Iron deficiency

Iron deficiency
Classification and external resources

Iron in heme
ICD-10 E61.1
ICD-9 280.9
DiseasesDB 6947
MedlinePlus 000584
eMedicine med/1188

Iron deficiency (sideropenia or hypoferremia) is one of the most common of the nutritional deficiencies. Iron is present in all cells in the human body, and has several vital functions. Examples include as a carrier of oxygen to the tissues from the lungs in the form of hemoglobin, as a transport medium for electrons within the cells in the form of cytochromes, and as an integral part of enzyme reactions in various tissues. Too little iron can interfere with these vital functions and lead to morbidity and death.

The direct consequence of iron deficiency is iron deficiency anemia. Children and pre-menopausal women are the groups most prone to the disease.

Total body iron averages approximately 3.8 g in men and 2.3 g in women. In blood plasma, iron is carried tightly bound to the protein transferrin. There are several mechanisms that control human iron metabolism and safeguard against iron deficiency. The main regulatory mechanism is situated in the gastrointestinal tract. When loss of iron is not sufficiently compensated by adequate intake of iron from the diet, a state of iron deficiency develops over time. When this state is uncorrected, it leads to iron deficiency anemia.

Contents

Causes

Though genetic defects causing iron deficiency have been studied in rodents, there are no known genetic disorders of human iron metabolism that directly cause iron deficiency.

Symptoms

Symptoms of iron deficiency can occur even before the condition has progressed to iron deficiency anaemia.

Symptoms of iron deficiency are not unique to iron deficiency (i.e. not pathognomonic). Iron is needed for many enzymes to function normally, so a wide range of symptoms may eventually emerge, either as the secondary result of the anemia, or as other primary results of iron deficiency. Symptoms of iron deficiency include:

Likely lab test results in people with iron deficiency

As always, laboratory values have to be interpreted with the lab's reference values in mind and considering all aspects of the individual clinical situation.

Serum ferritin can be elevated in inflammatory conditions and so a normal serum ferritin may not always exclude iron deficiency.

Consequences

Continued iron deficiency may progress to anemia and worsening fatigue. Thrombocytosis, or an elevated platelet count, can also result. A lack of sufficient iron levels in the blood is a reason that some people cannot donate blood.

Treatment

Before commencing treatment, there should be definitive diagnosis of the underlying cause for iron deficiency. This is particularly the case in older patients, who are most susceptible to colorectal cancer and the gastrointestinal bleeding it often causes. In adults, 60% of patients with iron deficiency anemia may have underlying gastrointestinal disorders leading to chronic blood loss.[4] It is likely that the cause of the iron deficiency will need treatment as well.

Upon diagnosis, the condition can be treated with iron supplements, e.g. in the form of ferrous sulfate, ferrous gluconate, or amino acid chelate tablets. Recent research suggests the replacement dose of iron, at least in the elderly with iron deficiency, may be as little as 15 mg per day of elemental iron.[5]

Food sources of iron

Mild iron deficiency can be prevented or corrected by eating iron-rich foods. Because iron is a requirement for most plants and animals, a wide range of foods provide iron. Good sources of dietary iron include red meat, poultry, insects,[6][7] lentils, beans, leafy vegetables, pistachios, tofu, fortified bread, and fortified breakfast cereals.

Iron from different foods is absorbed and processed differently by the body; for instance, iron in meat (heme iron source) is more easily broken down and absorbed than iron in grains and vegetables ("non-heme" iron source),[8] but heme/hemoglobin from red meat has effects which may increase the likelihood of colorectal cancer.[9][10] Minerals and chemicals in one type of food may inhibit absorption of iron from another type of food eaten at the same time.[11] For example, oxalates and phytic acid form insoluble complexes which bind iron in the gut before it can be absorbed.

Because iron from plant sources is less easily absorbed than the heme-bound iron of animal sources, vegetarians and vegans should have a somewhat higher total daily iron intake than those who eat meat, fish or poultry.[12] Legumes and dark-green leafy vegetables like broccoli, kale and oriental greens are especially good sources of iron for vegetarians and vegans. However, spinach and Swiss chard contain oxalates which bind iron making it almost entirely unavailable for absorption. Iron from nonheme sources is more readily absorbed if consumed with foods that contain either heme-bound iron or vitamin C. This is due to a hypothesised "meat factor" which enhances iron absorption.[13]

Iron deficiency can have serious health consequences that diet may not be able to quickly correct, and iron supplementation is often necessary if the iron deficiency has become symptomatic.

