Iron Deficiency Anemia: Definition, Clinical Diagnosis, Complications, Evolution and Treatment
Iron Deficiency Anemia Definition
Iron deficiency anemia is a hypochromic type of anemia caused by a disorder in hemoglobin synthesis due to decreased amount of total body iron. The fundamental disorder is responsible for all the signs and symptoms of this disease. This disease is affecting both sexes and occurs at all ages but predominantly in women. It is the most common form of anemia encountered in clinical practice.
Iron Deficiency Anemia Symptoms
It should be mentioned right at the beginning that anemia occurs most often secondary to other diseases. So patients history is very important to elucidate the diagnosis. Signs of central nervous system and sense organs:
- Morning headache
- Balance disorders
The onset is insidious and the progression of signs is gradual.
Examination of skin and mucous membranes:
- Skin is pale, dry, nails are brittle, break easily, have longitudinal grooves, platonichie type changes (flattened nails) or koilonichie (concave shape or cracks). The hair grows grey faster, may fall more easily and is brittle. Mucous membranes ar pale as well.
Cardiovascular system signs: Appear parallel with the degree of anemia and patient age:
Signs of the digestive system:
- Angular stomatitis (cheliosis) may appear or small, very painful, cracks at the mouth corners. Tongueburns appear spontaneous or stimulated by acidic foods or drinks due to atrophy of the lingual papillae. Atrophy of the pharyngeal mucosa leads to dysphagia especially for solid food, sign called Winson Plummer syndrome. These inflammatory changes continue into the esophagus and especially the gastric mucosa where hypertrophic gastritis installes. Gastritis has no clinical manifestations, but is sometimes associated with marked reduction of gastric secretion.
- It is present in 10% of patients, it is moderate in size and returns to normal after correction of iron deficiencys.
- The most common is the menstrual disorder in women, menorrhagia (an abnormally heavy and prolonged menstrual period at regular intervals), which is relieved after specific treatment.
Other signs and symptoms:
- Ozaena (nasal mucosal atrophy) occurs in patients with severe iron deficiency
- Pica: representing appetite for inedible but nontoxic substances (earth, lime) and occurs in iron deficiency anemia with severe mental disorders.
- Immune deficiencies favoring repeated infections.
Iron Deficiency Anemia Complications
Cardiovascular: mostly occur in elderly with known coronary heart disease, vary from unstable angina to myocardial infarction and heart failure.
Severe mental disorders: dizziness, dementia, anemic coma. Digestive: gastiric cancer, gastric mucosal atrophy, intestinal disorders like nonspecific enterocolitis.
Iron Deficiency Anemia Evolution
Evolution of patients with iron deficiency anemia is closely correlated with the degree of anemia and the time of its diagnosis. Once the diagnosis and cause of iron deficiency anemia has been detected, after a well managed treatment, the evolution is favorable. Prognosis is good, ad integrum restitutio in most cases.
Iron Deficiency Anemia Treatment
Etiologic treatment: targets detection and removing the causes of iron deficiency anemia.
Pathogenic therapy (the cause): targeting the correction of iron deficiency. Iron preparations are used orally, bivalent compounds (glutamate, aspartate or iron sulfates), the minimum dose of 100-200 mg / day of elemental iron. The main preparations used are Glubifer 3×2 dg/ day, Ferro-Gradumet 2 dg / day, Sorbifer 1 dg / day, preferably taken in the morning. Because of gastrointestinal side effects (nausea, burns), preparations can be administered after a light diet. Duration of treatment varies from 4-6 months to a year, depending on the severity of anemia. The treatment will continue for 4-6 months after correction of hemoglobin values for recovery of iron deposits. Parenteral preparations are administrated only in case of absolute digestive intolerance, severe enteropathy, severe anemia.
The dose used is 100 mg / day intramuscular, to be mentioned is the risk of anaphylactic shock from injectable iron preparations, and therefore treatment should be started in a hospital under strict medical supervision and prior to testing. Among the injectable iron preparations , the most common used are : Iron polymaltose 1 vial / day intramuscular, Ferrum Haussmann 1 vial / day intramuscular. Emergency transfusions to patients with severe anemia (Hb less than 6 g%) associated with ischemic heart disease.