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Iron Deficiency Anemia

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Description: Iron deficiency anemia is a condition characterized by a lack of healthy red blood cells due to insufficient iron, leading to reduced oxygen transport in the body.
Type: Iron deficiency anemia is not a genetic disorder. It is typically acquired due to insufficient iron intake, poor absorption of iron, or excessive loss of iron through bleeding.
Signs And Symptoms: Iron-deficiency anemia may be present without a person experiencing symptoms. It tends to develop slowly; therefore the body has time to adapt, and the disease often goes unrecognized for some time. If symptoms present, patients may present with the sign of pallor (reduced oxyhemoglobin in skin or mucous membranes), and the symptoms of feeling tired, weak, dizziness, lightheadedness, poor physical exertion, headaches, decreased ability to concentrate, cold hands and feet, cold sensitivity, increased thirst and confusion. None of these symptoms (or any of the others below) are sensitive or specific.
In severe cases, shortness of breath can occur. Pica may also develop; of which consumption of ice, known as pagophagia, has been suggested to be the most specific for iron deficiency anemia.Other possible symptoms and signs of iron-deficiency anemia include:
Prognosis: The prognosis for iron deficiency anemia is generally good with appropriate treatment. Most individuals respond well to iron supplementation and dietary changes. However, if left untreated, it can lead to more serious health problems, such as heart problems, pregnancy complications, and growth and development issues in children. Early diagnosis and treatment are key to a positive outcome.
Onset: The onset of iron deficiency anemia can be gradual, and symptoms may not appear until the condition is advanced. It often develops over time due to chronic blood loss, insufficient dietary iron intake, or impaired iron absorption. Early detection and diagnosis are typically achieved through routine blood tests or during evaluations for symptoms such as fatigue, weakness, and pallor.
Prevalence: Iron deficiency anemia is one of the most common types of anemia worldwide. It affects approximately 1.2 billion people globally, with the highest prevalence seen in women of reproductive age, young children, and individuals in low-income countries.
Epidemiology: A moderate degree of iron-deficiency anemia affects approximately 610 million people worldwide or 8.8% of the population. It is slightly more common in females (9.9%) than males (7.8%). Up to 15% of children ages 1–3 years have iron deficiency anemia. Mild iron deficiency anemia affects another 375 million. Iron deficiency affects up to 52% of pregnant women worldwide.The prevalence of iron deficiency as a cause of anemia varies among countries; in the groups in which anemia is most common, including young children and a subset of non-pregnant women, iron deficiency accounts for a fraction of anemia cases in these groups (25% and 37%, respectively). Iron deficiency is common in pregnant women.Within the United States, iron-deficiency anemia affects about 2% of adult males, 10.5% of White women, and 20% of African-American and Mexican-American women.A map provides a country-by-country listing of what nutrients are fortified into specified foods. Some of the Sub-Saharan countries shown in the deaths from iron-deficiency anemia map from 2012 are as of 2018 fortifying foods with iron.
Intractability: Iron-deficiency anemia is generally not considered intractable. It can usually be managed and treated effectively through dietary changes, iron supplements, and addressing any underlying causes, such as chronic blood loss or malabsorption issues. If the underlying cause is adequately addressed and iron levels are restored, the anemia can often be resolved.
Disease Severity: Iron deficiency anemia can range from mild to severe, depending on the level of iron depletion and the resultant decrease in hemoglobin levels. Mild cases might cause only minimal symptoms, while severe anemia can lead to significant fatigue, weakness, shortness of breath, chest pain, and increased susceptibility to infections.
Healthcare Professionals: Disease Ontology ID - DOID:11758
Pathophysiology: Iron-deficiency anemia occurs when the body lacks adequate iron to produce hemoglobin, a protein in red blood cells responsible for carrying oxygen. The pathophysiology involves several stages:

1. **Depletion of Iron Stores**: Initially, the body's iron stores, primarily in the liver, bone marrow, and spleen, are depleted. Ferritin levels, an indicator of stored iron, decrease.

