Iron deficiency: Causes, Symptoms, Diagnosis, Therapy And Solutio

Tiredness and concentration problems are among the most noticeable symptoms of iron deficiency.

Tiredness, dizziness, palpitations, rapid increase in heart rate during exertion, sleep disorders, difficulty concentrating, and headaches. These are just a few of the many symptoms that iron deficiency can cause.

The body needs iron for blood formation and for a number of metabolic processes, such as supplying oxygen to the cells. Iron deficiency often occurs after heavy blood loss (e.g. after operations, blood donations, menstruation). Poor diet or illnesses can also be causes of iron deficiency. The body cannot form iron itself, so it is dependent on the supply of food. Iron deficiency can develop into iron deficiency anemia. This refers to a disease that does not allow adequate blood formation due to a persistent iron deficiency.

 

Iron deficiency at a glance

Type: defect

Causes:  blood loss, malnutrition

Symptoms: Fatigue, headache, dizziness

Diagnosis: the blood test

Therapy:       Dietary changes, iron supplements, iron infusions if needed

Frequency of iron deficiency

In Central Europe, women of childbearing age are particularly affected by iron deficiency anemia. Almost 90% of adult women do not consume enough iron on a daily basis. About every fifth adult woman has a problematic iron supply, and girls in puberty can also be affected.

On average, the deficiency disease affects about 10% of the population. In men, a deficiency tends to occur in old age, but young men (especially athletes) can also be affected. About 600 million people worldwide have iron deficiency anemia.

Dr. Christian Cebulla (Medical Director, State Hospital Mistelbach-Gänserndorf) first explains the most important functions of iron. He then shows possible causes as well as symptoms and treatment options for iron deficiency. (Vienna, June 18, 2020)

 

How does iron deficiency arise?

The iron in the body forms, among other things, the red blood pigment hemoglobin. If the body is undersupplied with iron, the hemoglobin concentration in the blood drops. The protein hemoglobin is vital for the body because it transports oxygen from the lungs to every single cell in the body. If the body receives too little iron, no hemoglobin can be formed, the oxygen supply is insufficient and the "classic" symptoms such as tiredness, headaches, etc. occur. Iron deficiency, therefore, describes a disproportion between the iron requirement and the iron actually supplied through food.

 

Iron is soaking up in the upper area of the small intestine. However, a maximum of 20% of the iron supplied can actually be absorbed. In the small intestine, it is transported to the bone marrow with the help of the transport protein substance "transferrin". Red blood cells (erythrocytes) are formed there, and iron that cannot be used acutely can be stored with the help of the iron storage protein ferritin or is absorbed by scavenger cells and excreted.

 

One speaks of iron deficiency anemia

 

Women if the hemoglobin concentration is below 12 g/dl.

 

In men, when the hemoglobin concentration falls below 13 g/dl in the blood.

 

There are 3-5 grams of iron in the body, in men and women after menopause only about 1 gram. The largest part is used for hemoglobin formation; about 500-1000 mg (men) and 300-400 mg (women) are stored. Women lose about 1-3 mg of iron daily during menstruation. With an average daily intake, however, the body can absorb a maximum of one-fifth, and the rest is excreted with the stool. Men should consume about 10 mg of iron daily and women 15 mg of iron through food.

 

The requirement is increased during pregnancy, so the mother-to-be should get a daily dose of 30 mg. If iron deficiency anemia is left untreated, it can lead to serious diseases, such as changes in the mucous membranes of the tongue, throat, and esophagus (Plummer-Vinson syndrome).

 

Causes of iron deficiency

Blood loss: chronic blood loss due to certain gastrointestinal diseases, polyps, carcinomas, intestinal ulcers, etc. Heavy blood loss during menstruation, due to surgery, or after frequent blood donation.

 

Low-iron diet: A deficiency results from a mismatch between actual intake and iron requirements. Daily iron requirements can be met with a balanced diet. Above all, people in special metabolic situations (pregnant women, breastfeeding women, children, and elderly people) need more iron than the usual daily dose.

