What Diseases Can Cause Iron Deficiency Anemia – Worldwide, iron deficiency anemia is the most common type of anemia and has many causes. Pharmacists should be aware that patients may experience different symptoms.

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What Diseases Can Cause Iron Deficiency Anemia

What Diseases Can Cause Iron Deficiency Anemia

Anemia is defined as a condition in which either the number of circulating erythrocytes (red blood cells), or the concentration of hemoglobin (Hb) in them, is below the reference range; It is classified based on the size of erythrocytes and Hb concentration [1].

Fatigue And Anemia…is It Celiac Disease?

Iron deficiency anemia (IDA) is defined as microcytic (erythrocytes that are smaller than normal, as measured by low MCV cells) and hypochromic (low amount of cell Hb)[1].

There are anemias with different diseases, such as anemia of chronic disease, thalassemia and sideroblastic anemia; However, IDA is the most common type of anemia. Worldwide, it is reported to affect 500 million people and up to 50% of anemia cases. [1, 2] It is a public health issue seen in both high and low income countries. In low and middle income countries, low consumption of processed foods or animal products may contribute to the prevalence of anemia[3].

Globally, the highest rates of anemia are children under five and women of reproductive age (15-49 years)[1] [2]. In 2019, the global number was 36.5% and 29.6% in the same group of patients, respectively[4]. worldwide [1]. In comparison, the National Institute for Health and Care Excellence (NICE) estimates that it will be 2-5% in older men and postmenopausal women in high-income countries[2].

Iron plays an important role in the functioning of various cellular processes; It is an important part of hemoglobin and myoglobin – an oxygen-binding protein found only in heart and muscle cells – which contains about 60% of the total iron.

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Iron is involved in the production of erythrocytes in the bone marrow and is important for the synthesis of oxygen and Hb.IDA occurs when few erythrocytes are produced due to low iron stores [6]. Iron is stored as ferritin and hemosiderin in the liver, spleen, marrow, duodenum and skeletal muscle [7]. A typical western diet contains around 15mg of iron per day, of which 10% (1-2mg) is absorbed; However, 20-25mg of iron per day is required for erythrocyte production [5]. The source of iron is obtained from iron stores, and it is recycled by aged erythrocytes which have a life cycle of 120 days in the circulation [8].

Pharmacists work in the management of IDA to ensure that patients are educated on their iron replacement therapy for optimal results, and can provide advice on side effects management. , all of which are explained below.

IDA is common in general practice, and symptoms depend on how fast it grows and its severity [9]. In chronic IDA or acute blood loss, patients may tolerate low Hb levels, with minimal symptoms, due to hemodynamic compensation mechanisms that maintain delivery. sufficient oxygen [10].

What Diseases Can Cause Iron Deficiency Anemia

Anemic patients may present with non-specific symptoms, such as those listed in Table 1. Children may show decreased appetite [11].

This Common Disease Can Cause Iron Deficiency

Another common sign of IDA is angular cheilosis (lesions of the corners of the mouth). Changes in the nails, such as koilonychia (nail-like nails), are a rare symptom of IDA[2].

Severe symptoms, such as tachycardia or worsening signs of pre-existing heart failure (such as ankle sprains or dyspnoea at rest), will require immediate treatment [2, 12].

In addition, infants, especially those with a history of prematurity, may be at risk of IDA due to growth spurts that accumulate during pregnancy [5].

Iron requirements are raised during pregnancy due to the increase in maternal erythrocyte production for the growth of the placenta and fetus [9]. Menstruation is the most common cause of IDA in menopausal women [2].

A Guide To Diagnosis Of Iron Deficiency And Iron Deficiency Anemia In Digestive Diseases

Environmental factors, such as exposure to contaminated water that leads to parasitic infections of the gastrointestinal (GI) tract (such as whipworm and hookworm, which can be picked up when traveling in low-income countries), can cause IDA[9]. Athletes can also experience IDA due to hemolysis (i.e. breakdown of erythrocytes) [13].

A thorough clinical history should be taken when IDA is suspected. A physical examination should include an examination of the skin, tongue, nails, eyelids and heart rate. The questions that can help diagnose appear in box 1. The medical history should be reviewed, including. use of over-the-counter medications. Bleeding tests can reveal many causes, from hemorrhoid symptoms to carcinoma of the GI tract. Examples of GI symptoms include pain, ulcers, abdominal swelling and melena[14]. For menstruating women, prolonged or heavy periods indicate IDA[15].

