Iron deficiency anemia is a condition in which blood lacks adequate healthy red blood cells. Red blood cells carry oxygen to the body’s tissues. Anemia is due to insufficient iron. Without enough iron the body cannot produce enough of a substance called hemoglobin, which enables the red blood cell to carry oxygen. A blood test called a complete blood count is used to diagnose anemia. Additional testing, including iron level, ferritin and total iron binding capacity is also performed.

Initially, anemia can be so mild that it goes unnoticed. As the body becomes more deficient in iron the signs and symptoms become more intense. In early iron deficiency anemia, patients most commonly experience fatigue.

  • Fatigue
  • Pale skin
  • Weakness
  • Shortness of breath
  • Chest pain
  • Frequent infections
  • Dizziness or lightheadedness
  • Headache
  • Cold hands and feet
  • Brittle nails
  • Hair loss
  • Soreness or swelling of the tongue
  • Fast heartbeat
  • Unusual cravings for ice, dirt or starch
  • Poor appetite
  • Tingling or a crawling feeling in your legs

Causes of anemia include blood loss, lack of iron in the diet, inability to absorb iron, and pregnancy. The body absorbs iron from the foods we eat. If we consume too little iron over time we become iron deficient. Women with heavy periods are at risk for iron deficiency anemia because they loss blood during menstruation. Slow chronic blood loss such ass from a peptic ulcer, helicobacter pylori, hiatal hernia, a colon polyp or colorectal cancer can cause iron deficiency anemia.

Bariatric surgery patients are at increased risk for developing iron deficiency anemia for a number of reasons, including decreased production of hydrochloric acid in the stomach, reduced intake of iron rich foods (meats, enriched grains and vegetables), bypassing of the iron absorption sites of the duodenum and jejunum.

Mild iron deficiency usually does not cause complications. However, if left untreated, it may lead to health problems including an enlarged heart, congestive heart failure, rapid or irregular heart beat –arrhythmia, or premature birth and low birth weight babies.

The choice of iron preparation depends on the acuity of illness as well as the ability of the patient to tolerate oral preparations. Because oral iron is inexpensive and effective when taken as prescribed it is the first line therapy. Intravenous iron is effective for those unresponsive or intolerant of oral iron.

Frequent gastrointestinal side effects range from mild constipation, diarrhea, metallic taste and thick green stools. Ferrous sulfate is associated with significantly higher risk for GI side effects. It is absorbed in the distal duodenum and proximal jejunum, where iron transport proteins are. Accordingly, enteric coated or sustained release capsules which release iron further down in the intestinal tract are insufficient sources of iron.

Iron should not be given with food because phosphates, phytates (in nuts and beans), tannins (in tea and nuts) bind to the iron impair its absorption. Calcium supplements and antibiotics such as Quinolones and Tetracycline also inhibit the absorption of iron. Ingestion of iron with dietary fiber, tea, coffee, eggs or milk can inhibit the absorption of iron. Iron should also be given 2 hours before or 4 hours antacids. Vitamin C supplements can increase iron absorption.

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