Iron Deficiency Anemia: Risk Factors, Diagnosis, and Treatment

Risk Factors

• Age: Children have a greater risk of iron deficiency anemia due to rapid growth, particularly in the first two years of life.
• Gender: Women generally consume less iron than men and may have a greater need for iron, depending on their stage of life. On average, a menstruating woman loses 30 to 45 milligrams of iron per month. Pregnancy and delivery together use about 1 gram of maternal iron. Breast-feeding a child uses a total of about 1 gram of maternal iron in the first year of life.
• Peptic ulcer disease and gastritis: These disorders lead to blood loss, which can deplete iron stores. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) are often contributing factors.
• Cancer: Esophageal, gastric, and other gastrointestinal cancers often cause occult bleeding.
• Excessive exercise: Rarely, blood losses may occur due to intense exercise. Iron losses also result from increased sweating. In particular, such losses may predispose adolescent female athletes to anemia.
• Dietary factors (see Nutritional Considerations).
  

Diagnosis

• A careful history and physical examination, including dietary and menstrual history, are essential.
• Simple blood tests can accurately assess a person's iron status.
• Bone marrow biopsy to determine marrow iron stores was a standard means of diagnosis in the past, but this procedure is now only rarely necessary.
  

Treatment

Treatment involves resolving the patient's iron deficiency, as well as addressing the underlying cause (e.g., ulcer, malignancy, excess menstrual flow, dietary deficiency, iron malabsorption).

• Ferrous sulfate is most commonly used oral iron supplement and has the greatest bioavailability, but it may also lead to more stomach upset than other forms of iron. Typical adult dosage is 325 milligrams of ferrous sulfate taken up to three times daily.
• Dairy products should be avoided because they interfere with the absorption of oral iron (see Nutritional Considerations). Supplements should be taken on an empty stomach, if tolerated, and at least two hours before, or four hours after, antacids.
• Simultaneous intake of vitamin C (ascorbic acid) increases absorption of iron. A glass of orange juice contains sufficient vitamin C to significantly increase iron absorption from foods.
• If oral supplements are not sufficient, intramuscular iron shots and intravenous iron treatments are available.