Iron Deficiency Anaemia
Iron deficiency anaemia is a condition in which number of red blood cells (RBC) in the blood is low. A person having anaemia is known as anaemic. Iron is very essential for making haemoglobin which is a part of R.B.C. It carries oxygen to the different parts of the body.
Causes of Iron deficiency anaemia:
Iron deficiency anaemia occurs in low iron level in the body due to following reasons:
1. Menstrual bleeding and increased iron requirement in pregnancy and lactation.
2. Lack of iron in the diet.
3. Achlorhydria or Hypochlorhydria reduces the absorption of ingested iron.
4. Anaemia in Infants & children occur due to:
• Prolonged milk feeding
• Low birth weight
• Nutritional anaemia in the mother (iron deficiency)
• Infections in infants
• Intestinal mal-absorption
5. Post haemorrhagic iron deficiency anaemia occurs due to:
• Sudden loss of large amount of blood, one litre or more due to injury or intestinal bleeding (Acute Bleeding).
• Chronic post haemorrhagic anaemia occur in Menorrhagia
• Alimentary canal bleeding occur in Haemorrhoids, Carcinoma, Peptic ulcer, Anchylostomiasis and Aspirin intake.
Signs and Symptoms or clinical features of Iron deficiency anaemia:
There are no specific signs and symptoms observed in mild case of iron deficiency anaemia. In severe anaemia cases following signs & symptoms is observe:
• Pallor of skin & mucous membrane
• Feeling of lack of interest or energy
• Breathlessness on exertion
• Muscle pain during exercise
• Dizziness (a feeling that you are about to fall)
• Decrease vision
• Palpitation & increased heart beat
• Heart enlargement with functional systolic murmur
• Loss of appetite
• Par aesthesia in fingers & toes observed
• Oedema over the ankle seen
• Angular stomatitis with glossitis
• Trouble swallowing
• Cracked lips
• Smooth &sore tongue
• Koilonychias (nails become brittle & dry, then flat & thin and finally become spoon-shaped).
• Spleen may be palpable in sever chronic iron deficiency anaemia
• Growth is retarded in infants & small children with delayed skills like walking and talking, short attention and irritable. If they are treated in time usually symptoms go away. If not treated, mental & behaviour problems may be permanent
Blood examination shows a picture of Hypo-chromic microcytic anaemia. Haemoglobin may be as low as 4-8 gm per 100 ml, with the red count between 3 & 4-5 million and Mean Corpuscular Haemoglobin Concentration is 26 to 30%.Total and differential white counts show little change from normal. Bone marrow shows normoblastic reaction
Diagnosis of Iron deficiency anaemia:
Diagnosis of iron deficiency anaemia is made on the basis of:
• Blood examination: shows picture of hypo- chromic anaemia.
• Stool test: is done to exclude Ancylostoma dudenale & occult blood.
• Look for Haemorrhoids and
• Perform full radiographic exam. Of gastro intestinal tract
Prophylaxis of Iron deficiency anaemia:
In Women :
There are two main principles to prevent iron deficiency anaemia in women which is as follows:
• Balanced diet containing iron rich food
• Periodic intake of supplementary iron during pregnancy, lactation and when menstruation is in excess.
In Infants :
In Infants anaemia is prevented by maintaining a normal blood level in the mother is required. In premature and small infants medicinal iron is given.
Treatment of Iron deficiency anaemia:
Oral Iron Therapy :
In adults iron deficiency anaemia is treated by diet rich in iron and with medicinal iron (Iron Pills) orally. Avoid iron pills with milk, coffee, antacids and food rich in fibre.
When haemoglobin is below 5 gm / 100 ml, it is advisable to keep patient in bed and decision for blood transfusion is made on the basis of clinical state of patient instead of haemoglobin level.
Parenteral Iron Therapy :
Inject able iron therapy of commercial preparation of iron can be given intra -muscularly or intravenously. Parenteral route of administration of iron is advisable to those patients who are generally unable to take iron by mouth because of pain in abdomen, vomiting and diarrhoea or who are unable to absorb iron because of malabsorption syndrome of gastrointestinal tract.Injectable iron therapy is also given in following conditions:
• Anaemia in rheumatoid arthritis
• Severe anaemia correction in late stage of pregnancy
• Following major operations
Oral iron therapy should be discontinued before starting parenteral iron therapy.
Prognosis of Iron deficiency anaemia :
Prognosis of iron deficiency anaemia depends on the cause, its severity and age of the patient. It is good in young but poor in elder ones. Young people tolerate anaemia better than elders.