Iron deficiency anemia
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Iron Deficiency Anemia: A Comprehensive Overview
Prevalence and Global Impact of Iron Deficiency Anemia
Iron deficiency anemia (IDA) is the most common form of anemia worldwide, affecting over 1.2 billion individuals 57. It is particularly prevalent among children, premenopausal women, and individuals in low-income and middle-income countries 7. The condition arises when the balance of iron intake, iron stores, and the body's loss of iron are insufficient to support erythrocyte production 4. Despite its high prevalence, IDA is often overlooked by physicians, especially in developed countries 4.
Causes and Risk Factors
The primary causes of iron deficiency include increased iron requirements, reduced iron intake, defective absorption, and chronic blood loss 5. Blood loss due to menstrual periods and gastrointestinal bleeding are the main etiologies 3. In children, inadequate iron intake and increased demand during growth spurts are significant contributors 6. Additionally, inflammation can exacerbate iron deficiency by increasing hepcidin levels, which limits iron absorption 7.
Clinical Manifestations
IDA presents with a range of symptoms, from mild to severe. Common symptoms include fatigue, pallor, poor appetite, irritability, and dizziness 6. In severe cases, patients may experience tachycardia, shortness of breath, and poor capillary refilling 6. Beyond anemia, iron deficiency can lead to other manifestations such as hair loss, restless legs, and neurodevelopmental deficits in children 36.
Diagnosis
The diagnosis of IDA is primarily based on hemoglobin and serum ferritin levels 8. A low hemoglobin level, along with hypochromia and microcytosis on a peripheral blood film, should raise suspicion of IDA 6. Serum ferritin is the most efficient test for diagnosing iron deficiency, although it can be masked by inflammatory conditions 35.
Treatment and Management
Oral iron therapy is the first-line treatment for IDA, with ferrous preparations being the most cost-effective option 67. The optimal dosage for children is 3 to 6 mg/kg of elemental iron per day 6. In cases where oral iron is ineffective or contraindicated, intravenous iron can be administered, offering a rapid and persistent hematological response 57. It is crucial to identify and treat the underlying cause of iron deficiency to prevent recurrence 7.
Prevention Strategies
Preventing IDA involves both primary and secondary measures. Primary prevention includes dietary counseling, nutritional education, and iron fortification of staple foods 69. Secondary prevention involves screening for, diagnosing, and treating iron deficiency anemia, with universal laboratory screening recommended for children at approximately one year of age 6.
Special Considerations
In areas endemic for malaria and other infections, iron supplementation must be carefully managed to avoid exacerbating infections 5. Additionally, the psychiatric manifestations of IDA, such as low mood, anxiety, and restlessness, highlight the need for comprehensive management that includes addressing potential psychiatric comorbidities 10.
Conclusion
Iron deficiency anemia remains a significant global health issue, particularly affecting vulnerable populations such as children and women in low-income countries. Effective management requires a multifaceted approach, including accurate diagnosis, appropriate treatment, and preventive strategies. Increased awareness and targeted interventions can help mitigate the impact of this common but often overlooked condition.
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