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  4. Iron-Deficiency Anaemia (IDA)

What is Iron-Deficiency Anaemia (IDA)?

Every organ and tissue of our body needs oxygen to perform optimally and the Red Blood Cells are the body’s oxygen transport system. They carry oxygen from the lungs to the rest of the body. In Anaemia, the body does not have enough of these blood cells.

Iron is a mineral that the body needs to produce red blood cells. When the body does not get enough iron, it cannot produce the number of normal red blood cells needed to keep the body in good health – without enough oxygen in the blood, the person feels tired, weak and short of breath. This condition is termed as Iron-Deficiency Anaemia.

Iron Deficiency Anaemia affects both men and women, with women being more commonly affected. It is often underdiagnosed and undertreated because some people may not have any symptoms at first, and signs and symptoms of IDA could be like those of other conditions.

India carries a serious burden of anaemia with 51% of women of reproductive age and 58% of children under the age of five years being anaemic. While there are around 400 types of anaemia, IDA is the most common type of Anaemia. It is estimated that about 20% of maternal deaths are directly related IDA, and another 50% of maternal deaths are associated with it.

What Causes Iron-Deficiency Anaemia (IDA)?
IDA occurs when the body does not have enough iron to produce haemoglobin. Haemoglobin is the part of the red blood cells that enable them to carry oxygen throughout the body. It can result from low intake of foods containing iron or if the body cannot properly absorb iron because of certain diseases or conditions, or if the body loses iron through the blood, or during pregnancy.

Causes of IDA include:

  • Blood Loss
    • The blood contains iron within the red blood cells, and when the body loses blood, it loses some iron as well. Women with heavy periods are at risk of IDA as they lose blood during menstruation.
    • Slow, chronic blood loss within the body (peptic ulcer, hiatal hernia, worms, colorectal cancer etc.) can also cause IDA.
    • Some over the counter pain relievers, especially aspirin, can cause gastrointestinal bleeding, which might eventually lead to IDA.
  • Low Iron Diet
    • Age and gender are two determinants of the amount of iron the body needs – men need at least 8 mg daily, women aged 50 years and younger need around 18 mg. Some iron-rich foods are: meat, eggs, leafy green vegetables and iron-fortified foods. Infants and children need iron from their diets for proper growth and development.
  • Inability to Absorb Iron:
    • The iron from the foods is absorbed in the body’s small intestine. Intestinal disorders like Celiac Disease (that affects the intestine’s ability to absorb nutrients from digested food) can lead to IDA.
  • Pregnancy:
    • Many pregnant women need iron supplementation because their iron stores need to serve their own increased blood volume as well as be a source of haemoglobin for the growing foetus.

What are the Symptoms of Iron-Deficiency Anaemia (IDA)?

In the initial phase, IDA can be so mild that most of the time it goes unnoticed but as the body becomes more and more iron deficient, the anaemia worsens intensifying the signs and symptoms.

The common symptoms of IDA include:

  • Extreme fatigue
  • Weakness
  • Pale skin
  • Chest pain, fast heartbeat or shortness of breath
  • Headache, dizziness or lightheadedness
  • Cold hands and feet
  • Inflammation or soreness of the tongue
  • Brittle nails
  • Unusual cravings for non-nutritive substances, such as ice, dirt or starch
  • Poor appetite, especially in infants

On developing any of the above signs and symptoms, consult a doctor immediately and remember that IDA isn’t something to self-diagnose or treat. Do not attempt to take iron supplements on your own as overloading the body with iron can be dangerous as it can damage the liver and cause other complications.

Who are art risk of Acquiring Iron-Deficiency Anaemia (IDA)?

The following groups of people may have an increased risk of IDA:

  • Women: Since women lose blood during menstruation, women in general are at greater risk of IDA.
  • Infants & Children: Infants, especially low birth weight or premature infants, who do not get enough iron from breast milk may be at risk. Children need extra iron during growth spurts.
  • Vegetarians: People who do not eat meat may be at a greater risk if they don’t eat other iron-rich foods.
  • Frequent Blood Donors: People who routinely donate blood as frequent blood donation can deplete iron stores.

What are the Possible Complications of Iron-Deficiency Anaemia (IDA)?

While mild IDA doesn’t usually cause complications, but if left untreated, IDA can become severe and could possibly lead to health issues, including the following:

  • Heart Problems:
    • IDA could cause rapid or irregular heartbeat and the heart must pump more blood to compensate for the lack of oxygen carried in the blood. This can lead to an enlarged heart or heart failure.
  • Problems during Pregnancy:
    • In pregnant women, IDA is possibly linked to premature births, and low birth weight babies, however, with iron supplements as a part of their prenatal care, the condition is preventable.
    • Growth Problems: IDA could lead to delayed growth and development in infants and increased susceptibility to infections.

How can you Prevent Iron-Deficiency Anaemia (IDA)?

The risk of IDA can be reduced by consuming iron-rich foods.

The foods rich in iron include:

  • Red meat, pork and poultry
  • Seafood
  • Beans
  • Dark green leafy vegetables, such as spinach
  • Dried fruit, such as raisins and apricots
  • Iron-fortified cereals, breads and pastas
  • Peas

The body absorbs the most iron from meat than it does from other sources, and vegetarians need to increase the intake of iron-rich, plant-based foods to absorb the same amount of iron as does someone who eats meat – this can be done by choosing foods containing Vitamin C that can be found in: Broccoli, Kiwi, Leafy Greens, Melons, Oranges, Strawberries, Tomatoes.

To prevent IDA in infants, breast milk or iron-fortified formula for the first year is best. Cow’s milk is not a good source of iron for babies and isn’t recommended for infants under 1 year.

How is Iron-Deficiency Anaemia (IDA) Diagnosed?

To confirm the diagnosis of IDA, the doctor may order one or more of the following blood tests:

  • Complete Blood Count (CBC) – to check the number of red blood cells
  • Peripheral Blood Smear – to check the size and shape of the red blood cells – in IDA, the red blood cells are smaller than usual
  • Hematocrit – to show how much of the blood is made up of red cells
  • Haemoglobin – to show the amount of this protein in the blood – the haemoglobin levels are low in someone who has anaemia
  • Serum Iron – to show how much iron is there in the blood
  • Ferritin – to show how much iron is stored in the blood
  • Transferrin and Total Iron-Binding Capacity (TIBC) – to show how much of a protein called Transferrin is free to carry iron through the body
  • Reticulocyte Count – to show how many Reticulocytes (or immature red blood cells) are present in the blood. In IDA, the Reticulocyte count is low as the body is not making new red blood cells.

If the above blood tests indicate IDA, the doctor would do some further tests to find out its cause

  • Endoscopy
  • Pelvic Ultrasound or Uterine Biopsy: this test can find the cause for excessive bleeding during monthly periods.
  • Fecal Occult Blood Test – to look for tiny amounts of blood in the stool to check for cancer and other causes of bleeding in the intestines.

How is Iron-Deficiency Anaemia (IDA) Treated?

IDA can be treated by taking iron supplements – the doctor would recommend a does based on the patient’s iron levels (150 to 200 mg each day). The doctor would also ask the patient to take Vitamin C to help absorb the iron.

The iron supplements continue for a few months till the iron levels come back up to normal. And he/ she might also ask the patient to eat an iron-rich diet (as mentioned above).

If the intestines are not able to absorb iron well, the doctor might inject iron into the patient’s bloodstream through an intravenous tube (IV).

The doctor will keep monitoring the iron levels in the blood every week.

In certain cases, if the supplements don’t help with the symptoms or if the anaemia is severe, the doctor might order a transfusion of red blood cells.

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