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Iron deficiency anemia is the most common form of anemia. Iron is an essential component of the hemoglobin molecule: without iron the bone marrow is unable to produce hemoglobin. The red cell count falls and those which do enter circulation are smaller than normal (microcytic) and lacking in hemoglobin, hence they are pale (hypochromic).
The deficiency of iron may be absolute (there is no iron available for the production of hemoglobin - this is true iron deficiency anemia) or relative (the iron is present in storage in the marrow but other reasons prevent its incorporation into red blood cells).
Causes & Development
The average amount of iron in the average adult male is 4gm and in the average adult female 2.5gm. The normal North American diet contains approximately 15-20mg of iron per day. Most is present in meat and green vegetables; approximately 1.0mg is absorbed each day and just about an equal amount is lost in feces and sweat. As a result, the average adult's iron intake is in delicate balance, but is of little consequence as there is slightly more iron absorbed than lost and a store of iron is gradually accumulated. If, for some reason, the rate of iron loss increases, these stores can be depleted and an absolute iron deficiency develops. Such a deficiency requires large doses of supplemental iron to resupply the body stores and sufficient monitoring to prevent iron overload.
Causes of iron deficiency include:- Diet - uncommon except in children
- Failure to absorb
- Increased utilization (for example pregnancy, adolescent growth)
- Atransferrinemia
- Failure to utilize (for example lead poisoning, chronic diseases)
- Blood loss.
Chronic blood loss is the most common cause of iron deficiency anemia. It must be remembered that anemia in iron deficiency develops slowly. The type and severity of the anemia varies with time. The development stages are:- Depletion of iron stores, decreased ferritin levels, no anemia
- Increased transferrin levels, no anemia
- Fall in serum iron, no anemia
- Development of normocytic, normochromic anemia
- Development of microcytic, hypochromic anemia.
Signs & Symptoms
Along with those mentioned below, symptoms often include malaise (a vague feeling of physical discomfort or uneasiness).
Diagnosis & Tests
Laboratory Diagnosis of Iron Deficiency
Routine procedures. Hgb, Hct and RBC count are all decreased. The degree of decrease depends upon the length of time the marrow has been without sufficient supplies of iron. Because marrow can continue to produce empty cells, the red cell number will not be proportionately as low as the Hgb and Hct values. Serum ferritin is a better measure of body iron stores than any value in the complete blood count, as it will begin dropping long before other signs appear in the blood.
Indices. MCV - decreased, MCH - decreased, MCHC - decreased. The MCHC is the last to become lowered because as the marrow becomes more and more depleted of iron it produces smaller cells with a smaller amount of hemoglobin in each in an attempt to keep the concentration of hemoglobin in each normal. The RDW is increased, reflecting the anisocytosis characteristic of iron deficiency.
Treatment & Prevention
Treatment depends on the underlying cause. Iron deficiency anemia is usually easy to resolve; an anemia that does not respond as expected may require the help of a hematologist and additional testing.
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Signs, symptoms & indicators of Anemia (Iron deficiency):
Conditions that suggest Anemia (Iron deficiency):
Risk factors for Anemia (Iron deficiency): | | | | | Autoimmune |  Gluten Sensitivity / Celiac Disease | Anemia is a frequent presentation of celiac disease. In one study, 200 consecutive patients of a hematology clinic were screened for antigliadin and antiendomysial antibodies. Patients with both positive titers underwent intestinal biopsy, and in 10 patients (5%), results were positive for celiac disease. The prevalence increased to 8.5% if the patients with macrocytic anemia and the patients with bleeding who responded to iron therapy were excluded. |
Ulcerative Colitis
 Crohn's Disease |
Digestion |
Gastrointestinal Bleeding| | People with long-term bleeding that tends to occur in small amounts or intermittently may develop symptoms of anemia, such as tiring easily and looking unnaturally pale. |
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Nutrients |
Copper Deficiency| | Copper deficiency, due to its effects on ceruloplasmin, may cause an iron-deficiency anemia which can only be corrected with copper supplementation as it impairs iron absorption, reduces heme synthesis and increases iron accumulation in storage tissues. [J Orthomol Med 4( 2): pp.99-108, 1989] |
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Organ Health |
