Anaemia is the term medical personnel use when a person has too few red blood cells. Red blood cells are the cells in your blood that carry oxygen. If you have too few red blood cells, your body does not get all the oxygen it needs. Anaemia can be caused by a number of different conditions, including heavy menstrual periods, cancer, bleeding in the digestive tract, and sickle cell disease, just to name a few. Iron deficiency anaemia is a specific type of anaemia that is almost always caused by blood loss. Very rarely, decreased absorption of iron from foods can contribute to iron deficiency anaemia. Iron deficiency anaemia can be mild or severe, and can be temporary or chronic. The condition is common worldwide, affecting one to two per cent of adults. It is even more common in developing countries, primarily due to deficiencies of iron in their diet. Iron deficiency anaemia occurs when there is an insufficient amount of iron in the body to make haemoglobin (haemoglobin — usually abbreviated as just HB — is a substance that carries oxygen in the red blood cells and iron is a critical component of this haemoglobin). When the quantity of haemoglobin is reduced, red blood cells carry less oxygen throughout the body. However, a person may not have signs or symptoms of anaemia until their haemoglobin level is reduced by 20 per cent or more. Many people with iron deficiency anaemia have no symptoms at all and the symptoms might show up as the degree of anaemia that one has becomes worse. Of those who do, the most common symptoms might include; weakness, headache, irritability, fatigue, difficulty exercising (due to shortness of breath or rapid heartbeat). Less common symptoms of iron deficiency include brittle nails, sore tongue, abnormal craving to eat non-food items such as clay or dirt, paper products, or starch and more rarely, other people abnormally start craving to eat ice. Generally, the two common causes of iron deficiency anaemia are blood loss (most common) and very rarely decreased absorption of iron from food. The source of blood loss may be obvious, such as repeated blood donations, trauma, surgery, or in women who have heavy menstrual bleeding or multiple pregnancies over a short period of time. In other cases, the source of the blood loss is not visible, as in someone who has bleeding in their digestive tract, or someone with bleeding ulcers in the stomach or duodenum, intestinal parasite infestation, or hook worms, bleeding cancer of the intestines or elsewhere. Normally, the body absorbs iron from food through the gastrointestinal tract. If the GI tract is not functioning correctly, as in people with certain conditions (e.g., celiac disease, gastritis), an inadequate amount of iron may be absorbed, leading to iron deficiency anaemia. This is a much less common cause of iron deficiency anaemia than blood loss. A common cause of iron deficiency anaemia in developing countries is a lack of foods that contain iron. However, this is a rare problem in adults in developed countries because many foods have added iron (e.g., breakfast cereal, bread, pasta). Vegetarians are at increased risk for developing iron deficiency anaemia because iron from plant sources is not absorbed as readily as iron from meat sources. Vegetarian sources of iron are discussed below. Pregnant women often develop iron deficiency anaemia because of the increased iron requirements of the growing foetus and placenta, and the increased volume of blood circulating in the woman’s body during pregnancy, hence given iron supplements during their antenatal care to prevent iron deficiency anaemia. A person may be diagnosed with iron deficiency anaemia after blood testing done to evaluate symptoms, or after testing done for another unrelated reason. The initial workup generally involves a medical history, physical examination, and blood tests are done, where the value of one’s haemoglobin, among other red blood cell parameters, can be found to be reduced in someone with anaemia. Once the history, physical exam and these routine blood test results indicate anaemia, more specific blood tests are done to confirm that the person’s anaemia is caused by iron deficiency. The treatment for iron deficiency anaemia is an iron supplement as well as treating the cause of blood loss (such as stomach or intestinal ulcers, intestinal parasites, bleeding tumours, heavy menstrual periods). These supplements may be taken by mouth or given as an injection (called parenteral iron). This iron is needed to increase production of haemoglobin and also to rebuild the body’s iron reserves. Oral iron tablets are recommended in most people with iron deficiency anaemia. Injections of iron are usually reserved for people whose digestive tract is unable to adequately absorb iron, or in those who are unable to tolerate oral iron. A blood transfusion may be given if a person is actively bleeding and/or the person’s haemoglobin or haematocrit levels are very low. Dr. Ian Shyaka Resident in Surgery, Rwanda Military Hospital, iangashugi@gmail.com
