Iron Deficiency Causes and Treatment

Background

The iron content of an adult is about 3 to 4 g. In women, the value is somewhat lower than in men. About two-thirds is bound to heme as so-called functional iron, is present in hemoglobin, myoglobin, and in enzymes, and is essential for oxygen supply and metabolism. One-third is found in the iron stores ferritin and hemosiderin, and a small amount is bound to transferrin as transport iron. Before iron deficiency and anemia occur, the stores are emptied and the ferritin levels in the blood fall. Iron concentration is not regulated by elimination, since the body does not actively excrete iron, but by absorption, which increases when demand increases. Via the intestinal cells, Fe²⁺ is transported. Fe³⁺, found in many plant sources, must therefore first be converted by enzymes or vitamin C to Fe²⁺ before it can be taken up by enterocytes. Iron bound to heme (heme iron) is transported directly into intestinal cells via endocytosis. In most drugs to compensate for iron deficiency, iron is therefore present as Fe²⁺ (exception: Maltofer).

Symptoms

Iron deficiency manifests itself in nonspecific symptoms such as decreased endurance, impaired thermoregulation, susceptibility to infection, fatigue, weakness, lassitude, headache, irritability, lack of concentration, hair loss, performance intolerance, and reduced exercise tolerance. Whether these symptoms already occur in the absence of anemia is not undisputed, but there is some evidence that they do. Iron deficiency can also remain asymptomatic. During pregnancy, iron deficiency can lead to complications and during childhood to developmental problems. In iron deficiency anemia (anemia), there is a decrease in hemoglobin, hematocrit, and/or red blood cell (RBC) count. Depending on the severity, symptoms include pallor, low blood pressure, fainting, sleep disturbances, accelerated breathing and a rapid heartbeat. Severe iron deficiency anemia is rare in our country. Changes in the nails, brittle nails, cracks at the corners of the mouth, papilledema of the tongue, hair loss (telogen effluvium), dysphagia, eating disorders (pica: appetite for things that are not food, e.g., paper, soil, clay), and retinal hemorrhages occur.

Causes

There are numerous possible causes of iron deficiency. Women are often affected because they lose iron during menstruation, pregnancy, and lactation. The following list shows a selection of important physiological and pathophysiological languages. 1. insufficient intake:

• Insufficient intake through food, vegetarian or vegan diet, malnutrition.
• Insufficient iron absorption, malabsorption.
• Gastrointestinal diseases: Infections with Helicobacter pylori (even without ulcer), inflammatory bowel disease, celiac disease, worm disease, diarrhea, high gastric pH.

2. increased demand:

• Women: Pregnancy, lactation
• Children, adolescents in growth
• Treatment with erythropoietin and analogs, if iron is not substituted.

3. increased loss:

• Acute or chronic blood loss, gastrointestinal disease, blood donation, surgical procedures.
• Menstruation, heavy menstruation
• Hemolysis

Diagnosis

The clinical symptoms of iron deficiency are nonspecific and iron deficiency can have serious causes. Therefore, the diagnosis must be made in medical treatment with laboratory chemistry methods and therapy must be monitored regularly. If iron deficiency or iron deficiency anemia is suspected, the patient should therefore not self-medicate. According to the specialist information, iron preparations may only be dispensed in a pharmacy if the patient is under medical supervision. However, iron may be taken as a food supplement without monitoring to prevent deficiency.

Nonpharmacologic treatment

Nonpharmacologic treatment of iron deficiency may be possible, but it takes a long time, is costly, and success is not assured. Red meat and liver are good sources of iron because they contain heme iron, which is well absorbed. Many plant sources, such as legumes, breakfast cereals, and vegetables, contain Fe³⁺, which is less well absorbed and requires acid for release.It was recommended to use cast iron cookware. Promote iron absorption: Simultaneous intake of vitamin C, acid (needed to absorb Fe³⁺ in solution), acidic foods (e.g., tomato sauce). Reduce iron intake: Calcium, zinc, manganese, copper, phosphates (e.g., in soft drinks), fiber (dietary fiber), phytates, milk, polyphenols, tannins, black tea, coffee, wine, drugs: e.g., antacids, H2 antihistamines, proton pump inhibitors (increase stomach pH), quinolones, tetracyclines (form complexes with iron).

Drug treatment

Oral iron:

• Orally administered iron is considered the drug of first choice for the treatment of iron deficiency. It is commercially available, for example, in the form of tablets, dragées, as drops and syrup. Since Fe²⁺ is better absorbed than Fe³⁺ and its solubility is not pH-dependent, iron is present in most drugs as Fe²⁺. A number of substances can worsen absorption in the intestine. Therefore, iron is taken fasting and usually before food (there are exceptions). Treatment usually takes several months. Unpleasant gastrointestinal adverse effects pose a problem for adherence and success of therapy. If these occur, iron can also be administered with or after meals. However, absorption is reduced in this case. Short breaks in therapy of 1 to 2 days or intravenous administration can also be considered as a response to the adverse effects.

Iron infusions:

• Iron infusions are indicated as a 2nd-line agent if oral therapy is not sufficiently effective, intolerable, or not feasible. Intravenous iron should also be preferred for inflammatory gastrointestinal diseases, as these conditions may be exacerbated by oral administration. In many countries, the complexes iron carboxymaltose and iron sucrose are commercially available. Contraindications include hypersensitivity, anemia without confirmed iron deficiency, iron overload, and the first trimester of pregnancy. Gastrointestinal disturbances such as diarrhea, constipation, and nausea are also common with intravenous administration. Very rarely, dangerous anaphylactic reactions are possible. The cost of parenteral treatment is high, but compliance is better, the burden on patients is less, and the effect is more rapid.

Multivitamins:

• Multivitamin preparations may contain minerals that inhibit iron absorption, and the iron content of the drugs is usually low. Therefore, they should not be used to treat iron deficiency.

Alternative medicine:

• Schüssler salts (Ferrum phosphoricum, No. 3), homeopathics and similar alternative therapeutics are not suitable because they contain no or virtually no iron. It would be malpractice to try to remedy an iron deficiency with such medicines.

Prevention

• Iron-containing foods, watch for factors that enhance and worsen absorption.
• General or selective fortification of foods with iron (analogous to iodine in table salt, folic acid in bread), for example, iron-rich breakfast cereals for children.
• Oral iron supplements. Iron is included, for example, in the multivitamin preparations for pregnancy and lactation.