 

The following groups of people most frequently exhibit iron deficiency:

 

1. Women (due to menstrual bleeding, pregnancy, and childbirth)

 

2. People after operations (blood loss)

 

3. Chronically ill (especially heart disease)

 

4. People with intestinal diseases (e.g. Crohn's disease with chronic blood loss)

 

5. Top athletes (especially women)

 

6. Affected people with rheumatoid diseases, cancer, or kidney diseases

 

7. Blood donors (when donating blood, the body loses about 250 mg of iron)

 

8. Elderly people

 

9. Vegetarians and vegans (who consume less iron due to not eating meat)

 

10. Growing children

 

11. Babies who are not breastfed (breast milk is a source of iron)

 

Course and symptoms of iron deficiency

An iron deficiency can gradually become noticeable. Symptoms such as headaches and lack of energy can sometimes occur for years without those affected thinking of iron deficiency. However, the iron deficiency often goes unnoticed for years and leads to anemia and a lack of red blood cells. The body cells are no longer sufficiently supplied with oxygen, resulting in tiredness, listlessness, headaches, lack of concentration, or iron deficiency anemia.

 

Diagnosis of iron deficiency

Iron deficiency anemia can be diagnosed by a laboratory blood test. For a comprehensive diagnosis, not only the iron content is used, but also the following important parameters:

 

Ferritin (iron storage protein): must be at least 30 μg/l. Ferritin is an important marker that shows iron deficiency even at a mild stage. However, the value can be "wrong" if e.g. B. there is inflammation or liver disease

 

Transferrin saturation (transferrin = iron transport protein) at least 15%: The proportion of iron-saturated transferrin molecules in the plasma is usually 16-45%. If this value is below 15%, the body does not produce enough red blood cells due to iron deficiency. For some patient groups such as B. heart patients, and sometimes also gynecological patients, the lower saturation value is 20%.

If inflammation is present, this value can drop sharply and does not definitively indicate an iron deficiency.

 

Hemoglobin concentration in the blood: in women at least 12 mg/dl, in men at least 13 mg/dl.

 

The aim now is to find the cause of iron deficiency. After all, iron deficiency or iron deficiency stores are always a symptom. In the course of treatment, a diagnostic clarification must therefore always be carried out. For this purpose, the doctor conducts a detailed discussion with the patient (anamnesis), e.g. whether he has had an operation, whether he is a blood donor, whether the iron deficiency may be due to improper diet, whether there are infections or heavy menstrual bleeding. The doctor must be able to be sure that there is no chronic blood loss (e.g. due to blood in the stool, hemorrhoids, or intestinal diseases). If there is a suspicion that the cause of the iron deficiency is insidious blood loss due to a stomach or intestinal disease, a gastroscopy (stomach examination) or colonoscopy (intestine examination) is performed.

 

Iron deficiency therapy

Iron deficiency anemia can develop if iron deficiency is left untreated. There are three treatment options to treat this:

 

1. Conscious nutrition

 

2. Administration of iron supplements

 

3. Iron infusions

 

Conscious Nutrition

In order to fill the iron stores, it is important to ensure that there is an adequate supply of iron. In order to replenish the iron reserves after illness, surgery, or severe blood loss, a long-term, conscious diet is required, which can be supported with the administration of iron tablets if necessary. Good sources of iron are meat, fish, whole grain products, eggs, and vegetables (spinach). Fresh green spices (thyme, parsley, marjoram) also contain plenty of iron. If there is a pronounced iron deficiency, it cannot be remedied with iron-containing foods alone.

 

Administration of iron supplements

There are a number of different preparations to choose from, which are dosed according to the severity of the iron deficiency. Ingestion can be problematic, leading to side effects in some sufferers. For example, nausea, constipation, diarrhea, or abdominal pain can occur. It should be noted, however, that iron supplements should be taken on an empty stomach. In combination with a meal, absorption may be reduced. Oral iron preparations should also not be administered in the case of inflammation, as absorption is more difficult in this case.

 

Iron infusions

Iron infusion is a way of quickly restoring iron reserves. The infusion is given through the vein. This also excludes possible side effects that can occur with oral administration. This form of iron substitution is particularly suitable for those affected who cannot tolerate oral iron supplements or for whom oral supplements are not sufficient. With new infusions, about 1000 mg of iron can be administered per infusion. This treatment is a good choice, especially for people who already have iron deficiency anemia.

 

What you can do if you have an iron deficiency

If you pay attention to a balanced, conscious diet, you usually cover your iron requirements with fresh food. It is beneficial to promote the absorption of iron with various foods. For example, you can drink a fruit juice rich in vitamin C with a meal or eat citrus fruits for dessert. Avoid coffee, tea, or red wine with meals; the tannins they contain inhibit iron absorption.