2. **Reduced Erythropoiesis**: As iron deficiency progresses, there is insufficient iron available to meet the demands of erythropoiesis (red blood cell production). This leads to the production of fewer and smaller red blood cells (microcytic anemia).

3. **Hypochromic Cells**: The red blood cells also become hypochromic, meaning they contain less hemoglobin, which gives them a paler appearance on microscopic examination.

4. **Decreased Oxygen Transport**: With less hemoglobin available, the oxygen-carrying capacity of the blood diminishes, leading to symptoms such as fatigue, weakness, and pallor.

The body's compensatory mechanisms, such as increased cardiac output and redistribution of blood to vital organs, can only partially offset these deficits, leading to the clinical manifestations of anemia.
Carrier Status: Iron deficiency anemia is not a genetic condition, so the concept of carrier status does not apply. It is primarily caused by inadequate iron intake, chronic blood loss, or issues with iron absorption.
Mechanism: Anemia can result from significant iron deficiency. When the body has sufficient iron to meet its needs (functional iron), the remainder is stored for later use in cells, mostly in the bone marrow and liver. These stores are called ferritin complexes and are part of the human (and other animals) iron metabolism systems. Men store about 3.5 g of iron in their body, and women store about 2.5 g.Hepcidin is a peptide hormone produced in the liver that is responsible for regulating iron levels in the body. Hepcidin decreases the amount of iron available for erythropoesis (red blood cell production). Hepcidin binds to and induces the degradation of ferroportin, which is responsible for exporting iron from cells and mobilizing it to the bloodstream. Conditions such as high levels of erythropoesis, iron deficiency and tissue hypoxia inhibit hepcidin expression. Whereas systemic infection or inflammation (especially involving the cytokine IL-6) or increased circulating iron levels stimulate hepcidin expression.Iron is a mineral that is important in the formation of red blood cells in the body, particularly as a critical component of hemoglobin. About 70% of the iron found in the body is bound to hemoglobin. Iron is primarily absorbed in the small intestine, in particular the duodenum and jejunum. Certain factors increase or decrease absorption of iron. For example, taking Vitamin C with a source of iron is known to increase absorption. Some medications such as tetracyclines and antacids can decrease absorption of iron. After being absorbed in the small intestine, iron travels through blood, bound to transferrin, and eventually ends up in the bone marrow, where it is involved in red blood cell formation. When red blood cells are degraded, the iron is recycled by the body and stored.When the amount of iron needed by the body exceeds the amount of iron that is readily available, the body can use iron stores (ferritin) for a period of time, and red blood cell formation continues normally. However, as these stores continue to be used, iron is eventually depleted to the point that red blood cell formation is abnormal. Ultimately, anemia ensues, which by definition is a hemoglobin lab value below normal limits.
Treatment: Treatment should take into account the cause and severity of the condition. If the iron-deficiency anemia is a result of blood loss or another underlying cause, treatment is geared toward addressing the underlying cause. Most cases of iron deficiency anemia are treated with oral iron supplements. In severe acute cases, treatment measures are taken for immediate management in the interim, such as blood transfusions or intravenous iron.For less severe cases, treatment of iron-deficiency anemia includes dietary changes to incorporate iron-rich foods into regular oral intake and oral iron supplementation. Foods rich in ascorbic acid (vitamin C) can also be beneficial, since ascorbic acid enhances iron absorption. Oral iron supplements are available in multiple forms. Some are in the form of pills and some are drops for children.Most forms of oral iron replacement therapy are absorbed well by the small intestine; however, there are certain preparations of iron supplements that are designed for longer release in the small intestine than other