Iron deficiency anemia natural history, complications and prognosis

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Overview

The symptoms of iron deficiency are similar as in any other case of anemia. Iron deficiency anemia has age specific presentations. Iron deficiency anemia can lead to severe complications if not treated. The prognosis of iron deficiency anemia is good if iron supplementation is started.

Natural History

  • .The stage of anemia develops when there is chronic deficiency of iron and all the iron stores of body are used up.
  • Initially in iron defiicency, no symptoms develop as body has sufficient store of iron in the form of ferritin.
  • Normal ferittin levels are 20 to 300 ng/mL. This level denotes suffiicient iron levels in the body.
  • Ferittin levels between 20-40 ng/ml denotes iron deficiency without anemia.
  • Ferittin levels <20 ng/ml denotes iron deficency with anemia and signs and symptoms of anemia develop at this stage.
  • Iron deficiency anemia has age specific presentations:
    • Infants (age 0-12 months) and Preschool Children (age 1-5 years)
      • Iron-deficiency anemia is defined as a Hb concentration of less than or equal to 10.0 g/dL .
      • Developmental delays.
      • Behavioral disturbances (e.g., decreased motor activity, social interaction, and attention to tasks)
      • Iron-deficiency anemia also contributes to lead poisoning in children by increasing the gastrointestinal tract's ability to absorb heavy metals, including lead.
      • Psychiatric illnesses such as unipolar disorder, bipolar disorder and autism spectrum disorder in adolescense.
    • Adults (persons aged greater than or equal to 18 years)
      • Decreased functional capacity
      • Signs of hypoxia due to low oxygen delivery to the tissues.
    • Pregnant Female
      • Increased chances of pre term labor
      • Low birth weight baby

Complications

Prognosis

  • The prognosis of iron deficiency anemia is good if iron supplementation is started.
  • Serum iron levels improve within 2 months of starting treatment.
  • Severe iron defiicency is present when ferritin <10 ng/mL and Hb <7mg/dl. At this stage severe complications may start developing.
  • The severity of iron deficiency anemia depends on:
    • Level of severity.
    • Age of onset.
    • Presence of chronic disease.
    • Speed of onset.
    • Cause of iron deficiency.
  • In cases like chronic diseases, restoring iron stores will not treat the anemia unless the disease is treated as cause of anemia is not decreased iron deficiency but iron trapped in its storage form.
  • Reversible causes like bleeding can be managed with blood transfusion and have a good prognosis if blood can be restored in sufficient time .
  • Iron supplementation improves learning, memory, and cognitive test performance in adolescents who have low levels of iron. Iron supplementation also improves the performance of athletes with anemia and iron deficiency.

Finding the cause of iron deficiency

The gastrointestinal tract may be the cause, even in the absence of signs of gastrointestinal bleeding[16]. The prevalence of gastrointestinal lesions among asymptomatic patients with iron deficiency were[16]:

  • Occult blood positive: 67%
  • Occult blood negative: 41%


Gastrointestinal evaluation is underused[17][18][19].

