a day x 5-7 days, and finally the one tablet three times a day. Some formulations, such as Iberet Filmtabs, available by prescription only, may be better tolerated.
  If you have a problem with a medication that is recommended or prescribed, discuss alternatives with your clinician.
• Taking iron supplements without medical guidance is not recommended. Too much iron can lead to zinc and copper deficiencies and can cause complications related to iron overload.

Follow up: Within 7-10 days of regularly taking iron, a blood test should show and increased number or reticulocytes. These are cells that indicate the iron is being absorbed and correcting the anemia. Within four weeks, the hemoglobin should have increased by 2 grams.

It is important to recheck your blood at this time to be sure the problem is resolving. It requires three to six months of continuous iron therapy to replace iron stores if they have been depleted. Ferritin levels can be checked in three months.

Preventing Iron Deficiency Anemia

A balanced, healthy diet is the best way to prevent iron deficiency anemia.

The iron from animal sources such as meat, fish, and poultry is absorbed better than the iron from plant sources. Non-meat sources of iron include: fortified cereals, nuts, seeds, dried beans, dried fruits (apricots, raisins, prunes, and peaches), and dark green, leafy vegetables. Including foods rich in Vitamin C, such as fruits and leafy green vegetables, in your meal will promote iron absorption.

Some foods interfere with and decrease iron absorption, so they should not be eaten with iron rich foods. These include oxalic acid in spinach, phosphates in milk, egg white, phytates in beans and some vegetables, and, possibly, tannin in tea. Calcium supplements also decrease iron absorption.

To get enough iron, eat a wide variety of iron rich foods, including those on the following list. Start your day with an iron fortified cereal, and a glass of orange juice for Vitamin C. Continue good nutrition through your day by eating iron fortified breads and grains, and plenty of fruits and vegetables.

Last Modified 12/22/2005