Treatment

The main treatment for iron deficiency anemia is oral iron supplements.  "Oral ferrous iron salts are the most economical and effective medication for the treatment of iron deficiency anemia"(Harper).  A usual dosage is 65 mg three times a day, but this can be decreased to lessen side effects.  These side effects include "stomach upset and pain, constipation or diarrhea, nausea, and vomiting"(Iron).  Taking the iron tablets with food can decrease symptoms, but it can also decrease the absorption of the iron into the body.  If possible, the iron tablets should be taken on an empty stomach (Iron).  Additionally, "patients should avoid tea and coffee and may take vitamin C (500 units) with the iron pill once daily" to increase absorption (Harper).

Below is a chart showing the different kinds of oral iron supplements:
(Treating)

In patients who either can't absorb iron, or do not respond to the oral iron tablets, parenteral iron is a good option.  It "has been used safely and effectively in patients with inflammatory bowel disease (eg, ulcerative colitis, Crohn disease), as the ferrous sulfate preparations may aggravate the intestinal inflammation" (Harper).  However, perenteral iron is more expensive and has a greater morbidity than the oral tablets, so in general the tablets are safer (Harper).

Another option for patients who do not respond to the oral tablets are ferric carboxymaltose injections.  Approved in 2013 by the FDA, this treatment has also been shown to work for patients with non – dialysis-dependent chronic kidney disease (Harper).

High dosage of oral iron supplements, more than 45 mg, is not recommended, especially for women who are pregnant or nursing (Iron).

If the iron deficiency anemia is caused by an internal hemorrhage, managing the hemorrhage is a possible treatment to stop continued anemia.  This may include surgery on "neoplastic or nonneoplastic disease of the gastrointestinal (GI) tract, the genitourinary (GU) tract, the uterus, and the lungs" (Harper).

A transfusion of packed RBC is also an option, specifically "for patients who either are experiencing significant acute bleeding or are in danger of hypoxia and/or coronary insufficiency" (Harper).



Works Cited:
Harper, J. (n.d.). Iron Deficiency Anemia. Retrieved September 14, 2015.
http://emedicine.medscape.com/article/202333-overview#a7

"Iron." WebMD. WebMD. Web. 19 Oct. 2015. <http://www.webmd.com/vitamins-supplements/ingredientmono-912-iron.aspx?activeingredientid=912&activeingredientname=iron>.

"Treating Iron Deficiency." Treating Iron Deficiency. Web. 19 Oct. 2015. <http://www.pharmacytimes.com/publications/issue/2011/june2011/treating-iron-deficiency>.

Signs and Symptoms

Patients with iron deficiency anemia may report the following:

• Fatigue and diminished capability to perform hard labor

• Leg cramps on climbing stairs

• Craving ice (in some cases, cold celery or other cold vegetables) to suck or chew

• Poor scholastic performance

• Cold intolerance

• Reduced resistance to infection

• Altered behavior (eg, attention deficit disorder)

• Dysphagia with solid foods (from esophageal webbing)

• Worsened symptoms of comorbid cardiac or pulmonary disease

Findings on physical examination may include the following:

• Impaired growth in infants

• Pallor of the mucous membranes (a nonspecific finding)

• Spoon-shaped nails (koilonychia)

• A glossy tongue, with atrophy of the lingual papillae

• Fissures at the corners of the mouth (angular stomatitis)

• Splenomegaly (in severe, persistent, untreated cases)

• Pseudotumor cerebri (a rare finding in severe cases 

Children and adolescents with iron deficiency anemia were at higher risk for the following:

Unipolar depressive disorder

Bipolar disorder

Anxiety disorder

Autism spectrum disorder

Attention-deficit/hyperactivity disorder

Tic disorder

Delayed development

Mental retardation

Often, patients can pin point when general symptoms, like fatigue and cold intolerance, began to occur (Harper).

Pica, the craving for non food items like clay, chalk, paper, or dirt, is also a result of iron deficiency anemia, and is the link between iron deficiency anemia and lead poisoning.  This can be sign of advanced iron deficiency anemia.

(11 Reasons)

Work Cited:

Harper, J. (n.d.). Iron Deficiency Anemia. Retrieved September 14, 2015.

http://emedicine.medscape.com/article/202333-overview#a7

"11 Reasons You're Always Tired and How to Fix It - Dr. Axe." Dr Axe. 25 Mar. 2015. Web. 19 Oct. 2015. <http://draxe.com/always-tired/>.

