Iron is one of the essential minerals needed to carry out the body’s vital functions. One of the most important and basic functions of iron, as part of haemoglobin, is transporting oxygen to cells in the body. Iron deficiency is defined as a decreased amount of total body iron stores and, depending on the degree of reduction, iron deficiency can be mild, moderate, or severe.
Iron is an integral part of hemoglobin. If the iron supply is low, the hemoglobin production also decreases, resulting in a reduced number of red blood cells. This condition is called iron deficiency anemia. According to WHO (World Health Organization), anemia is a condition in which the number of red blood cells or the hemoglobin concentration within them is lower than the normal amount.
Anemia has been a serious global health problem over the past few years. It is most prevalent in young children and pregnant females. According to WHO, 42 percent of children under the age of 5 years and 40 percent of pregnant females are anaemic worldwide. Iron deficiency is a common nutrition deficiency prevalent in developing and developed countries. Read on to learn about causes, types, low ferritin symptoms, and iron sources.
In general, there are three major types of anaemia based on the size of red blood cells.
- Microcytic anemia is the type of anaemia where red blood cells are smaller than normal, while microcytic, hypochromic anemia describes the type of anemia where the red blood cells (RBCs) are smaller than the normal size of RBCs and have decreased red colour. It is the most common type of anaemia. Prominent microcytic anemia causes include iron-deficiency anemia and thalassemia.
- Normocytic anaemia is the type of anaemia where red blood cell size is normal but low in concentration. Such a type of anaemia is associated with chronic diseases or kidney disease.
- Macrocytic anaemia is the type of anaemia where the red blood cell size is larger than normal. Pernicious anaemia and anaemia related to alcoholism are the causes of macrocytic anaemia.
The most common iron deficiency anemia causes in developing countries are malnutrition and poor dietary intake. The causes of iron deficiency can be broadly classified into two categories. One is the increased need for iron, and the other is the reduced iron intake/absorption.
The body’s increased demand for iron may be part of the development, blood loss (Hemorrhagic anemia), pregnancy, infections, inflammatory bowel disease, or blood donations. Women with gynaecological diseases or having heavy menstrual flow are at greater risk for developing iron deficiency anemia. Pregnant and lactating women, with iron RDA of 27 mg/day, have higher iron needs than non-pregnant women, with iron RDA of 15-18 mg/day. However, most women consume a diet lacking in heme-iron, but adequate in non-heme iron that is absorbed poorly in the body.
Genetic disorders like thalassemia and sickle cell disease can cause anaemia, aggravating the health condition. Moreover, bone marrow diseases that suppress red cell production, chronic renal failure, rheumatoid arthritis, and tuberculosis, among many other diseases, are some of the causes of developing anaemia.
Hemolytic anemia causes iron deficiency anemia as well. It is the type of anaemia in which red blood cells rupture and become dysfunctional. Hemolytic anemia is usually hereditary but this type of destruction may also happen to normal red blood cells due to certain diseases or medications.
The lack of iron-containing foods in the diet is one of the major reasons for iron deficiency. In a diet of 10-15 mg of dietary iron, only about 1-3 mg/day is absorbed. Hence, optimizing diet according to needs is necessary. Decreased iron absorption in the body can also be due to various reasons, such as taking certain medications or food items that might inhibit the absorption of iron from the diet.
People often want to know how low can hemoglobin go before death. Generally, hemoglobin level of less than 6.5 gm/dL is thought to be life-threatening. The onset of this condition is characterized by mild symptoms that may go unnoticed. But as the body becomes more deficient in iron, the symptoms worsen and may prompt the affected person to consult a healthcare provider.
Iron deficiency anaemia develops slowly because it takes several months for the body’s iron stores to deplete completely. Symptoms may not appear in the beginning, but as the disease progresses, the symptoms become evident. Some of the general hemoglobin low symptoms include the following:
- Extreme Fatigue
- Low body temperature, cold hands, and feet
- Pale or yellow skin
- Rapid or irregular heartbeat
- Shortness of breath or chest pain
- Brittle nails
- Developing cravings for non-food items, such as ice, dirt, chalk, paper, etc
- Inflammed tongue
- Emotional instability
Children under the age of 5 years are at a higher risk of developing anemia. The 5 signs and symptoms to check if a child suffers from this deficiency include:
- Overall lack of energy and fatigue
- Pale skin due to low haemoglobin levels
- Brittle nails, redder than the normal tongue, or cracks on the side of the mouth
- Poor appetite
- Craving non-food items, such as ice, dirt, paint, etc.
