Iron Deficiency Symptoms and Effects

Iron Deficiency Anemia

• Iron deficiency anemia is characterized by anorexia, poor weight gain, poor nutrition, angular stomatitis, and atrophic glossitis.
• Irritability and anorexia occur in advanced cases.
• The spleen is palpably enlarged in 10-15% of cases.

Effects on the Body

• Iron deficiency affects alertness and learning abilities in children and adolescents.
• Nail changes include thin, brittle, broken, or spoon-shaped nails with longitudinal ridges.

Laboratory Diagnosis

• Complete blood count shows microcytic hypochromic anemia, normal reticulocyte count, normal white cell count, and thrombocytosis may occur.
• Serum ferritin is decreased to less than 10 ng/ml.
• Serum iron level is decreased to less than 30 μg/dl.
• Total iron binding capacity (serum transferrin) is increased to more than 350 μg/dl.
• Free erythrocytic protoporphyrin is increased.

Bone Marrow Examination

• Bone marrow is hypercellular with erythroid hyperplasia.
• Normoblasts show decreased hemoglobin content.
• Leukocytes and megakaryocytes are normal.

Stool Examination

• Stool examination detects overt or occult blood or parasites like hookworms.

Differential Diagnosis

• Thalassemia trait: family history of thalassemia, reticulocytosis, Hb levels not decreased below 7 gm/dl, elevated Hb A2 (3.4-7%), and normal serum iron, iron-binding capacity, and serum ferritin.
• Anemia of chronic disease and infection: serum iron level and iron-binding capacity are reduced, and serum ferritin levels are normal.
• Lead poisoning: blood film shows coarse basophilic staining of RBCs, and elevated blood lead.

Treatment

• Treatment of the underlying cause
• Iron therapy: oral iron supplementation of 6mg/kg/day of elemental iron, given in 3 divided doses, better between meals.

Compensatory Mechanisms

• To increase oxygen delivery:
  • Increase in blood flow
  • Increase in red cell mass
  • Increase oxygen unloading

Hemoglobin

• Hemoglobin is an iron-containing protein in RBCs that carries oxygen from the lungs to the body tissues.
• Hemoglobin deficiency can be caused by decreased amount of hemoglobin molecules or decreased ability of each molecule to bind oxygen.

Blood Indices

• Normal RBCs: no nucleus, biconcave discs, center 1/3 pallor, pink cytoplasm, and 100-120 days life span.
• Reticulocytes (young RBCs): no definite nucleus, reticulum of RNA, deep blue staining, light blue cytoplasm, and cell size about 10 µ.
• Hematocrit value (HCT): portion of 100 blood composed of the erythrocytes, normal males range from 37-49%, and normal females range from 36-46%.
• Mean corpuscular volume (MCV): average size or volume of the RBC, calculated as follows: MCV = Volume of packed red cells in 1000 ml blood (Hct X 10)/ RBC Count (Red cell count) in million in microliter, normal value 70-100 femtoliter (fl).
• Mean Cell Hemoglobin (MCH): weight of Hb in the average red cell, calculated as follows: MCHC = Amount of Hb in 100 ml blood X 100/ Hct Volume of packed red cells, normal value 32-36%.