Low iron
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Understanding Low Iron: Causes, Effects, and Treatments
Iron Deficiency: A Global Health Issue
Iron deficiency is a significant global health problem, particularly affecting children, premenopausal women, and individuals in low-income and middle-income countries2. It is a leading cause of anemia, which can result in various clinical and functional impairments even in the absence of anemia2. The primary regulator of systemic iron homeostasis, hepcidin, plays a crucial role in iron absorption and distribution, especially during inflammation2.
Intracellular Iron Transport and Storage
Intracellular iron is managed by low molecular weight iron compounds that act as intermediates between extracellular iron and various intracellular processes1. These compounds are in equilibrium with storage iron and iron enzymes, highlighting their importance in iron toxicity and chelation therapy1. Research has identified a low molecular weight iron complex in rat liver, which includes amino acids like glutamate and aspartate, and is readily donated to high-affinity chelators3.
Iron Deficiency in Specific Populations
Low Birth Weight Infants
Low birth weight (LBW) infants are at a higher risk of iron deficiency due to their increased postnatal growth requirements9. Studies have shown that iron supplementation in marginally low birth weight (MLBW) infants significantly reduces the risk of iron deficiency and iron deficiency anemia (IDA) without adverse effects on growth or morbidity6 8. Supplementation with 2 mg/kg per day from 6 weeks to 6 months of age is particularly effective6 8.
Premenopausal Women
Premenopausal women with low serum ferritin levels but without anemia can experience significant fatigue. Intravenous iron treatment has been shown to improve fatigue in these women, especially those with serum ferritin concentrations ≤ 15 ng/mL7. This treatment is both safe and well-tolerated, providing a viable option for managing fatigue associated with low iron stores7.
Iron Deficiency and Anemia
Iron deficiency is often assumed to cause about half of all anemia cases. However, a systematic review of national surveys indicates that the proportion of anemia attributable to iron deficiency varies significantly by region, inflammation exposure, and urban/rural settings4. For instance, in countries with high anemia prevalence and high inflammation exposure, the proportion of anemia due to iron deficiency is lower than previously assumed4. This suggests that anemia-reduction strategies should be tailored to specific regional data rather than a one-size-fits-all approach4.
Iron Supplementation Strategies
Oral iron therapy is typically the first line of treatment for iron deficiency. However, the upregulation of hepcidin by oral iron supplementation can limit its absorption efficiency, particularly during inflammation2. Modern parenteral iron formulations have revolutionized iron treatment, enabling rapid and safe total-dose iron replacement2. For infants, additional iron supplementation beyond iron-fortified formulas may not significantly enhance hemoglobin levels, suggesting that routine screening and supplementation in healthy, formula-fed infants may be unnecessary9.
Conclusion
Iron deficiency remains a critical health issue with varied impacts across different populations. Effective management strategies, including targeted supplementation and tailored anemia-reduction programs, are essential for addressing this widespread problem. Understanding the nuances of iron metabolism and the specific needs of vulnerable groups can help in devising more effective interventions to combat iron deficiency and its associated complications.
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Most relevant research papers on this topic
Low molecular weight intracellular iron transport compounds.
Intracellular iron transport compounds play a crucial role in iron toxicity and chelation therapy, acting as intermediates between extracellular iron and various intracellular processes.
Highly CitedIron deficiency
Modern parenteral iron formulations enable rapid, safe total-dose iron replacement, improving treatment efficiency and addressing underlying causes in iron deficiency patients.
Rigorous JournalHighly CitedIntracellular low molecular weight iron
This study identified a low molecular weight iron oligomer in rat liver, suggesting it is iron(III) and readily donated to high-affinity chelators like hydroxypyridinones and desferoxamine.
The Proportion of Anemia Associated with Iron Deficiency in Low, Medium, and High Human Development Index Countries: A Systematic Analysis of National Surveys
The proportion of anemia associated with iron deficiency is lower than previously assumed in low, medium, and high Human Development Index countries.
Meta-Analysis
Very Rigorous JournalHighly CitedA review on the enrichment of iron values of low-grade Iron ore resources using reduction roasting-magnetic separation
Reduction roasting-magnetic separation is a promising technique for enriching iron content in low-grade iron ores with complex mineralogy and liberation issues.
Literature ReviewHighly CitedIron Supplementation Until 6 Months Protects Marginally Low-Birth-Weight Infants From Iron Deficiency During Their First Year of Life
Iron supplements with 2 mg kg1 day1 until 6 months of life effectively reduce the risk of iron deficiency during the first 12 months of life in marginally low-birth-weight infants.
RCTIntravenous iron for the treatment of fatigue in nonanemic, premenopausal women with low serum ferritin concentration.
Intravenous iron effectively improves fatigue in nonanemic, premenopausal women with low serum ferritin concentrations, with a good safety and tolerability profile.
RCTHighly CitedIron Supplements Reduce the Risk of Iron Deficiency Anemia in Marginally Low Birth Weight Infants
Iron supplementation at 2 mg/kg per day from 6 weeks to 6 months effectively reduces the risk of iron deficiency and anemia in marginally low birth weight infants without short-term adverse effects on morbidity or growth.
RCTHighly CitedRandomized, placebo-controlled trial of iron supplementation in infants with low hemoglobin levels fed iron-fortified formula.
Additional iron supplementation in low-income infants with low hemoglobin levels fed iron-fortified formulas does not enhance Hgb values, and screening healthy infants fed iron-fortified formula at 6 months is not justified.
RCT
Large Human TrialIron Deficiency and Iron Homeostasis in Low Birth Weight Preterm Infants: A Systematic Review
Premature and low birth weight infants have higher iron requirements, but excess iron may affect organ development, requiring careful monitoring and management.
Systematic ReviewVery Rigorous Journal