Causes of iron deficiency anemia | Iron deficiency anaemia

Causes of iron deficiency anemia

Iron deficiency is caused on the one hand by disorders in the gastrointestinal tract, such as after removal of the stomach (gastrectomy), absorption disorders in the intestine (malassimilation) or by chronic intestinal diseases. Furthermore, bleeding is considered the most frequent cause. The source of these losses can be: An increased iron requirement also exists during pregnancy or growth.

Nutrition also plays an important role in iron deficiency anaemia. Vegetarians can be particularly affected. The bivalent iron in meat can be particularly well absorbed by the body.

If a person eats a vegetarian diet, care must be taken to ensure that sufficient sources of replacement are available.

  • Menstruation too strong and too frequent
  • Bleeding due to tumors, ulcers or
  • Hemorrhoids

Female sex (menstrual bleeding) Pregnancy/breastfeeding Chronic diseases (heart failure, renal insufficiency) Cancer Chronic inflammation (chronic) blood loss (stomach and intestinal ulcer, hemorrhoids) Competitive athletes After gastrointestinal resection

  • Female sex (menstrual bleeding)
  • Pregnancy/nursing period
  • Chronic diseases (heart failure, renal failure)
  • Cancer diseases
  • Chronic inflammation
  • (chronic) blood loss (stomach and intestinal ulcer, hemorrhoids)
  • Competitive athletes
  • After gastric and intestinal resection

Women of child-bearing age have a particularly high risk of developing iron deficiency anemia. On a normal day the healthy body loses about 1mg of iron.

This amount can be balanced out with a balanced diet. In women with heavy menstrual bleeding, the loss of blood and thus iron can increase immensely. Normally, a woman loses 30-60ml of blood (60-120mg of iron) per month, but in the case of heavy bleeding she loses up to 800ml of blood (1600mg of iron). Since only 10-15% of the iron absorbed through food is absorbed in the intestines, iron deficiency can quickly occur.

Laboratory parameters for iron deficiency anemia

In iron deficiency anemia, laboratory parameters such as decreased serum iron and ferritin, increased transferrin with decreased saturation and decreased reticulocyte hemoglobin are observed. The soluble transferrin receptor sTfR is elevated. The differential diagnosis (alternative causes) is still based on whether an inflammation is also present.

The parameters transferrin and ferritin show altered concentrations in inflammatory reactions. They are also known as acute-phase proteins (ferritin, the value is elevated in the case of inflammation) or anti-acute-phase proteins (transferrin, the value is lowered in the case of inflammation). Therefore, the inflammation parameters CRP and leukocytes are also determined.

Morphologically, the red blood cells appear hypochromic-mircocytic, i.e. the hemoglobin content (MCH) and cell volume (MCV) are reduced. The erythrocytes can impress in the blood smear as anulocytes or target cells. This means that the cells are ring-shaped blown off due to the lower hemoglobin content.

In addition to blood analysis, a clinical examination (examination of the affected person by a physician) is mandatory. FerritinMCV means medium corpuscular volume i.e. it shows the average volume of red blood cells (erythrocytes). The value can be calculated from the hematocrit (proportion of solid components in the blood) and the erythrocyte count.

In iron deficiency anemia, fewer and, above all, smaller red blood cells are produced, since the important building block iron is less available. The MCV is therefore lower – this is called microcytic anaemia. The normal value is 85-98 fl.

Changes in the MCV alone are not meaningful; other blood values such as hemoglobin, hematocrit, MCH (average amount of hemoglobin per erythrocyte) and MCHC (average concentration of hemoglobin per erythrocyte) must always be taken into account. Transferrin is a protein that transports iron. It is produced in the liver, depending on the iron content in the body.

The total transferrin in the body can bind 12mg of iron, but usually only 30% is loaded with iron. Iron deficiency results in a decrease in transferrin levels, as well as during pregnancy.Elevated values are seen in chronic inflammation, tumor diseases or iron overload. The term ferritin is used to describe a protein that serves to store iron.

As the storage form of iron, it acts as an indicator for the iron supply in the blood plasma. Serum ferritin is a basic building block for diagnostic procedures of iron metabolism. Its reference range is normally 30-300 μg/l for men and 10-200 μg/l for women.

In the case of iron deficiency anemia, the ferritin value is lowered and is decisive in the differential diagnosis. For example, iron deficiency anemia cannot be ruled out if the ferritin value is elevated because chronic inflammation may be present at the same time, which would increase the ferritin parameter. Reticulocytes are newly formed, young, immature red blood cells (erythrocytes).

During blood formation, the red blood cells pass through various stages of maturation. Reticulocytes are the last stage before mature functional erythrocytes. Normally, the blood contains 1% reticulocytes.

In cases of anemia, which is caused by blood loss, the reticulocyte count increases to compensate for the loss of red blood cells as quickly as possible. If there is an iron deficiency, however, reticulocytes can only be formed more slowly, since an important component is missing. In iron deficiency anemia, the reticulocyte count is therefore reduced.