Iron Deficiency Anemia (IDA) is a global health concern
Editors:
- Dr. Praful B. Godkar (Ph.D)
Eminent Author, Medical Biochemist and Scientist, Technical Education consultant. AGD Biomedicals (Pvt) LTD. - Dr. Gauri Kulkarni MD (Pathology)
Vice President, AGD Biomedicals (Pvt) LTD.
Iron deficiency anemia (IDA) is a widespread and significant global health issue, particularly affecting vulnerable populations such as women of reproductive age, pregnant women and young children(1,2,3). IDA in pregnancy increases risks of premature birth, low birth weight, and restricted fetal growth. IDA increases the risk of postpartum complications for mothers, including hemorrhage, fatigue, rapid heartbeat, and depression(8,14). IDA may also affect an infant’s long-term neuro development. In children, IDA is linked to neurological development issues, which may result in reduced learning capacity and changes in motor functions(8,14). Early screening of blood by CBC hematology analyzer such as HT-340 can provide accurate and fast detection of Microcytic hypochromic anemia related to IDA.(7,15). Timely diagnosis of IDA could facilitate personalized care and informed medical decisions and ensure that IDA could be managed efficiently and effectively(11,13).
NOTE:
(A) According to the World Health Organization it is estimated that approximately 1.62 billion people (24.8% of the global population) are affected by anemia. IDA is a leading cause of anemia(2).
(B) The National Family Health Survey (NFHS-5, 2019-21) indicates, approximately 57.2% of Indian women aged 15-49 years are anemic, with 53.1% of children aged 6-59 months are also affected(6).
(C) Iron deficiency anemia (IDA) represents a prevalent nutritional disorder globally, with especially elevated incidence rates observed in developing nations. Contributing factors include restricted iron-supported dietary variety and increased prevalence of infections(3).
(D) Iron deficiency anemia (IDA) remains a significant concern in high-income countries as well, particularly among women of reproductive age. A study conducted in the United States indicated that iron deficiency anemia affects 5–10% of premenopausal women and 2–5% of men(3 ).
(E ) Pregnant women in India are particularly vulnerable to IDA. Various studies show that nearly 50-60% of pregnant women are anemic, which increases the risk of maternal complications like preterm delivery, postpartum hemorrhage and low birth weight(8).
Q1. What are the common symptoms associated with IDA?
ANS: Common symptoms of IDA include weakness, fatigue, dizziness, palpitations, shortness of breath, pale skin, sore tongue, chest pain, cold hands and feet.
Q2. What are the characteristic features of IDA?
ANS: IDA involves reduced red blood cell count and lower hemoglobin due to inadequate iron stores. Low levels of iron lead to impaired oxygen transport to various tissues and cells causing various systemic manifestations which can adversely affect quality of life and productivity.
NOTE : Iron is a key component of the metalloprotein hemoglobin in red blood cells, which binds oxygen and delivers it to the cells and tissues of the body for energy production.
Q3. What are general Iron Deficiency Anemia (IDA) Profile tests?
ANS: The following are IDA profile tests (15):
(1) Complete hemogram with Metzer Index (MI)
(2) Determination of serum total iron and iron-binding capacity (TIBC)
(3) Determination of serum ferritin
(4) Determination of serum transferrin
NOTE:
(A) IDA is diagnosed on the basis of the following laboratory test values(9,15):
(1) MI > 13
(2) Low serum iron
(3) High TIBC
(4) Low serum ferritin and
(5) High serum transferrin.
(B) Microcytic hypochromic anemia is observed in IDA as well as in Thalassemia minor. However, from the following general observations listed in Table 1, it is possible to diagnose IDA using CBC report:
TABLE 1
| CBC PARAMETERS | IRON DEFICIENCY ANEMIA | THALASSEMIA MINOR |
| MI | > 13 | < 13 |
| MCV | Decreased | Decreased |
| MCH | Decreased | Decreased |
| Serum iron | Decreased | Normal |
| TIBC | Increased | Normal |
| Serum ferritin | Decreased | Normal |
| Serum transferrin | Decreased | Normal |
| Hb electrophoresis | Normal | HbA2 increased |
CASE STUDY 1
A 18-year-old female student presented to a local health center with complaints of generalized weakness, fatigue, palpitations, pallor and chest pain. Her complete hemogram report values were as follows:
COMPLETE HEMOGRAM
| TEST | RESULT | NORMAL RANGE |
| Hemoglobin | 10.3 g/dl | 13–18 g/dl |
| Total erythrocyte count | 4.45 X 1012/l | 5.0 ± 0.5 X 1012 /l |
| Total leukocyte count | 8.3 X 109/l | 7.0 ± 3.0 X 109/l |
| Differential leukocyte count | ||
| Neutrophils | 70% | 40–75% |
| Lymphocytes | 37% | 20–45 % |
| Eosinophils | 2% | 1–4 % |
| Monocytes | 1% | 2–8% |
| PCV | 29 % | 36–48% |
| MCV | 64 fL | 82–92 fL |
| MCH | 19 pg | 27–32 pg |
| MCHC | 29 % | 32–36 % |
| RDW- CV | 18 % | 12–14 |
| Platelet count | 170 X 109/l | 150–400 X 109/l |
| Metzer Index (MI) | 14.38 | > 13 |
| Stained blood smear examination observations: | ||
| Microcytes | +++ | |
| Anisocytes | +++ | |
| poikilocytes | +++ | |
| Hypochromia | +++ | |
| Microcytosis | +++ | |
NOTE(15)
(A) The patient was suffering from microcytic hypochromic anemia related to Iron Deficiency Anemia (IDA) on the basis of the following CBC parameters: MI >13, very low Hb, PCV, MCV, MCH, MCHC, and high RDW-CV. To confirm diagnosis the following additional tests were recommended: Serum total iron, TIBC, serum transferrin and serum ferritin.
