September 21

IRON ARGUMENT. THE TRUTH ABOUT ANEMIA

Iron (Fe) is an essential element for the proliferation and differentiation of cells. Iron deficiency causes many immune dysfunctions in patients, and this condition is frequently associated with anemia. Therefore, iron supplementation in anemic patients seems to be essential for maintaining immune homeostasis and preventing degenerative disease outcomes. Clinical trials in healthy patients have demonstrated that iron supplementation is beneficial in iron deficiency anemia to avoid iron stores. Iron stores, in turn, have been shown to lead to chronic inflammation in age-associated disease, thus sustaining oxidative damage.

Iron deficiency anemia refers to inefficient hemoglobin synthesis caused by inadequate storage or deficiency of iron within the body. This disease can be caused by a relative lack of iron absorption, as is manifested during the growing stage of infants, adolescent development and menstrual onset in females, and the period of pregnancy or lactation in women. It can also be caused by blood loss, such as acute or chronic bleeding of the alimentary canal, hemorrhoid bleeding, hookworm disease, and menorrhagia. A third factor is a functional disturbance of digestion and absorption, such as functional disorder of the stomach and intestines, iron-absorbing dysfunction of the stomach and intestines, and inadequate iron absorption after surgery. Clinically it is the most common form of anemia and, if diagnosed and treated promptly, can have a favorable prognosis.

Anemia in Children

Anemia is a common problem in children. Many of the same types of anemia in adults also occur in children. However, the clinical and diagnostic issues related to these conditions can differ. The kinds of anemia occurring in newborn infants are particularly unique. To appreciate how anemia is recognized in children, it is essential to understand that the normal hemoglobin values and RBC(red blood cells) characteristics of childhood change as a function of age. Iron deficiency anemia is one of the most common causes of anemia in children. The typical age of presentation is between 1 and 3 years. Due to their rapid growth, children need increased amounts of iron for red cell production. Premature babies are particularly at risk of early iron deficiency because fetuses receive most of their maternal iron during the third trimester of pregnancy. Full-term babies who are exclusively breastfed need iron supplementation at around 4 months of age, as recommended by the American Academy of Pediatrics.

Children who are exclusively breastfed during the first year of life and then take excessive amounts of cow’s milk after age 1 are at the highest risk of iron deficiency anemia, usually presenting between 1 and 2 years of age. Cow’s milk contains no iron but has high-calorie content such that iron-deficient children gain weight normally. In children older than 3 years of age, iron deficiency due to inadequate dietary intake can occur, but this is a diagnosis of exclusion. Just as in adults, older children with iron-deficiency anemia need to be scrutinized for other causes such as bleeding or gastrointestinal disease that impairs iron absorption.

Vitamin B12 deficiency is an uncommon cause of anemia in children. Dietary causes are infrequent but sometimes are seen in children who are true vegans. In some cases, there are congenital disorders that impair vitamin B12 absorption.

Diagnostic Key Points

History of iron deficiency, chronic bleeding, increased demand for iron, or utilization disturbance of iron.

Clinical manifestations: Dull or yellowish complexion, dizziness, weariness, ringing in the ears, and palpitations.

Physical signs: Possibly pale mucous membrane, bluish sclera, or flat, uneven, and fragile nails; glossitis and stomatitis in some cases.

Laboratory examination: Increase in serum iron and the association rate of total iron.

Decrease or absence of bone marrow sideroblast and exocellular iron.

Cautions and Advice

Once a clear diagnosis is made, prompt treatment aiming at the causes should be administered. Patients should regulate their diet and consume more iron-rich foods such as iron-fortified bread and cereals, tofu, dried fruits, animal viscera, chicken egg yolks, beans, apples, spinach and other dark green leafy vegetables.

The care of patients with anemia has benefitted from the judicious application of progress in general medical care. As a result, we have achieved an increased survival and improved quality of life for many patients. At the present time, most patients with anemia can be offered a reasonably accurate diagnosis and either definitive therapy or sufficient supportive care to reduce the impact of the anemia on their lives.

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