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Not just fatigue: what you need to know about iron deficiency anemia

Each year, World Iron Deficiency Day on November 26th raises awareness among individuals and the medical community about this issue and prevention opportunities. Therefore, today, we are discussing the importance of iron deficiency conditions for health and highlighting the need for timely diagnosis.

Iron deficiency anaemia - it's serious!

Anemia is a condition in which the body has a reduced amount of healthy red blood cells (erythrocytes) or hemoglobin in these cells, essential for oxygen transport to all organs and tissues of our body.1

approximately 2 bn2 billion people worldwide suffer from anemia, according to WHO estimates, with the majority being women and children1,2
Women are much more likely to experience anemia than men due to physiological characteristics. Globally, the prevalence of anemia among women is 33.7%, compared to 11.3% in men2
Iron deficiency anemia (IDA) results from a lack of iron in the body
It ranks first among all anaemias, accounting for 80-90%3 of all anemia cases and representing a major national health issue.4

HOW COMMON IS IRON DEFICIENCY ANEMIA AND WHY IS IT DANGEROUS?

Iron deficiency anemia (IDA) is a common health issue that poses a significant risk to well-being. Anyone, regardless of gender, age, or social status, can experience it.
Certain groups are particularly vulnerable to anemia and its health risks — pregnant women, children, and the elderly
37%
of pregnant women are diagnosed with iron defficiency anemia1
This is due to the increased need for iron while carrying a baby.4
~1400 mg
of iron is lost by women during pregnancy, childbirth, and breastfeeding, requiring careful nutrition to replenish these stores5
Low iron levels in pregnancy are linked to increased blood volume and fetal growth. The developing baby requires numerous micro and macronutrients for proper growth, all sourced from the mother.
THE DANGER IS…
For pregnant women, anemia can lead to serious consequences, including low birth weight, premature birth, and increased risk of mortality for both mother and child 6
up to 40%
of children under five suffer from anemia1
Children are also highly affected by IDA
The maximum risk is seen before the age of 2 years and during periods of active growth such as puberty (12-15 years).2 This is because the growing body requires more iron for the synthesis of haemoglobin, the formation of red blood cells and other body cells. Many factors affect iron levels, from a child's age and lifestyle to concomitant chronic or past illnesses.
THE DANGER IS…
Children are at risk of developing anaemia, which can interfere with their physical and mental development. This early childhood condition is associated with stunted growth and increased susceptibility to infections. In addition, anaemia in children is associated with poor academic performance and behavioural problems, highlighting the importance of addressing the problem early on7,8
~ 33%
of the elderly may suffer from various forms of anemia, including iron deficiency9
Older adults also have high IDA rates
Causes can include chronic diseases, poor nutrition and decreased absorption of iron from food.10,11 Thus, it is important to conduct regular screening and preventive interventions to detect and treat anaemia in these vulnerable populations.4
Often iron deficiency conditions arise due to changes in diet, including the exclusion of red meat. Age-related diseases that are accompanied by bleeding from the gastrointestinal tract: erosive gastritis, ulcers, oncological diseases can also become prerequisites.12
THE DANGER IS…
In older people, anaemia often goes unnoticed but can exacerbate existing health problems and increase the risk of hospitalisation. Older people may experience fatigue, weakness and reduced quality of life. Studies show that the prevalence of anaemia in older people is significant and is often associated with chronic diseases such as kidney disease, cancer, exacerbating their course9
OTHER RISK GROUPS FOR IDA
Women of reproductive age

In women of reproductive age, the development of anaemia may be associated with heavy bleeding during menstruation.13
Women should consult a gynaecologist to assess the severity of menstrual blood loss, examination, development of a programme for individual correction of these conditions, and further prevention of iron deficiency.13

Postoperative patients

Blood loss in the pre- and postoperative period is common and leads to the development of iron deficiency anaemia in 90% and 60-75% respectively.4

People on plant-based diets

The main sources of iron are meat products, making vegan or vegetarian diets risk factors for iron deficiency anaemia. Careful attention to an iron-rich diet and regular check-ups can help control important blood counts. However, recommendations for oral iron supplementation to prevent latent iron deficiency remain.4

