Iron deficiency anemia: current strategies for the diagnosis and management
DOI:
https://doi.org/10.7175/rhc.v4i3.480Keywords:
Iron deficiency anemia, Homeostasis, Iron supplementationAbstract
Iron deficiency is one of the commonest nutritional deficiencies in the world. It is multifactorial and may be caused by lack of intake, blood loss and intestinal causes. Clinical features are highly variable, and most patients are asymptomatic. Typical laboratory features of iron deficiency anemia (IDA) include a hypochromic microcytic anemia, low serum iron level, high total iron binding capacity, low serum ferritin level. Usefulness of monitoring serum transferrin receptor level (sTfR) and hepcidin for identifying IDA have been examined in a few studies. Available data suggest that sTfR can potentially become a valuable tool for regular testing of patients in the future. Despite IDA is easily corrected with iron therapy, establishing the cause can be difficult, particularly in cases caused by disorders of iron transport. Education for clinician needs to focus on increasing awareness of the importance of failure respond to iron supplementation. The aim of this review was to outline the current strategies for the diagnosis and management of IDA in the light of the latest reports.
References
World Health Organization, The Unites Nations Children’s Fund, Unites Nations University. Iron deficiency anemia; assessment, prevention, and control. Available at: http://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/en (Last accessed July, 2004)
Zimmermann MB, Hurrell RF. Nutritional iron deficiency. Lancet 2007; 370: 511-20; http://dx.doi.org/10.1016/S0140-6736(07)61235-5
Suskind DL. Nutritional deficiencies during normal growth. Pediatr Clin N Am 2009; 56: 1035-53; http://dx.doi.org/10.1016/j.pcl.2009.07.004
Lozoff B, Brittenham GM, Viteri FE, et al. Developmental deficits in iron deficient infants: effects of age and severity of iron lack. J Pediatr 1982; 101: 948-52; http://dx.doi.org/10.1016/S0022-3476(82)80016-4
Zlotkin S. Clinical nutrition: 8. The role of nutrition in the prevention of iron deficiency anemia in infants, children and adolescents. CMAJ 2003; 168: 59-63
Johnson-Wimbley TD, Graham DY. Diagnosis and management of iron deficiency anemia in the 21st century. Therap Adv Gastroenterol 2011; 4: 177-84; http://dx.doi.org/10.1177/1756283X11398736
Green R. Anemias beyond B12 and iron deficiency: the buzz about other B’s, elementary, and nonelementary problems. Hematology Am Soc Hematol Educ Program 2012; 2012: 492-8; http://dx.doi.org/10.1182/asheducation-2012.1.492
Finch CA, Huebers HA. Iron metabolism. Clin Physiol Biochem 1986; 4: 5-10
Clark SF. Iron deficiency anemia. Nutr Clin Pract 2008; 23: 128-41; http://dx.doi.org/10.1177/0884533608314536
Bermejo F, Garcia Lopez S. A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases. World J Gastroenterol 2009; 15: 4638-43; http://dx.doi.org/10.3748/wjg.15.4638
Iolascon A, Camaschella C, Pospisilova D, et al. Natural history of recessive inheritance of DMT 1 mutations. J Pediatr 2008; 152: 136-9; http://dx.doi.org/10.1016/j.jpeds.2007.08.041
Kaya Z, Yildiz E, Gursel T, et al. Serum prohepcidin levels in children with solid tumors, inflammatory bowel disease and iron deficiency anemia. J Trop Pediatr 2011; 57: 120-5; http://dx.doi.org/10.1093/tropej/fmq058
Rivera S, Nemeth E, Gabayan V, et al. Synthetic hepcidin causes rapid dose-dependent hypoferremia and is concentrated in ferroportin-containing organs. Blood 2005; 106: 2196-9; http://dx.doi.org/10.1182/blood-2005-04-1766
Ganz T, Nemeth E. Iron imports: IV. Hepcidin and regulation of body iron metabolism. Am J Physiol Gastrointest Liver Physiol 2006; 290: 199-203; http://dx.doi.org/10.1152/ajpgi.00412.2005
Griffin IJ, Abrams SA. Iron and breastfeeding. Pediatr Clin North Am 2001; 48: 401-13; http://dx.doi.org/10.1016/S0031-3955(08)70033-6
Zhu A, Kaneshiro M, Kaunitz JD. Evaluation and treatment of iron deficiency anemia:A gastroenterological perspective. Dig Dis Sci 2010; 55: 548-59; http://dx.doi.org/10.1007/s10620-009-1108-6
Scholl TO. Maternal iron status: relation to fetal growth, length of gestation and iron endowment of the neonate. Nutr Rev 2011; 69: 23-9; http://dx.doi.org/10.1111/j.1753-4887.2011.00429.x
Majid S, Salih M, Wasaya R, et al. Predictors of gastrointestinal lesions on endoscopy in iron deficiency anemia without gastrointestinal symptoms. BMC Gastroenterol 2008; 8: 52; http://dx.doi.org/10.1186/1471-230X-8-52
