Iron deficiency anemia

Abstract

Iron deficiency anemia (IDA) is a global health problem affecting more than 1.2 billion individuals worldwide. The disease affects many different age groups: including children, pregnant women and the elderly. There are many sources of total body iron deficiency, also called absolute iron deficiency, including increased requirements, blood loss, pathological defective absorptions and genetic causes. Iron homeostasis is maintained by adaptive mechanisms on the hepcidin-ferroportin axis, iron responsive protein and iron responsive elements machinery. Signs and symptoms of iron deficiency are non-specific, variable and often easily overlooked. Iron deficiency is associated with decreased cognition, delay in motor development, decrease in physical performance and quality of life. The diagnosis may be made by measurement of hemoglobin, iron and ferritin levels. Alternatively, bone marrow aspiration and a biopsy to evaluate iron stores may be needed in certain situations to confirm the diagnosis. Overlapping inflammatory conditions may cause anemia and creating a challenging diagnosis. Treatment involves oral or intravenous/parenteral iron formulations and should take into consideration several disease and patient related factors. In the elderly age group diagnosed with IDA, an intensive gastrointestinal, genito-urological and gynecological work up need to be completed to identify the source of blood loss. Ongoing efforts and clinical trials are attempting to optimize the repletion of iron based on the physiology of hepcidin control and reduction in adverse effects of oral therapy. This chapter will review the recent updates on the pathogenesis, diagnosis and management of IDA.