Chronic Renal Insufficiency| | Patients with CRF often suffer from complications such as anemia, which occurs when failing kidneys no longer produce sufficient erythropoietin, a hormone that stimulates the production of oxygen-carrying red blood cells (RBCs). In addition to decreased levels of RBCs, patients often begin to accumulate toxic metabolites, which shorten the lifespan of existing RBCs. |
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Symptoms - Reproductive - General |
(Much) recent breastfeeding| | Breast-feeding a baby can deplete iron stores. |
Being in late/being in mid-/being in early pregnancy| | Pregnancy can deplete iron stores. |
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Tumors, Benign |
Fibroids| | Submucous fibroids are the type that most commonly cause significant problems; even small tumors located in or bulging into the uterine cavity may cause heavy bleeding, anemia, pain, infertility or miscarriage. |
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Tumors, Malignant |
Non-Hodgkin's Lymphoma |
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Anemia (Iron deficiency) suggests the following may be present: | | | | | Hormones | Counter-indicators:
 Hypothyroidism| | If anemia is identified as a problem then the likelihood of Hypothyroidism is reduced. Therefore, it is wise to rule out anemia first, because both can contribute to similar symptomology. Of course, it is not impossible for both to occur simultaneously, but this is less likely. |
Low Adrenal Function / Adrenal Insufficiency| | If anemia is identified as a problem then the likelihood of low adrenal function is reduced. Therefore, it is wise to rule out anemia first, because both can contribute to similar symptomology. Of course, it is not impossible for both to occur simultaneously, but this is less likely. |
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Immunity |
Counter-indicators:
Chronic Fatigue / Fibromyalgia Syndrome| | If anemia is identified as a problem then the likelihood of CFS is reduced. Therefore, it is wise to rule out anemia first, because both can contribute to similar symptomology. Of course, it is not impossible for both to occur simultaneously, but this is less likely. |
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Nutrients |
 Iron Requirement |
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Recommendations and treatments for Anemia (Iron deficiency): | | | | | Botanical |  Chlorella |
Diet |
 Caffeine/Coffee Avoidance| | Research has shown that drinking coffee causes a significant loss of several vitamins and minerals, including vitamins B and C, calcium, iron, and zinc. |
Not recommended:
 Therapeutic Fasting| | Fasting should be avoided in severe cases of iron deficiency anemia. |
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Homeopathy |
Ferrum phosphoricum Cell Salt |
Lab Tests/Rule-Outs |
 CBC (Complete Blood Count) Test
Test Iron Stores (Ferritin) |
Mineral |
Iron| | Iron supplementation, with as much as 200mg of elemental iron per day, is the obvious therapy for treating and preventing the recurrence of iron deficiency anemia. |
Molybdenum| | Molybdenum may help prevent anemia by helping mobilize iron, provided there are sufficient iron stores. |
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Vitamins |
Vitamin C (Ascorbic Acid)| | It has been well established that better iron absorption occurs from both plant and animal sources when vitamin C is taken at the same time, whether from foods or as a supplement. 75mg of vitamin C in a meal will cause about a six-fold increase in the absorption of heme iron. It appears that vitamin C enhances non-heme iron absorption in individuals with low iron status, but does not increase iron status unnecessarily in iron-replete individuals. [Effect of ascorbic acid on iron absorption from different types of meals. Hum Nutr: Appl Nutr,1986 40A: pp.97-113] |
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KEY | | Weak or unproven link | | | Strong or generally accepted link | | | Proven definite or direct link | | | Strongly counter-indicative |  | | Very strongly or absolutely counter-indicative | | | May do some good | | | Likely to help | | | Highly recommended | | | May have adverse consequences |
GLOSSARY
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Adrenal Insufficiency (Adrenal Exhaustion, Low Adrenal Function)
A condition in which the adrenal gland is compromised in its production of epinephrine, norepinephrine, cortisol, corticosterone or aldosterone. Symptoms include primarily fatigue, weakness, decreased appetite with ensuing weight loss, as well as nausea, vomiting, abdominal pain, diarrhea or constipation, or increased pigmentation of the skin. Cortical insufficiency (low or no corticosteroids) produces a more serious condition called Addison’s Disease, characterized by extreme weakness, low blood pressure, pigmentation of the skin, shock or even death.