References

  1. ↑ Price EA, Mehra R, Holmes TH, Schrier SL (2011). "Anemia in older persons: etiology and evaluation". Blood Cells Mol Dis. 46 (2): 159–65. doi:10.1016/j.bcmd.2010.11.004. PMID 21208814.
  2. ↑ Mast AE, Bialkowski W, Bryant BJ, Wright DJ, Birch R, Kiss JE; et al. (2016). "A randomized, blinded, placebo-controlled trial of education and iron supplementation for mitigation of iron deficiency in regular blood donors". Transfusion. 56 (6 Pt 2): 1588–97. doi:10.1111/trf.13469. PMC 4905782. PMID 26813849.
  3. ↑ Cook JD, Skikne BS (1989). "Iron deficiency: definition and diagnosis". J Intern Med. 226 (5): 349–55. PMID 2681511.
  4. ↑ Annibale B, Capurso G, Chistolini A, D'Ambra G, DiGiulio E, Monarca B; et al. (2001). "Gastrointestinal causes of refractory iron deficiency anemia in patients without gastrointestinal symptoms". Am J Med. 111 (6): 439–45. PMID 11690568.
  5. ↑ Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L (2016). "Iron deficiency anaemia". Lancet. 387 (10021): 907–16. doi:10.1016/S0140-6736(15)60865-0. PMID 26314490.
  6. ↑ Khadem G, Scott IA, Klein K (2012). "Evaluation of iron deficiency anaemia in tertiary hospital settings: room for improvement?". Intern Med J. 42 (6): 658–64. doi:10.1111/j.1445-5994.2012.02724.x. PMID 22288902.
  7. ↑ Ioannou GN, Rockey DC, Bryson CL, Weiss NS (2002). "Iron deficiency and gastrointestinal malignancy: a population-based cohort study". Am J Med. 113 (4): 276–80. PMID 12361812. Review in: ACP J Club. 2003 May-Jun;138(3):80
  8. ↑ Corazza GR, Valentini RA, Andreani ML, D'Anchino M, Leva MT, Ginaldi L; et al. (1995). "Subclinical coeliac disease is a frequent cause of iron-deficiency anaemia". Scand J Gastroenterol. 30 (2): 153–6. PMID 7732338.
  9. ↑ Unsworth DJ, Lock RJ, Harvey RF (2000). "Improving the diagnosis of coeliac disease in anaemic women". Br J Haematol. 111 (3): 898–901. PMID 11122153.
  10. ↑ Hershko C, Hoffbrand AV, Keret D, Souroujon M, Maschler I, Monselise Y; et al. (2005). "Role of autoimmune gastritis, Helicobacter pylori and celiac disease in refractory or unexplained iron deficiency anemia". Haematologica. 90 (5): 585–95. PMID 15921373.
  11. ↑ Eschbach JW, Cook JD, Scribner BH, Finch CA (1977). "Iron balance in hemodialysis patients". Ann Intern Med. 87 (6): 710–3. PMID 931207.
  12. ↑ Hershko C, Camaschella C (2014). "How I treat unexplained refractory iron deficiency anemia". Blood. 123 (3): 326–33. doi:10.1182/blood-2013-10-512624. PMID 24215034.
  13. ↑ Iolascon A, d'Apolito M, Servedio V, Cimmino F, Piga A, Camaschella C (2006). "Microcytic anemia and hepatic iron overload in a child with compound heterozygous mutations in DMT1 (SCL11A2)". Blood. 107 (1): 349–54. doi:10.1182/blood-2005-06-2477. PMID 16160008.
  14. ↑ Simpson E, Mull JD, Longley E, East J (2000). "Pica during pregnancy in low-income women born in Mexico". West J Med. 173 (1): 20–4, discussion 25. PMC 1070964. PMID 10903283.
  15. ↑ Rector WG (1989). "Pica: its frequency and significance in patients with iron-deficiency anemia due to chronic gastrointestinal blood loss". J Gen Intern Med. 4 (6): 512–3. PMID 2585159.
  16. ↑ 16.0 16.1 Rockey DC, Cello JP (1993). "Evaluation of the gastrointestinal tract in patients with iron-deficiency anemia". N Engl J Med. 329 (23): 1691–5. doi:10.1056/NEJM199312023292303. PMID 8179652.
  17. ↑ Singh H, Daci K, Petersen LA, Collins C, Petersen NJ, Shethia A; et al. (2009). "Missed opportunities to initiate endoscopic evaluation for colorectal cancer diagnosis". Am J Gastroenterol. 104 (10): 2543–54. doi:10.1038/ajg.2009.324. PMC 2758321. PMID 19550418.
  18. ↑ Read AJ, Waljee AK, Chen CS, Holleman R, Kumbier KE, Saini SD (2021). "Prevalence of Appropriate Testing for Incident Anemia in the US Department of Veterans Affairs". JAMA Netw Open. 4 (1): e2034406. doi:10.1001/jamanetworkopen.2020.34406. PMC 7838922 Check |pmc= value (help). PMID 33496793 Check |pmid= value (help).
  19. ↑ Read AJ, Waljee AK, Sussman JB, Singh H, Chen GY, Vijan S; et al. (2021). "Testing Practices, Interpretation, and Diagnostic Evaluation of Iron Deficiency Anemia by US Primary Care Physicians". JAMA Netw Open. 4 (10): e2127827. doi:10.1001/jamanetworkopen.2021.27827. PMC 8486982 Check |pmc= value (help). PMID 34596670 Check |pmid= value (help).

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