Ferritin and iron are two different entities. Iron is a mineral while ferritin is a protein that stores iron, releasing it when the body requires it. Most doctors order a ferritin test if they suspect the patient experiencing an iron deficiency or overload.
A ferritin test measures the amount of ferritin in the blood. Low ferritin in the blood means low iron stores in the body and vice versa. Low ferritin symptoms are similar to iron deficiency symptoms.
- Chronic headaches
- Ringing in ears
Iron absorption greatly depends on the food type and its preparation method.
There are two types of iron found in food: heme iron and non-heme iron. Heme iron is an essential component of the red blood cells that transports oxygen in the body. This type of iron is mainly found in animal-based products. Non-heme iron is found in plant-based products, but the body does not absorb non-heme iron as well as heme iron.
Heme iron is the organic form of iron found in:
- Red meat (beef, mutton, lamb, veal)
- Organ meats (liver, kidney)
- Fish: (sardines, salmon, tuna)
The absorption rate of non-heme iron is lower than heme iron. Its absorption depends on the presence of dietary enhancing factors, particularly Vitamin C, meat, fish, and poultry. Non-heme iron is obtained from plant-based sources, such as beans, lentils, nuts and seeds, dry fruits, fortified breakfast cereals, enriched rice or bread, and tofu.
- Sweet potatoes
- Red peppers
The recommended dietary allowance for iron during pregnancy is about 27 mg per day. It is important to incorporate food that contain iron into the diet to meet a daily goal. Iron containing foods include:
- Dark, leafy green vegetables, such as spinach, collard greens, kale, beetroot, broccoli, Brussel sprouts, potatoes
- Dried fruits, including prunes, raisins, figs
- Fruits, such as apricots, raspberries,
- Beans, peas, and lentils
- Meat including red meat, liver, chicken, lamb
- Other sources include tuna, oysters, tofu, fortified cereals, grains, pasta, oatmeal, and whole wheat bread.
How to overcome iron deficiency? How to increase hemoglobin? Intervention options to address iron deficiency problems varies widely and depend on the cause and severity of the disease. Iron deficiency anemia treatment depends on what is causing it.
For example, if anemia is mild and is caused by low iron levels, then iron supplements along with iron containing foods may be prescribed by the doctor. On the other hand, if anemia is due to sudden blood loss from an injury or disease, then hospitalization or blood transfusion (transfusion of red blood cells) may be required to relieve the symptoms.
The simple solution for iron deficiency treatment includes iron food sources and iron supplements.
- Iron food sources
Including iron-rich foods in the diet is a common way of treating and preventing iron deficiency anemia. It is important to add iron food sources, such as red meat, poultry, seafood, beans, dark green leafy vegetables, dried fruits, iron-fortified cereals, bread, and pasta. The human body absorbs iron more efficiently from animal-based sources as compared to plant-based sources. Iron absorption greatly depends on the food type and its preparation method. Some foods increase iron absorption (dietary enhancers) while others inhibit the absorption (dietary inhibitors).
- Iron supplementation
The chief treatment for iron deficiency anemia includes the oral administration of inorganic iron in the ferrous form. Healthcare providers mostly prescribe iron supplementation for three months three times daily.
Depending on the severity of anaemia and the patient’s tolerance, the daily recommended dose of elemental iron is 50 to 100 mg three times per day for adults. Moreover, healthcare professionals also encourage continuing iron therapy for four to five months after haemoglobin restoration to fill the body’s normal iron reserves.
- Intravenous iron
Iron infusion is the way of delivering iron to the body intravenously. Iron infusions are usually prescribed by the doctor as iron deficiency anemia treatment. Intravenous iron increases the body’s iron levels quickly and is a more immediate treatment than iron supplementation or dietary changes. This is helpful in situations where anaemia is severe and life-threatening.
- Blood Transfusions
Blood transfusion, similar to intravenous iron, is helpful when anaemia is severe. It is a safe, common procedure in which blood is transfused through an IV line and requires careful matching of the donor’s blood with the recipient’s blood.
Iron deficiency anemia is the most common type of anemia that occurs due to poor dietary intake or reduced absorption of iron by the body. It is not a good practice to treat anemia deficiency by yourself. It is important to consult a healthcare provider for proper diagnosis and treatment. Self-treating with iron supplements can cause other health conditions, such as constipation or even liver damage.