Anemia (Anaemia, Anemias)
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Antibody (Antibodies)
A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Biopsy
Removal of a sample of tissue from a living being for diagnosis. A pathologist later uses a microscope to look for certain features, such as cancer cells, in the sample. A fine-needle aspiration biopsy involves inserting a thin needle to remove a small amount of tissue, sometimes using CT or ultrasound to guide the needle. A core biopsy involves obtaining a sample of tissue with a thick needle or by inserting a thin, lighted tube (laparoscope) into a small incision in the abdomen. Another biopsy method is to remove tissue during an operation.
Calcium
The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. The body also needs calcium to carry nerve signals, keep the heart functioning, contract muscles, clot blood and maintain healthy skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.
Celiac Disease (Gluten Sensitivity)
A digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten. Common symptoms include diarrhea, increased appetite, bloating, weight loss, irritability and fatigue. Gluten is found in wheat (including spelt, triticale, and kamut), rye, barley and sometimes oats.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Chronic Fatigue Syndrome (CFS, Chronic Fatigue)
A disorder of unknown cause that lasts for prolonged periods and causes extreme and debilitating exhaustion as well as a wide range of other symptoms such as fever, headache, muscle ache and joint pain, often resembling flu and other viral infections. Also known as Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS), Chronic Epstein-Barr Virus (CEBV), Myalgic Encephalomyelitis (ME), "Yuppy Flu" and other names, it is frequently misdiagnosed as hypochondria, psychosomatic illness, or depression, because routine medical tests do not detect any problems.
Complete Blood Count (CBC)
A set of measurements that are generally determined by specially designed machines that analyze the different components of blood in less than a minute. The values generally included are:- White blood cell count (WBC). The number of white blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4,300 and 10,800 cells per cubic millimeter. This can also be referred to as the leukocyte count and can be expressed in international units as 4.3 - 10.8 x 10^9 cells per liter.
- Automated white cell differential. A machine-generated percentage of the different types of white blood cells, usually split into granulocytes, lymphocytes, monocytes, eosinophils, and basophils.
- Red cell count (RBC). The number of red blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4.2 - 5.9 million cells per cubic millimeter. This can also be referred to as the erythrocyte count and can be expressed in international units as 4.2 - 5.9 x 10^12 cells per liter.
- Hemoglobin (Hb). The amount of hemoglobin in a volume of blood. Normal range for hemoglobin is different between the sexes and is approximately 13 - 18 gm/dl for men and 12 - 16 for women (international units 8.1 - 11.2 millimoles/liter for men, 7.4 - 9.9 for women).
- Hematocrit (Hct). The ratio of the volume of red cells to the volume of whole blood. Normal range for hematocrit is different between the sexes and is approximately 45 - 52% for men and 37 - 48% for women.
- Mean cell volume (MCV). The average volume of a red cell. This is a calculated value derived from the hematocrit and red cell count. Normal range is 86 - 98 femtoliters.
- Mean cell hemoglobin (MCH). The average amount of hemoglobin in the average red cell. This is a calculated value derived from the measurement of hemoglobin and the red cell count. Normal range is 27 - 32 picograms.
- Mean cell hemoglobin concentration (MCHC). The average concentration of hemoglobin in a given volume of red cells. This is a calculated volume derived from the hemoglobin measurement and the hematocrit. Normal range is 32 - 36%.
- Red cell distribution width (RDW). A measurement of the variability of red cell size. Higher numbers indicate greater variation in size. Normal range is 11 - 15.
- Platelet count. The number of platelets in a volume blood. Platelets play a vital role in blood clotting. Normal range varies slightly between laboratories but is in the range of 150,000 - 400,000 per cubic millimeter (150 - 400 x 10^9 per liter).
Copper
An essential mineral that is a component of several important enzymes in the body and is essential to good health. Copper is found in all body tissues. Copper deficiency leads to a variety of abnormalities, including anemia, skeletal defects, degeneration of the nervous system, reproductive failure, pronounced cardiovascular lesions, elevated blood cholesterol, impaired immunity and defects in the pigmentation and structure of hair. Copper is involved in iron incorporation into hemoglobin. It is also involved with vitamin C in the formation of collagen and the proper functioning in central nervous system. More than a dozen enzymes have been found to contain copper. The best studied are superoxide dismutase (SOD), cytochrome C oxidase, catalase, dopamine hydroxylase, uricase, tryptophan dioxygenase, lecithinase and other monoamine and diamine oxidases.
