20 December 2025, Saturday

Anemia is defined as a decrease in hemoglobin concentration and/or the number of red blood cells (RBCs) per unit volume of blood. IDA is classified as a microcytic, hypochromic anemia. Iron deficiency disrupts hemoglobin synthesis, suppresses erythropoiesis, and leads to tissue hypoxia and nutritional deficiencies.

Risk Factors

• Young children
• Pregnancy and lactation
• Vegetarian diet
• Use of certain medications (e.g., proton pump inhibitors)
• Presence of polymorbid conditions

Etiolog

The primary cause of IDA is an imbalance between iron demand and its supply.

Main causes include:

1.    Insufficient iron intake:

• Inadequate nutrition
• Vegetarian or vegan diets

2.    Blood loss (chronic hemorrhages of various localizations):

• Nasal
• Gastrointestinal
• Uterine
• Renal
• Intravascular hemolysis

3.    Impaired iron absorption:

• Atrophic gastritis
• Celiac disease
• Gastrectomy
• Medication-related (e.g., PPI use)

4.    Increased iron requirements:

• Infancy
• Pregnancy
• Lactation

 

Symptoms

Symptoms may be absent in the early stages. Later, patients may present with:

• General weakness, fatigue
• Pallor of skin and mucous membranes
• Palpitations
• Dyspnea on exertion
• Dizziness, headaches
• Poor concentration
• Constipation or diarrhea
• Pica (craving for non-food items)
• Angular stomatitis
• Nail and hair dystrophy

 

Diagnosis

Clinical findings:

• Pallor of skin and mucous membranes
• Cold extremities
• Signs of trophic disturbances in hair and nails
• Possible features of heart failure

Laboratory parameters:

• Hemoglobin <120 g/L in women, <130 g/L in men
• MCV < 80 fL
• MCHC < 31%
• Ferritin < 15 µg/L
• Decreased serum iron
• Transferrin saturation < 15–20%
• Elevated total iron-binding capacity (TIBC)
• Reticulocytes: normal or elevated in the presence of blood loss

Note:

• Ferritin can be falsely elevated in inflammation — measure C-reactive protein (CRP) to interpret correctly
• Hemoglobin levels may be falsely elevated in smokers, patients with chronic hypoxia, or those living at high altitudes

Additional Tests in Confirmed IDA Cases

• Esophagogastroduodenoscopy (EGD)
• Colonoscopy
• Gynecological consultation
• Thyroid function testing
• IgA anti-EmA and IgA anti-TTG antibodies to rule out celiac disease

 

IDA  Treatment

a. Etiologic Therapy
Identification and treatment of the underlying cause.

b. Nutritional Support
Iron-rich diet:

• Beef, poultry, fish
• Vegetables and fiber-rich foods
• Vitamin C-rich foods enhance iron absorption
• Dairy, tea, coffee, and carbonated drinks impair absorption — should be consumed at least 4 hours before or after iron intake

c. Pharmacologic Treatment

Oral Iron Therapy:

• Recommended elemental iron dose: 150–200 mg/day
• Higher doses are ineffective as absorption is saturated
• Examples:
  • Ferrous sulfate 325 mg, 2–3 times/day
  • Ferrous fumarate 324 mg, twice/day
  • Ferrous gluconate 300 mg, 2–3 times/day
• Common side effect: constipation
  • Recommend hydration, fiber intake, sometimes PPIs if GI intolerance is present

Parenteral Iron Therapy — Indicated when:

• The patient cannot tolerate oral forms
• Malabsorption due to GI disorders
• Chronic blood loss
• Iron requirements exceed absorption capacity (e.g., heavy uterine bleeding)
• Oral treatment has failed

d. Replenishment of Iron Stores

Minimum treatment duration: 3 months to fully restore iron reserves

e. Relapse Prevention

Long-term monitoring and control of underlying risk factors

 

Follow-Up

• After normalization of hemoglobin: checkups every 3 months for 1 year
• If stable: every 6 months
• Iron stores are usually replenished about 4 weeks after hemoglobin correction