Diagnosis and Prognosis

Iron Deficiency Anemia can be diagnosed using the following tests:

• Complete blood count

• Peripheral blood smear

• Serum iron, total iron-binding capacity (TIBC), and serum ferritin

• Evaluation for hemosiderinuria, hemoglobinuria, and pulmonary hemosiderosis

• Hemoglobin electrophoresis and measurement of hemoglobin A 2 and fetal hemoglobin

• Reticulocyte hemoglobin content

Tests useful for establishing the etiology of iron deficiency anemia and excluding or establishing a diagnosis of another microcytic anemia include the following:

• Stool testing

• Incubated osmotic fragility testing

• Measurement of lead in tissue

• Bone marrow aspiration

CBC results in iron deficiency anemia include the following:

• Low mean corpuscular volume (MCV)

• Low mean corpuscular hemoglobin concentration (MCHC)

• Elevated platelet count (>450,000/µL) in many cases

• Normal or elevated white blood cell count

Peripheral smear results in iron deficiency anemia are as follows:

• RBCs are microcytic and hypochromic in chronic cases

• Platelets usually are increased

• In contrast to thalassemia, target cells are usually not present, and anisocytosis and poikilocytosis are not marked

• In contrast to hemoglobin C disorders, intraerythrocytic crystals are not seen

Results of iron studies are as follows:

• Low serum iron and ferritin levels with an elevated TIBC are diagnostic of iron deficiency

• A normal serum ferritin can be seen in patients who are deficient in iron and have coexistent diseases (eg, hepatitis or anemia of chronic disorders

"Chronic iron deficiency anemia is seldom a direct cause of death; however, moderate or severe iron deficiency anemia can produce sufficient hypoxia to aggravate underlying pulmonary and cardiovascular disorders" (Harper).  Overall, iron deficiency anemia is easily treated and can ultimately be cured.  However, as it is usually connected with other underlying health issues, like neoplasia or hear disorders,  it can be a sign of something much more serious that cannot be cured as easily (Harper). 

Works Cited:

Harper, J. (n.d.). Iron Deficiency Anemia. Retrieved September 14, 2015.

http://emedicine.medscape.com/article/202333-overview#a7

Pathophysiology

The body is constantly trying to maintain an equilibrium of iron content through absorption and loss.  The normal amount of iron in a "70 kg man is about 4 g" but "the body only absorbs 1 mg of iron daily to maintain equilibrium," although the internal requirement is about 20-25 mg because of the turnover of red blood cells, which have a life cycle lasting around 120 days (Harper).  The table below shows the flow maintaining the balance of iron in the blood.
(Harper)

The concentration of iron in the body "is regulated carefully by absorptive cells in the small intestine, which alter iron absorption to match body losses of iron" (Harper).  These cells are shown in the picture below:

These cells have a 2-3 day life cycle, and are sloughed off into the intestinal lumen when they die (Harper).

Iron is absorbed through three different pathways, heme, ferrous, and ferric acid, that are shown in the picture below:
(Harper).
Dietary iron contains both heme and nonheme elements, which are absorbed "noncompetitively into duodenal and jejunal mucosal cells" (Harper).  However, many different factors can cause these pathways to malfunction, as shown in the picture below:
(Harper).
"Either diminished absorbable dietary iron or excessive loss of body iron can cause iron deficiency" (Harper).  Diminished absorbable iron is usually a result of a lack of iron consumption, and hemorrhages are the main cause for a loss of body iron.  When a hemorrhage occurs, "the bone marrow is stimulated to increase production of hemoglobin, thereby depleting iron in body stores. Once they are depleted, hemoglobin synthesis is impaired and microcytic hypochromic erythrocytes are produced" (Harper).

Some other blood loss diseases include hemosiderinuria, hemoglobinuria, and pulmonary hemosiderosis.  These are blood loss through the urine, through heart surgery, and through renal disorders (Harper).

Iron deficiency anemia resulting from poor absorption can be caused by either a genetic disorder, having a major surgery performed on the small intestine, or having a DI tract disease (like celiac disease) which may cause absorption problems (Harper).

Works Cited:
Harper, J. (n.d.). Iron Deficiency Anemia. Retrieved September 14, 2015.
http://emedicine.medscape.com/article/202333-overview#a7