Gram (gm, gms, Gramme, Grammes, Grams)
A metric unit of weight, there being approximately 28 grams in one ounce.
Heme
The deep red iron-containing hemoglobin found in foods of animal origin.
Hemoglobin
The oxygen-carrying protein of the blood found in red blood cells.
Hormones (Hormone)
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Hypothyroidism (Hypothyroid)
Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.
Iron
An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.
Kidneys (Kidney, Renal)
Bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage. The kidneys are sophisticated reprocessing machines, each day handling about 50 gallons of blood to sift out about half a gallon of waste products and extra water. The waste and extra water become urine, which flows to the bladder through tubes called ureters. The actual filtering occurs in tiny units inside the kidneys called nephrons. Every kidney has about a million nephrons. In a nephron, a glomerulus -- which is a tiny blood vessel, or capillary -- intertwines with a tiny urine-collecting tube called a tubule. A complicated chemical exchange takes place, as waste materials and water leave your blood and enter your urinary system. The kidneys recycle chemicals such as sodium, phosphorus, and potassium and thus regulate their levels. Renal: Pertaining to the kidneys.
Leiomyomas (Fibroids, Fibromyoma, Leiomyoma, Myofibroma)
Benign tumors of the involuntary muscle. An encapsulated tumor made up of disorganized and irregular connective tissue. The most common of these is the "fibroid" tumor that develops in many women. It is really a leiomyoma of the uterus.
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Malaise
A vague feeling of bodily discomfort, as at the beginning of an illness. A general sense of depression or unease.
Metabolite (Metabolites)
Any product (foodstuff, intermediate, waste product) of metabolism.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Mineral (Minerals)
Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.
Miscarriage (Miscarriages, Spontaneous Abortion)
The expulsion of a fetus before it is able to survive outside of the womb.
Molybdenum
An essential trace element. It helps regulate iron stores in the body and is a key component of at least three enzymes: xanthine oxidase, aldehyde oxidase and sulfite oxidase. These enzymes are involved with carbohydrate metabolism, fat oxidation and urine metabolism. The average adult has about 9mg of molybdenum concentrated mostly in the liver, kidney, adrenal glands, bones and skin. Molybdenum deficiencies are associated with esophageal cancer, sexual impotency and tooth decay.
Red Blood Cell (Erythrocyte, Erythrocytes, RBC, Red Blood Cells)
Any of the hemoglobin-containing cells that carry oxygen to the tissues and are responsible for the red color of blood.
Serum
The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.
Tumor (Tumors, Tumour, Tumours)
An abnormal growth of tissue resulting from uncontrolled, progressive multiplication of cells and serving no physiological function; a neoplasm. Literally, a swelling; in the past the term has been used in reference to any swelling of the body, no matter what the cause. However, the word is now being used almost exclusively to refer to a neoplastic mass, and the more general usage is being discarded.
Uterus (Uterine)
The part of the female reproductive system specialized to allow the implantation, growth and nourishment of a fetus during pregnancy.
Vitamin C (Ascorbic Acid)
A water-soluble antioxidant vitamin essential to the body's health. When bound to other nutrients, for example calcium, it would be referred to as "calcium ascorbate". As an antioxidant, it inhibits the formation of nitrosamines (a suspected carcinogen). Vitamin C is important for maintenance of bones, teeth, collagen and blood vessels (capillaries), enhances iron absorption and red blood cell formation, helps in the utilization of carbohydrates and synthesis of fats and proteins, aids in fighting bacterial infections, and interacts with other nutrients. It is present in citrus fruits, tomatoes, berries, potatoes and fresh, green leafy vegetables.
Zinc
An essential trace mineral. The functions of zinc are enzymatic. There are over 70 metalloenzymes known to require zinc for their functions. The main biochemicals in which zinc has been found to be necessary include: enzymes and enzymatic function, protein synthesis and carbohydrate metabolism. Zinc is a constituent of insulin and male reproductive fluid. Zinc is necessary for the proper metabolism of alcohol, to get rid of the lactic acid that builds up in working muscles and to transfer it to the lungs. Zinc is involved in the health of the immune system, assists vitamin A utilization and is involved in the formation of bone and teeth.
Last updated: Nov 14, 2009
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