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Why iron deficiency often goes unnoticed

Why iron deficiency often goes unnoticed

People with iron deficiency are mostly asymptomatic and are detected only during routine laboratory evaluation
Photo by Suyash Chandra

In 2017, when assistant professor Shilpi Saha from Mangaluru, Karnataka, conceived her first child, she was found to be anemic. The 35-year-old, who currently teaches at the city’s Manel Srinivas Nayak Institute of Management, told Happiest Health over phone that her hemoglobin level went as low as 9 gram/deciliter during the pregnancy — her first.

The standard hemoglobin range is generally defined as 13.2 to 16.6 grams (g) of hemoglobin per deciliter (dL) of blood for men and 11.6 to 15 g/dL for women. Saha’s hemoglobin level was low since she conceived her child and it remained so till she was in the eighth month of her pregnancy. The doctor told Saha, who gave birth to her daughter in October 2017, that she was having iron-deficiency anemia.

Initially, the obstetrician and gynecologist gave her iron supplements. “However, it did not help. I developed constipation because of the supplements. Then I started eating chicken liver and vegetables rich in iron. It helped a lot and my hemoglobin level reached 11g/dL,” Saha said.

Causes of iron-deficiency anemia

Pregnancy is one of the common causes of iron deficiency that leads to anemia. “Along with pregnancy, the other causes of iron deficiency include not getting enough iron in your diet, chronic blood loss and excessive exercise. Some people become iron deficient if they are unable to absorb iron,” Dr Brunda MS, consultant, internal medicine, Aster CMI Hospital, Bengaluru, told Happiest Health.

Experts say iron deficiency occurs due to increased demand and decreased supply. “Iron requirement increases during periods of pregnancy and growth spurt. Demand also increases during physiological losses such as in menstrual cycles. Iron deficiency could also be due to helminthic infections such as hook worm or secondary to chronic gastrointestinal blood loss, H pylori-associated chronic gastritis, use of certain drugs like aspirin, steroids and anticoagulants, gastrointestinal malignancies and malabsorption disorders as in celiac disease,” said Dr Roopashree YP, associate consultant, internal medicine, Apollo Hospitals, Bengaluru.

Doctors generally investigate for chronic blood loss among men (of any age group) and post-menopausal women to find out iron deficiency anemia among them.

“Iron deficiency can also be seen in certain conditions such as infection, inflammation and liver disorders where blood transport is affected because of increased hepcidin,” said Dr Roopashree.

Iron deficiency – hard to detect?

Doctors say most cases like Saha’s, who was found to be having iron-deficiency anemia only after she went through her pregnancy-related tests, go undetected. “Most of the times people with iron deficiency are asymptomatic and are detected only during routine laboratory evaluation,” said Dr Roopashree.

There are three stages of iron deficiency. The first is when the iron stores are depleted. The second is the iron-deficient erythropoiesis or absolute iron deficiency anemia — which still cannot be detected in routine evaluation without complete blood cell count or hemogram. The third and final stage of iron deficiency anemia is low hemoglobin. Many of the young patients remain asymptomatic until severely anemic.

Symptoms of iron deficiency

However, there are several tell-tale signs of iron deficiency. Doctors say these are:

  • Extreme fatigue
  • Weakness
  • Irritability
  • Pale skin
  • Chest pain, fast heartbeat or shortness of breath
  • Headache, dizziness or light-headedness
  • Cold hands and feet
  • Inflammation or soreness of your tongue
  • Brittle nails

Iron and its importance

To keep the body replenished with adequate amount of iron, it is important to understand what is iron and its various components.

“Iron is an essential mineral that the body needs for growth and development. The human body uses iron to make hemoglobin, a protein in the red blood cells that carries oxygen from the lungs to all parts of the body, and myoglobin, a protein that provides oxygen to muscles. Also, iron is essential to make some hormones in our body,” said Dr Brunda.

“Our body cannot make enough healthy oxygen-carrying red blood cells when there is a deficit of iron content. It can cause anemia. Also, without enough iron, there won’t be enough red blood cells to transport oxygen, which leads to fatigue.”

Food sources for iron

Eating the right food is the key to keeping iron deficiency at bay, say doctors. Animal foods that contain hemoglobin (such as red meats, fish and poultry) are rich in iron. Iron from animal sources is known as heme and iron from plants is known as non-heme.

The main dietary sources of non-heme iron are dark leafy vegetables, beans, lentils, tofu and fortified breakfast cereals.

“The heme iron has greater bioavailability than the non-heme. Foods rich in vitamin C help in increasing iron absorption and certain foods like vegetables containing phytates and phosphates and tannin in tea, coffee reduce iron absorption,” said Dr Roopashree.

Doctors recommend that vegetarians should eat iron-rich lentils (like beans and peas), tofu, soybeans, nuts and seeds (like pumpkin, sesame, flaxseeds, cashews and pine nuts), vegetables (like spinach and kale or leaf cabbage), tomatoes, potatoes and mushrooms, fruits (like prunes, olives, mulberries), whole grains (like oats) and coconut milk.

When to see a doctor?

If a person is experiencing unexplained bouts of tiredness, dizziness, weakness, or other symptoms, they should speak with a doctor. “Doctors will be able to diagnose whether someone has anemia or not. They will also investigate the root cause and suggest ways to prevent it from happening,” said Dr Brunda.  “To treat iron deficiency anemia, doctors generally recommend people to take iron supplements. Treatment includes having iron tablets on an empty stomach and iron tablets with vitamin C.”

Doctors recommend that iron deficiency can be cured by increasing the intake of dietary foods rich in iron and oral iron supplementation. “Oral iron is best taken between meals when it is best absorbed,” said Dr Roopashree. “Treatment should be continued till iron stores are replenished, which might take six to nine months. Adherence to the treatment is extremely important. Intravenous iron infusion — a method of delivering iron by infusion with a needle into a vein — is recommended when the person is not able to tolerate oral iron or has malabsorption disorders. Blood transfusion is required in severely anemic people.”

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