preparations. Oral iron supplements are best taken up by the body on an empty stomach because food can decrease the amount of iron absorbed from the small intestine. The dosing of oral iron replacement therapy is as much as 100–200 mg per day in adults and 3–6 mg per kilogram in children. This is generally spread out as 3–4 pills taken throughout the day.The various forms of treatment are not without possible adverse side effects. Iron supplementation by mouth commonly causes negative gastrointestinal effects, including constipation, nausea, vomiting, metallic taste to the oral iron and dark colored stools. Constipation is reported by 15–20% of patients taking oral iron therapy. Preparations of iron therapy that take longer to be absorbed by the small intestine (extended release iron therapy) are less likely to cause constipation.It can take six months to one year to get blood levels of iron up to a normal range and provide the body with iron stores. Oral iron replacement may not be effective in cases of iron deficiency due to malabsorption, such as celiac disease, inflammatory bowel disease, or H. pylori infection; these cases would require treatment of the underlying disease to increase oral absorption or intravenous iron replacement.As iron-deficiency anemia becomes more severe, if the anemia does not respond to oral treatments, or if the treated person does not tolerate oral iron supplementation, then other measures may become necessary. Two options are intravenous iron injections and blood transfusion. Intravenous can be for people who do not tolerate oral iron, who are unlikely to respond to oral iron, or who require iron on a long-term basis. For example, people receiving dialysis treatment who are also getting erythropoietin or another erythropoiesis-stimulating agent are given parenteral iron, which helps the body respond to the erythropoietin agents to produce red blood cells.Intravenous iron can induce an allergic response that can be as serious as anaphylaxis, although different formulations have decreased the likelihood of this adverse effect. In certain cases intravenous iron is both safer and more effective than the oral route. For patients with severe anemia such as from blood loss, or who have severe symptoms such as cardiovascular instability, a blood transfusion may be considered.Low-certainty evidence suggests that IBD-related anemia treatment with Intravenous (IV) iron infusion may be more effective than oral iron therapy, with fewer people needing to stop treatment early due to adverse effects. The type of iron preparation may be an important determinant of clinical benefit. Moderate-certainty evidence suggests response to treatment may be higher when IV ferric carboxymaltose, rather than IV iron sucrose preparation is used, despite very-low certainty evidence of increased adverse effects, including bleeding, in those receiving ferric carboxymaltose treatment. Ferric maltol, marketed as Accrufer and Ferracru, is available in oral and IV preparations. When used as a treatment for IBD-related anemia, very low certainty evidence suggests a marked benefit with oral ferric maltol compared with placebo. However it was unclear whether the IV preparation was more effective than oral ferric maltol. A Cochrane review of controlled trials comparing intravenous (IV) iron therapy with oral iron supplements in people with chronic kidney disease, found low-certainty evidence that people receiving IV-iron treatment were 1.71 times as likely to reach their target hemoglobin levels. Overall, hemoglobin was 0.71g/dl higher than those treated with oral iron supplements. Iron stores in the liver, estimated by serum ferritin, were also 224.84 µg/L higher in those receiving IV-iron. However there was also low-certainty evidence that allergic reactions were more likely following IV-iron therapy. It was unclear whether type of iron therapy administration affects the risk of death from any cause, including cardiovascular, nor whether it may alter the number of people who may require a blood transfusion or dialysis.Ferric derisomaltose (Monoferric) was approved in the United States in January 2020, for the treatment of iron deficiency anemia.
Compassionate Use Treatment: Compassionate use treatment and off-label or experimental treatments for iron deficiency anemia may include:

1. **Intravenous (IV) Iron Therapy**: While it's a standard treatment for certain cases, its use might be considered off-label in some situations, particularly if oral iron is not tolerated or effective.

2. **Erythropoiesis-Stimulating Agents (ESAs)**: These are typically used in specific conditions like chronic kidney disease, but they may be used off-label in severe cases of anemia where standard treatments have failed.

3. **Ferinject (Ferric Carboxymaltose)**: This is an IV iron formulation that is sometimes used off-label for rapid replenishment of iron stores.

4. **Ferric Derisomaltose (Monofer)**: Another IV iron formulation that might be used in experimental treatments, especially for patients with a history of severe reactions to other iron formulations.

5. **Iron Isomaltoside**: This is used in Europe and may be considered off-label in some regions.

6. **Hypoxia-Inducible Factor (HIF) Stabilizers**: These are newer drugs primarily studied for anemia associated with chronic kidney disease but may be explored in clinical trials for iron deficiency anemia.

These treatments should be considered and administered under the guidance of a healthcare professional, particularly when standard treatments are not suitable or effective.
Lifestyle Recommendations: For managing iron deficiency anemia through lifestyle changes, consider the following recommendations:

1. **Dietary Adjustments**:
- **Iron-Rich Foods**: Include red meat, poultry, fish, beans, lentils, tofu, dark leafy greens, and iron-fortified cereals.
- **Vitamin C Intake**: Consume foods high in vitamin C, such as citrus fruits, strawberries, bell peppers, and broccoli, to enhance iron absorption.
- **Avoid Inhibitors**: Limit intake of substances that inhibit iron absorption, such as tea, coffee, and dairy, especially around meal times.

2. **Cooking Practices**:
- Use cast iron cookware, which can add a small amount of iron to your food.

3. **Regular Monitoring**:
- Schedule regular check-ups with your healthcare provider to monitor iron levels and adjust dietary or supplement intake as necessary.

4. **Hydration**:
- Stay well-hydrated to help overall body function and nutrient transport.

5. **Physical Activity**:
- Engage in moderate physical activity to improve overall health and wellness, but balance it with adequate rest.

Implementing these lifestyle changes can help manage and improve iron deficiency anemia. If symptoms persist, consult a healthcare provider for further evaluation and possible supplementation.
Medication: Medications for iron deficiency anemia typically include iron supplements like ferrous sulfate, ferrous gluconate, or ferrous fumarate. In some cases, intravenous iron preparations such as iron dextran or iron sucrose may be prescribed.
Repurposable Drugs: Iron deficiency anemia involves a deficiency in red blood cells due to insufficient iron. Several drugs originally approved for other uses have shown potential benefits for treating iron deficiency anemia:

1. **Proton Pump Inhibitors (PPIs)**: Typically used to reduce stomach acid, PPIs can potentially improve iron absorption in certain cases where increased stomach acid impairs iron levels.

2. **Erythropoiesis-Stimulating Agents (ESAs)**: These drugs, used primarily for anemia associated with chronic kidney disease or chemotherapy, can stimulate red blood cell production and may be helpful in severe cases of iron deficiency anemia.

Consulting a healthcare provider is essential for proper diagnosis and treatment.
Metabolites: Iron deficiency anemia is associated with several key metabolites, including:

1. **Serum Ferritin**: A measure of stored iron in the body; levels are typically low in iron deficiency anemia.
2. **Serum Iron**: Reflects the amount of circulating iron bound to transferrin; usually low in this condition.
3. **Total Iron-Binding Capacity (TIBC)**: Often elevated as the body tries to bind and transport more iron due to its deficiency.
4. **Transferrin Saturation**: The percentage of transferrin (iron transport protein) that is actually bound with iron; typically low in iron deficiency anemia.

These metabolites help diagnose and manage the condition effectively.
Nutraceuticals: Nutraceuticals for iron deficiency anemia typically include iron supplements, which can come in various forms such as ferrous sulfate, ferrous gluconate, and ferrous fumarate. Additionally, vitamin C is often recommended alongside iron supplements to enhance absorption. Other beneficial nutraceuticals may include folic acid and vitamin B12, both of which are important for red blood cell production.

Nanotechnology has been explored as a means to improve the efficacy and delivery of iron supplements. Nano-iron formulations can increase the bioavailability of iron while reducing gastrointestinal side effects. Examples include iron oxide nanoparticles and liposomal iron, which are designed to target iron delivery directly to cells needing supplementing, thereby potentially improving treatment outcomes and patient compliance.
Peptides: Peptides are short chains of amino acids that can enhance iron absorption in iron deficiency anemia by forming iron-peptide complexes. These complexes improve iron bioavailability and may reduce gastrointestinal side effects.

Nanotechnology (nan) applications in iron deficiency anemia include using iron nanoparticles as an advanced delivery method. These nanoparticles can improve iron absorption, decrease dosage frequency, minimize side effects, and enhance treatment efficacy.