Bioavailability and bacterial infection

Iron is needed for bacterial growth making its bioavailability an important factor in controlling infection.[14] Blood plasma as a result carries iron tightly bound to transferrin, and only releases it to cells with appropriate cell markers thus preventing its access to bacteria.[15] Between 15 and 20 percent of the protein content in human milk consists of lactoferrin[16] that binds iron. As a comparison, in cow's milk, this is only 2 percent. As a result, breast fed babies have fewer infections.[15] Lactoferrin is also concentrated in tears, saliva and at wounds to bind iron to limit bacterial growth. Egg white contains 12% conalbumin to withhold it from bacteria that get through the egg shell (for this reason prior to antibiotics, egg white was used to treat infections).[17]

To reduce bacterial growth, plasma concentrations of iron are lowered in fever,[18] and following surgery after open wounds where it acts as a protection against infection.[19] Reflecting this link between iron bioavailability and bacterial growth, the taking of iron supplements can increase the risk of infection.[20] A moderate iron deficiency, in contrast, can provide protection against acute infection.[21]

References

  1. ^ Wintergerst, E. S., Maggini, S. Hornig, D. H. (2007) "Contribution of selected vitamins and trace elements to immune function". Ann Nutr Metab. 51: 301-323. PubMed
  2. ^ Rangarajan, Sunad; D'Souza, George Albert. (April 2007). "Restless legs syndrome in Indian patients having iron deficiency anemia in a tertiary care hospital". Sleep Medicine. 8 (3): 247–51. doi:10.1016/j.sleep.2006.10.004. PMID 17368978. 
  3. ^ Longmore, Murray; Ian B. Wilkinson, Supaj Rajagoplan (2004). Oxford Handbook of Clinical Medicine, 6th Edn. Oxford University Press. pp. 626–628. ISBN 0-19-852558-3. 
  4. ^ Rockey D, Cello J (1993). "Evaluation of the gastrointestinal tract in patients with iron-deficiency anemia". N Engl J Med 329 (23): 1691–5. doi:10.1056/NEJM199312023292303. PMID 8179652. 
  5. ^ Rimon E, Kagansky N, Kagansky M, Mechnick L, Mashiah T, Namir M, Levy S (2005). "Are we giving too much iron? Low-dose iron therapy is effective in octogenarians". Am J Med 118 (10): 1142–7. doi:10.1016/j.amjmed.2005.01.065. PMID 16194646. 
  6. ^ Defoliart,G. 1992. Insects as Human Food. Crop Protection, 11:395-99
  7. ^ Bukkens SGF. 1997. The Nutritional Value of Edible Insects. Ecol. Food. Nutr. Vol. 36(2-4): pp287-319
  8. ^ Iron deficiency. Food Standards Agency.
  9. ^ Sesink AL, Termont DS, Kleibeuker JH, Van der Meer R (1999). "Red meat and colon cancer: the cytotoxic and hyperproliferative effects of dietary heme". Cancer Research 59 (22): 5704–9. PMID 10582688. http://cancerres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=10582688. 
  10. ^ Glei M, Klenow S, Sauer J, Wegewitz U, Richter K, Pool-Zobel BL (2006). "Hemoglobin and hemin induce DNA damage in human colon tumor cells HT29 clone 19A and in primary human colonocytes". Mutat. Res. 594 (1-2): 162–71. doi:10.1016/j.mrfmmm.2005.08.006. PMID 16226281. 
  11. ^ Iron in diet. MedlinePlus.
  12. ^ Mangels, Reed. Iron in the vegan diet. The Vegetarian Resource Group.
  13. ^ Iron. The Merck Manuals Online Medical Library.
  14. ^ Kluger, M. J. Rothenburg, B. A. (1979) "Fever and reduced iron: their interaction as a host defense response to bacterial infection". Science. 203: 374-376. PubMed
  15. ^ a b Nesse, R. M.; Williams, G. C. Why We Get Sick: The New Science of Darwinian Medicine. New York. page 30 ISBN 0-679-74674-9.
  16. ^ T. William Hutchens, Bo Lönnerdal; Lactoferrin: Interactions and Biological Functions (1997). page 379 on Google Books
  17. ^ Nesse, R. M.; Williams, G. C. Why We Get Sick: The New Science of Darwinian Medicine. New York. page 29 ISBN 0-679-74674-9.
  18. ^ Weinberg, E. D. (1984) "Iron withholding: a defense against infection and neoplasia". Physiol Rev. 64: 65-102. PubMed
  19. ^ Ballantyne, G. H. (1983) "Rapid drop in serum iron concentration following cholecystectomy. A metabolic response to stress". Am Surg. 49: 146-150. PubMed
  20. ^ Murray, M. J., Murray, A. B., Murray, M. B. Murray, C. J. (1978) "The adverse effect of iron repletion on the course of certain infections". Br Med J. 2: 1113-1115. PubMed
  21. ^ Wander, K., Shell-Duncan, B. McDade, T. W. (2008) "Evaluation of iron deficiency as a nutritional adaptation to infectious disease: An evolutionary medicine perspective". Am J Hum Biol. PubMed

Further reading

External links


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