Iron Deficiency Anemia

Anemia in the developing world is most commonly caused by an iron deficiency, which affects up to 50 percent of the population in some countries. Iron deficiency not only impairs the production of red cells in the blood, but also affects general cell growth and proliferation in tissues like the nervous system and the gastrointestinal tract. Red cells in a patient with iron-deficiency anemia are both microcytic and hypochromic.

Sickle-cell anemia is a genetic disease that causes normal red blood cells (left) to become rigid and sickle-shaped (right). The misshapen cells can impede blood circulation, causing pain and possibly tissue damage. [Photograph by Stanley Flegler. Visuals Unlimited. Reproduced by permission.]

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Iron deficiency affects young children, adolescents, and women of reproductive age—three periods of rapid growth during which the body's iron needs are higher than normal. In children, iron requirements are highest between the ages of six and eighteen months, and can be ten times the requirement of a normal adult. Iron is commonly absorbed from both human milk and cow's milk, and, if consumed in good quantities, these sources can meet the body's iron needs. A deficiency can result from inadequate intake, or it can occur if milk remains the sole source of a child's nutrition after the age of four months, when iron needs exceed that provided by milk alone. Research in Chile has shown that 40 percent of children whose main source of nutrition was breast milk developed iron-deficiency anemia. Such children can appear tired and inattentive, and they can suffer from delayed motor development. Some children can even develop mild to moderate mental retardation as a result of iron-deficiency anemia. Recent research has shown that iron-deficiency anemia can also contribute to emotional development problems, with malnourished children acting more irritable and fussy.

nutrition: the maintenance of health through proper eating, or the study of malnourished: lack of adequate nutrients in the diet same

TYPES AND CAUSES

OF ANEMIA

Type

Lab values

Causes

Macrocytic, normochromic

MCV: > 100fl MCHC: 34

Vitamin B12 deficiency, folate deficiency, vitamin C deficiency, chemotherapy (megaloblastic marrow); aplastic anemia, hypothyroidism (normoblastic marrow)

Microcytic, hypochromic

MCV: < 80 MCHC: < 30

Iron deficiency, thalassemia, sideroblastic anemia, chronic lead poisoning, anemia of chronic illness

Normocytic, normochromic

MCV: 80-99fl MCHC: 34 +/-2

Iron deficiency (early), chronic disease

MCV: mean corpuscular volume

MCHS: mean corpuscular hemoglobin concentration fl: femtoliter (one quadrillionth of a liter)

parasitic: feeding off another organism hookworm: parasitic nematode that attaches to the intestinal wall malaria: disease caused by infection with Plasmodium, a single-celled proto-zoon, transmitted by mosquitoes

DNA: deoxyribonucleic acid; the molecule that makes up genes, and is therefore responsible for heredity

RNA: ribonucleic acid, used in cells to create proteins from genetic information bone marrow: dividing cells within the long bones that make the blood congenital: present from birth kwashiorkor: severe malnutrition characterized by swollen belly, hair loss, and loss of skin pigment marasmus: extreme malnutrition, characterized by loss of muscle and other tissue neural: related to the nervous system cardiovascular: related to the heart and circulatory system cancer: uncontrolled cell growth

Pregnant women can have up to double the requirement of iron for a normal adult, with the majority of the mother's iron being transferred to her growing fetus. Adult diets in most of the developing world tend to be iron-poor, and a low dietary intake can result in iron deficiency. Deficiency can also occur as a result of poor iron absorption due to gastrointestinal pathology, blood loss due to normal menstruation, blood loss from parasitic infections such as hookworm and malaria, and blood loss from chronic diarrhea—all of which are common in developing countries.

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