(B) In normal individual 70% iron is present in the hemoglobin, 20% stored in ferritin in liver and rest of the iron present in compounds such as cytochrome, myoglobin, peroxidase, etc. Depletion of red blood cells and ferritin leads to IDA.
THE REPORTS OF THE ADDITIONAL TESTS WERE AS FOLLOWS:
| TEST | RESULT | NORMAL RANGE |
| Serum total iron | 26 µg/ l | 60-150 µg/ l |
| Serum Total Iron Binding Capacity (TIBC) | 540 µg/ l | 270-380 µg/ l |
| Serum ferritin | 2.0 µg/ l | 10-120 µg/ l |
| Additional test HbA2 (Hemoglobin A2) determination (HPLC method) |
1.6% | 1.3- 3.5% |
DIAGNOSIS
Iron Deficiency Anemia (IDA)
NOTE:
It is necessary to identify the cause of iron-deficiency anemia on the basis of case history, and additional IVD laboratory tests by considering these points: IDA can be caused due to (A) Decreased iron intake, (B) Increased iron demand, or (C ) Increased iron loss(15).
NOTE(15)
(1) Increased iron demand often occurs during periods of growth, as seen in children and also in pregnant women.
(2) Various reasons of blood loss:
(A) Heavy menstrual periods lead to excessive blood,
(B) Parasitic disease (caused by helminths, mainly by hook worms) leading to chronic blood loss,
(C ) Gastrointestinal bleeding can result from regular use of certain medicines such as aspirin (non-steroidal anti-inflammatory drug), bleeding piles, peptic ulcer, clopidogrel (antiplatelet drug) and warfarin (anticoagulants),
(D) Colon cancer,
(E) Frequent blood donations, etc.
(3) Additional tests recommended to find out blood loss:
(A) Routine urine examination
(B) Routine feces examination
(C) Routine examination of gastric fluid.
(4) Additional test to find out if jaundice is present: Serum total, indirect and direct bilirubin and SGPT.
Q4. What are the examples of iron-rich foods?
ANS: Examples of iron-rich foods include: Leafy green vegetables, meat, eggs, nuts, legumes, dates and iron-fortified foods.
NOTE: Cow’s milk is not a good source of iron(15).
Q5. What is the recommended daily allowance (RDA) of iron?
ANS: According to The National Academy of Medicine RDA for iron is as follows:
(A) Men: 8 mg/day
(B) Women: 18 mg/day
(C) Children: 8 mg/day
(D) Post-menopausal women: 8 mg/day
(E) Pregnant women: 27 mg/day(15)
References
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(2) World Health Organization (WHO). The global prevalence of anemia in 2019. Geneva: WHO. 2021.
(3) Centers for Disease Control and Prevention (CDC). Iron deficiency anemia in the United States. Atlanta: CDC. 1998.
(4) SB Kumar, SR Arnipalli, P Mehta, S Carrau, O Ziouzenkova. Iron Deficiency Anemia: Efficacy and Limitations of Nutritional and Comprehensive Mitigation Strategies. Nutrients 2022.
(5) Indian Council of Medical Research (ICMR). Anemia in India: Trends, implications, and strategies. 2020.
(6) National Family Health Survey (NFHS-5). Ministry of Health and Family Welfare, Government of India. 2019-2021.
(7) Siu AL (October 2015). “Screening for Iron Deficiency Anemia in Young Children: USPSTF Recommendation Statement”. Pediatrics. 136 (4): 746–52. doi:10.1542/peds.2015-2567. PMID 26347426.Abu-Ouf NM, Jan MM (February (8) 2015).
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(15) Godkar PB, Godkar DP. Text book of Medical laboratory technology (4th edition, 2024), Bhalani Publishers, Mumbai. India.