Serefhanoğlu S, Büyükaşik Y, Emmungil H, et al. Identification of clinical and simple laboratory variables predicting responsible gastrointestinal lesions in patients with iron deficiency anemia. Int J Med Sci 2010; 8: 30-8
Finch CA, Cook JD, Labbe RF, et al. Effect of blood donation on iron stores as evaluated by serum ferritin. Blood 1977; 50: 441-7
Finberg KE, Heeney MM, Campagna DR, et al. Mutations in TMPRSS6 cause iron-refractory iron deficiency anemia (IRIDA). Nat Genet 2008; 40: 569-71; http://dx.doi.org/10.1038/ng.130
Biondich PG, Downs SM, Carroll AE, et al. Shortcomings in infant iron deficiency screening methods. Pediatrics 2006; 117: 290-4; http://dx.doi.org/10.1542/peds.2004-2103
Bogen DL, Duggan AK, Dover GJ, et al. Screening for iron deficiency anemia by dietary history in a high risk population. Pediatrics 2000; 105: 1254-9; http://dx.doi.org/10.1542/peds.105.6.1254
Lozoff B, Çorapci F, Burden MJ, et al. Preschool aged children with iron deficiency anemia show altered affect and behavior. J Nutr 2007; 137: 683-9
Oner N, Kaya Z, Türkyilmaz Z, et al. An unusual cause of iron deficiency anemia in a child with colonic lithobezoar: Case report and review of the literature. J Hematol 2012; 1: 28-31
Felt BT, Beard JL, Schallert T, et al. Persistent neurochemical and behavioral abnormalities in adulthood despite early iron supplementation for perinatal iron deficiency anemia in rats. Behav Brain Res 2006; 171: 261-70; http://dx.doi.org/10.1016/j.bbr.2006.04.001
Akman M, Cebeci S, Okur V, et al. The effects of iron deficiency on infants developmental test performance. Acta Paediatr 2004; 93: 1391-6; http://dx.doi.org/10.1111/j.1651-2227.2004.tb02941.x
Ortiz E, Pasquini JM, Thompson K, et al. Effect of manipulation of iron storage, transport, or availability on myelin composition and brain iron content in three different animal models. J Neurosci Res 2004; 77: 681-9; http://dx.doi.org/10.1002/jnr.20207
Grantham-McGregor S, Ani C. A review of studies on the effect of iron deficiency on cognitive development in children. J Nutr 2001; 131: 649-66S
Urrechaga E, Borque L, Escanero JF. Erythrocyte and reticulocyte parameters in iron deficiency and thalassemia. J Clin Lab Anal 2011: 25: 223-8; http://dx.doi.org/10.1002/jcla.20462
Dallman PR, Siimes MA. Percentile curves for hemoglobin and red cell volume in infancy and childhood. J Pediatr 1979; 94: 26-31; http://dx.doi.org/10.1016/S0022-3476(79)80344-3
Koerper MA, Dallman PR. Serum iron concentration and transferrin saturation in the diagnosis of iron deficiency in children: normal developmental changes. J Pediatr 1977; 91: 870-4; http://dx.doi.org/10.1016/S0022-3476(77)80879-2
Olivares M, Walter T, Cook JD, et al. Usefulness of serum transferrin receptor and serum ferritin in diagnosis of iron deficiency in infancy. Am J Clin Nutr 2000; 72: 1191-5
Punnonen K, Irjala K, Rajamaki A. Serum transferin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood 1997; 89: 1052-7
Brugnara C, Laufer MR, Friedman AJ, et al. Reticulocyte hemoglobin content(CHr):early indicator of iron deficiency and response to therapy. Blood 1994; 83: 3100-1
Dallman PR, Yip R, Oski FA. Iron deficiency and related nutritional anemias. In: Nathan DG, Oski Fa (eds) Hematology in infancy and childhood. Philadelphia: Saunders, 1993
Chaparro CM. Setting the stage for child health and development: prevention of iron deficiency in early infancy. J Nutr 2008; 138: 2529-33
Grant CC, Wall CR, Brewster D, et al. Policy statement on iron deficiency in preschool aged children. J Paediatr Child Health 2007; 43: 513-21; http://dx.doi.org/10.1111/j.1440-1754.2007.01128.x
Bopche AV, Dwivedi R, Mishra R, et al. Ferrous sulphate versus iron polymaltose for treatment of iron deficiency anemia in children. Ndian Pediatr 2009; 46: 883-5
Cogswell ME, Parvanta I, Ickes L, et al. Iron supplementation during pregnancy, anemia, and birth weight: a randomized controlled trial. Am J Clin Nutr 2003; 78: 773-81
Fishbane S, Kowalski EA. The comparative safety of intravenous iron dextran, iron saccharate, and sodium ferric gluconate. Semin Dial 2000; 13: 381-4; http://dx.doi.org/10.1046/j.1525-139x.2000.00104.x
Published
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. The Publication Agreement can be downloaded here, and should be signed by the Authors and sent to the Publisher when the article has been accepted for publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
- Authors are permitted to post their work online after publication (the article must link to publisher version, in html format)