HOW DOES IDA DEVELOP?
The main cause of anaemia in the majority of the population is a lack of iron in the diet
Unbalanced nutrition and high stress lead to a decrease in the level of the trace element in the blood and deterioration of health. In addition to nutrition, infections, chronic diseases and hereditary factors can trigger iron deficiency.4
Physiological iron requirements vary considerably, being 10 mg/day for men and 18 mg/day for women14
Unfortunately, iron intake among women is often below normal. In European countries, for example, up to 97% of women do not get enough iron from food.15 In Russia, women receive 11.0-11.9 mg/day of iron from food, while the norm is 18 mg/day.14
Folate deficiency worsens iron deficiency
Folic acid (vitamin B9) is an essential vitamin found in large quantities in green leaves and vegetables. The role of folic acid is particularly important in pregnancy: it is involved in the formation of the foetus' neural tube, the development of the cardiovascular system, and protects the foetus from the effects of certain anomalies and malformations.16
Folic acid deficiency increases rapidly with the development of iron deficiency7
In this case, iron and folic acid deficiency mutually exacerbate each other's effects.17
The development of IDA is preceded by a period of latent iron deficiency (LID), the laboratory criteria of which are low serum iron and ferritin values with normal haemoglobin levels.4
Without treatment, latent iron deficiency can lead to anaemia. This means that the body's iron stores are depleted and anaemia is one step away.4
SYMPTOMS OF IRON DEFICIENCY
The difficulty in detecting IDA lies in the absence of pronounced symptoms. Common manifestations are:1
  • fatigue and increased tiredness
  • shortness of breath
  • dizziness
  • cold extremities
Among the more serious symptoms are:1
  • pale skin and mucous membranes
  • rapid breathing and pulse rate
  • dizziness when standing up
Prolonged anaemia can lead to hypoxia of organs and tissues, which causes various diseases:1,4
  • cardiovascular disorders
  • decreased muscle tone
  • digestive problems
  • neurotic reactions
Iron deficiency anaemia, like many diseases, can start at a mild stage, which can develop into moderate to severe anaemia without timely diagnosis and treatment.
Without giving importance to the primary symptoms, you can start a state of iron deficiency, against which there is a decrease in haemoglobin and a decrease in the volume of erythrocytes.
DIAGNOSIS OF IDA
Early IDA symptoms are easy to miss or mistaken for fatigue. Observing changes, it is important to consult a physician
Target hemoglobin levels are set at:4
for women 120-140 g/L
for men 130-160 g/L
Serum ferritin target levels are:4
> 40-60 ng/mL
The following instrumental investigations are recommended for all patients with newly diagnosed GID to search for a possible source of bleeding and to identify concomitant pathology:4
TREATMENT AND
PREVENTION OF IDA
100% of IDA cases are treatable with timely diagnosis, identifying causes, and proper therapy4
The goal of treatment of iron deficiency is to normalise haemoglobin levels and tissue iron stores. To achieve this, the doctor needs to find the cause of the deficiency and neutralise it. Treatment results in replenishment of tissue iron stores (serum ferritin) and normalisation of haemoglobin levels. The duration of treatment can be from 1 to 6 months, depending on the severity of the anaemia.4
For drug therapy, oral iron preparations are used.4
IRON SUPPLEMENTATION
Replenishment of micronutrient deficiency solely by food is unlikely, so drug support prescribed by a doctor can significantly accelerate the process of getting out of the iron deficiency state.
IRON + FOLIC ACID
IRON FORM
One of the most effective yet safe iron salts is ferrous fumarate.
This form is also more physiological compared to inorganic salts. According to studies, iron fumarate very rarely caused undesirable effects from the GI tract and nausea due to good tolerability even in pregnant women.18
Preparations with divalent iron are absorbed several times better than with trivalent iron, so they can give a faster effect and normalise haemoglobin levels in an average of 1-2 months.20
The choice of the dosage form of the drug is left to the discretion of the patient and the treating physician. The main principle is patient comfort, taking into account long-term use.
The patient's commitment to therapy is the key to effective treatment. Therefore, special attention should be paid to the selection of the dosage form in the prevention and treatment of IDA.
Therapy of iron deficiency should be prescribed by a physician after careful history taking and should also be supervised by a specialist with control diagnostics of iron content in the blood.
DIETARY ADJUSTMENTS
Iron medications are aimed at replenishing iron deficiency. At the same time, it is equally important to eat a balanced diet and take time to select iron-rich foods so that the deficiency does not return.
Dietary iron is available in two forms: haem iron, found in meat, and non-haem iron, found in both animal products and plant foods.21
Useful sources of iron are:4,21
  • greens
  • legumes
  • meat
  • whole grains
  • dried fruit
  • nuts
  • seeds
  • green vegetables
Fruits and vegetables contain vitamin C and organic acids (citric acid) that keep iron in a reduced form, increasing the absorption of non-heme iron when consumed in one meal.21
The absorption of iron from food is approximately 15%. This is due to the peculiarities of the functioning of the gastrointestinal tract and the physiological needs of the body.4
To prevent iron deficiency successfully, it is important to avoid foods that slow the absorption of iron

Casein protein in milk and some forms of calcium inhibit iron absorption. Tea, coffee and cocoa should not be taken together with iron preparations, as polyphenols and tannins contained in these beverages inhibit the absorption of non-heme iron.21

It is not necessary to completely exclude them from the diet, it is enough just to spread their intake over time, so that micro- and macronutrients have time to be absorbed.

INJECTION METHODS
In severe iron deficiency anaemia, inpatient treatment may be prescribed. Intravenous iron preparations help to quickly replenish iron deficiency in the body in emergency cases, for example, before surgery, as well as in serious intestinal diseases in which oral forms of iron are not absorbed. 4
Intravenous forms of iron are prescribed by the attending physician after careful history taking and usually in consultation with a haematologist. Treatment is carried out in an appropriate inpatient setting under the supervision of medical staff.
Iron deficiency anaemia is a problem that can be faced by people of any gender and age. But it is quite solvable with timely diagnosis and a competent approach to treatment
Be aware of your body and take care of your loved ones so you don't miss an iron deficiency condition
Sources cited:

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