Bleeding is the most common cause of iron deficiency, either from parasitic infection (hookworm) or other causes of blood loss.
Vegetarians are more likely to develop iron deficiency, unless their diet is supplemented with iron. National programmes of dietary iron supplementation are initiated in many portions of the world where meat is sparse in the diet and iron deficiency anemia is prevalent.
Infants and toddlers are the primary risk groups for dietary iron deficiency anemia. Neonates who double their birth weight are a special risk group.
Whereas iron deficiency anemia is a laboratory diagnosis, a carefully obtained history can facilitate its recognition. The history can be useful in establishing the etiology of the anemia and, perhaps, in estimating its duration.
Iron deficiency in the absence of anemia is asymptomatic. One half of patients with moderate iron deficiency anemia develop pica (pagophagia). Usually, they crave ice to suck or chew. Occasionally, patients are seen who prefer cold celery or other cold vegetables in lieu of ice. Leg cramps, which occur on climbing stairs, also are common in patients deficient in iron.
Often, patients can provide a distinct point in time when these symptoms first occurred, providing an estimate of the duration of the iron deficiency.
Fatigue and diminished capability to perform hard labour are attributed to the lack of circulating hemoglobin; however, they occur out of proportion to the degree of anemia and probably are due to a depletion of proteins that require iron as a part of their structure.
Although the history and physical examination can lead to the recognition of the condition and help establish the etiology, iron deficiency anemia is primarily a laboratory diagnosis.
Useful tests include a complete blood count (CBC); a peripheral smear; serum iron, total iron-binding capacity (TIBC), and serum ferritin; hemoglobin electrophoresis , reticulocyte cells count and stool testing are useful for establishing the etiology of iron deficiency anemia and for excluding or establishing a diagnosis of 1 of the other causes of microcytic hypochromic anemia.
In most patients, the iron deficiency should be treated with oral iron therapy, and the underlying etiology should be corrected so the deficiency does not recur.
The British Society of Gastroenterology guidelines suggest that all patients require iron supplementation and that parenteral iron can be used if oral preparations are not well tolerated. The guidelines also state that blood transfusions should be reserved only for patients who are at risk for or who have cardiovascular instability due to their anemia.