For IDA testing, a complete blood count should be requested. In cases where both Hb and MCV are low, the ferritin level will show that the level of IDA.Hb for the diagnosis of hypochromia is based on gender and age, and it is divided as follows:

What Diseases Can Cause Iron Deficiency Anemia

The reference range for MCV is 80-96 femtolits[15]. It should be noted that MCV alone cannot be used to detect IDA; although the price is lower, it will be higher than IDA. For example, MCV<75 femtolits will identify only 68% of people with IDA[2].

Iron Deficiency, Thyroid Disease, And Fatigue

A serum ferritin test indicates iron stores. The reference range for ferritin is 30-300 micrograms/L in men and 15-200 micrograms/L in women. Ferritin levels less than 30 micrograms/L will support the diagnosis of IDA. The sensitivity and specificity of the ferritin test are 92% and 98%, respectively [17]. Serum ferritin is not reliable in pregnancy because it is expected to be low in the second and third trimester due to iron overload.

Other conditions that can affect serum ferritin are those with ongoing inflammation, such as arthritis and chronic heart disease, or disease, where serum ferritin levels are elevated as part of the immune response. Elevated ferritin levels have also been observed in liver disease[15, 18].

Low ferritin is a reliable predictor of IDA, while normal, or high, ferritin is not a reliable predictor of iron production when there is ongoing inflammation. Iron level.IDA can be present when the ferritin level is > 50micrograms / L, which can make the diagnosis difficult; therefore, further research will be needed to confirm the interpretation of the results, such as the level of C-reactive protein, which is raised in the stimulation. situation [2]. Other specific tests include total iron binding capacity (TIBC) and transferrin saturation[19]. TIBC measures the blood’s ability to attach itself to iron. In IDA, serum iron falls and TIBC is elevated, while transferrin is significantly reduced in IDA, which is the ratio of serum iron in TIBC[15]. Elevated reticulocyte (i.e. mature erythrocytes) hemoglobin is also a strong predictor of IDA. It can be used for diseases that are difficult to diagnose and is useful when ferritin is elevated [20].

Deficiencies of iron, vitamin B12 and folate can occur in the presence of small bowel disease so all should be checked and corrected.

Iron Deficiency In Teens — Karen Kennedy

When diagnosing IDA for postmenopausal men and women, without any obvious blood loss, upper and lower GI examination should be considered to rule out malignancy or peptic ulcer [21].

Microcytosis and hypochromia can also occur in other anemias of chronic disease (such as chronic arthritis, rheumatoid arthritis and malignant disease) and haemoglobinopathies, such as thalassemia and sideroblastic anemia[15].

Most patients with anemia of chronic disease are normocytic and normochromic; Microcytosis and hypochromia are seen in about 20% of cases [2]. Ferritin levels remain relatively low in anemia of chronic disease and thalassemia, compared to IDA. Sideroblastic anemia, in which ferritin levels are elevated, is a rare anemia that can be inherited either it is to get it.[22]. Hepatosplenomegaly is present in one-third to one-half of sideroblastic anemia patients and is not seen in IDA[2].

What Diseases Can Cause Iron Deficiency Anemia

The initial management of IDA aims to identify the cause and treat it, in part correcting the anemia using iron replacement therapy [21]. Many factors can lead to treatment failure, such as malabsorption (as in the case of celiac disease), the cause is not resolved or the presence of other anemia[15]. Non-adherence to oral iron therapy with side effects and multiple daily doses may also contribute to ongoing symptoms of IDA.

Iron Deficiency Anemia: Symptoms, Causes, Diagnosis, And Treatment

Ongoing referrals should be made to various groups as appropriate; for example, nutritionists should be recruited for nutrition support and counseling. Cancer screening methods should be used for patients 60 with IDA[23]. A gastroenterology referral should be made when GI bleeding is suspected. A hematology referral should be made for persistent anemia that does not respond to treatment.

Patients with IDA may be advised to change their diet by eating iron-rich foods, such as vegetables (watercress and kale), meat, dried fruits (apricots, prunes and raisins) and legumes (beans, peas and lentils). Tea, coffee, milk and milk products should be minimized because they can affect iron absorption[24]. The World Health Organization recommends micronutrient powders containing iron in infants and children aged 6-23 months[25].

There are many iron salt preparations available, with different elemental levels

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