Causes of Anemia, Iron-Deficiency
Anemia, Iron-Deficiency Causes: Book Excerpts
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Iron deficiency anemia:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Iron deficiency anemia may result from:
❑ inadequate dietary intake of iron (less than 1 to 2 mg/day), such as in prolonged unsupplemented breast-feeding or bottle-feeding of infants or during periods of stress such as rapid growth in children and adolescents
❑ iron malabsorption, such as in chronic diarrhea, partial or total gastrectomy, chronic diverticulosis, and malabsorption syndromes, such as celiac disease and pernicious anemia
❑ blood loss secondary to drug-induced GI bleeding (from anticoagulants, aspirin, and steroids) or due to heavy menses, hemorrhage from trauma, GI ulcers, esophageal varices, or cancer
❑ pregnancy, which diverts maternal iron to the fetus for erythropoiesis
❑ intravascular hemolysis-induced hemoglobinuria or paroxysmal nocturnal hemoglobinuria
❑ mechanical erythrocyte trauma caused by a prosthetic heart valve or vena cava filters.
A common disease worldwide, iron deficiency anemia affects 10% to 30% of the adult population of the United States. It occurs most commonly in premenopausal women, infants (particularly premature or low-birth-weight neonates), children, and adolescents (especially girls). Persons who are at increased risk for iron deficiency include those of low socioeconomic status who don’t get a well-balanced diet that includes iron-rich foods.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Iron deficiency anemia:
Causes
(Handbook of Diseases)
Iron deficiency anemia may result from:
❑ inadequate dietary intake of iron (less than 2 mg/day) — for example, during prolonged, unsupplemented periods of breast- or bottle-feeding (not eating solid foods after age 6 months) and during periods of stress, such as rapid growth in children and adolescents
❑ iron malabsorption, as in chronic diarrhea, partial or total gastrectomy, and malabsorption syndromes such as celiac disease
❑ blood loss secondary to drug-induced GI bleeding (from anticoagulants, aspirin, or steroids) or due to heavy menses, hemorrhage from trauma, a GI ulcer, cancer, or bleeding varices
❑ pregnancy, which diverts maternal iron to the fetus for erythropoiesis
❑ intravascular hemolysis-induced hemoglobinuria or paroxysmal nocturnal hemoglobinuria
❑ mechanical erythrocyte trauma caused by a prosthetic heart valve or vena cava filters.
Iron deficiency anemia is most common in premenopausal women, infants (particularly premature and low-birth-weight infants), children, and adolescents (especially girls).
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Source: Handbook of Diseases, 2003
Iron Deficiency Anemia:
Iron Deficiency Anemia - risk factors
(The 5-Minute Pediatric Consult)
- Low socioeconomic status
- Certain ethnic groups (such as southeast Asian) may be at increased risk due to dietary practices.
Iron Deficiency Anemia - pathophysiology
- Iron is required for oxygen transport by hemoglobin.
- Iron is absorbed primarily in the duodenum.
- Iron deficiency develops because of an inadequate supply or increased demand for iron, or a combination of these.
- Sequential stages of iron deficiency:
- Depletion of iron stores: Reflected by low serum ferritin and absent bone marrow stores (Prussian blue staining)
- Iron-deficient erythropoiesis: Near-normal number of red blood cells produced, but they have abnormal hemoglobin synthesis with wide distribution in RBC size
- Iron deficiency anemia: Microcytosis evident
Iron Deficiency Anemia - etiology
- Causes of inadequate supply include dietary deficiency and malabsorption:
- Dietary deficiency in infants and young children results from introduction of cow’s milk prior to age 12 months, exclusive breast-feeding beyond age 6 months without iron supplementation, and excessive cow’s milk intake (>24 oz/d).
- Malabsorption results from surgical resection of intestine, celiac disease
- Certain foods impair iron absorption (tannins in tea and coffee, phytates).
- Causes of increased demand include rapid growth and blood loss:
- Periods of rapid growth include infancy (especially low-birth-weight infants) and adolescence.
- GI blood loss is most common and includes cow’s milk enteropathy (seen in infants), inflammatory bowel disease (IBD), and bleeding from Meckel diverticulum.
- Other etiologies of blood loss include perinatal loss, menorrhagia, pulmonary hemosiderosis, and hematuria.
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Source: The 5-Minute Pediatric Consult, 2008
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