Iron deficiency anemia (IDA) is one of the most severe nutritional deficiencies in the world. It is a condition where one has inadequate amounts of iron to meet body demands such as during periods of rapid growth and pregnancy. The WHO estimates that as many as 4-5 billion people may be iron deficient and as many as 2 billion people are anemic, mainly due to iron deficiency. In developing countries, iron deficiency is frequently exacerbated by malaria and hookworm infections.
Iron deficiency anemia is known to impair psychomotor development, affects physical activity and work capacity, lowers resistance to infection and adversely affects birth outcomes and infant and maternal survival. This public health problem affects all age groups to varying degrees.
Iron deficiency also increases a child's susceptibility to lead (Pb) toxicity. When iron is unavailable, lead (Pb) replaces iron in the absorptive pathway. A healthy iron status largely prevents lead absorption. Severe chronic iron deficiency anemia in children has been reported to cause irreversible harm to their learning capability.
Iron-deficiency anemia may be caused by the following:
Iron is obtained from foods in our diet but only a small part of that iron is absorbed into the blood circulation. Many food components, particularly phytates, form insoluble iron complexes and therefore inhibit iron absorption. A person unable to have a balanced iron-rich diet may suffer from some degree of iron-deficiency anemia.
An increased iron requirement and increased red blood cell production is required when the body is going through changes such as growth spurts in children and adolescents, or during pregnancy and lactation.
Mal-absorption of iron is common after some forms of gastrointestinal surgeries. Most of the iron taken in by foods is absorbed in the upper small intestine. Any abnormalities in the gastrointestinal (GI) tract could alter iron absorption and result in iron-deficiency anemia.
Loss of blood can cause a decrease of iron and result in iron-deficiency anemia. Sources of blood loss may include GI bleeding, menstrual bleeding, or injury.
Anemia develops slowly after the normal stores of iron have been depleted in the body and in the bone marrow. Women, in general, have smaller stores of iron than men and have increased loss through menstruation, placing them at higher risk for anemia than men. In men and postmenopausal women, anemia is usually caused by gastrointestinal blood loss associated with ulcers, the use of aspirin or nonsteroidal anti-inflammatory medications (NSAIDS), or certain types of cancer (esophagus, stomach, colon).
High-risk groups include women of child-bearing age who have blood loss through menstruation; pregnant or lactating women who have an increased requirement for iron; infants, children ,and adolescents in rapid growth phases; and people with a poor dietary intake of iron. Risk factors related to blood loss are peptic ulcer disease, long term aspirin use and colon cancer.
There may be no symptoms if anemia is mild. The following are the most common symptoms of iron-deficiency anemia. However, each individual may experience symptoms differently. Symptoms may include:
 pale skin color
irritability
lack of energy
increased heart rate (tachycardia)
sore or swollen tongue
enlarged spleen
unusual food cravings (a condition called pica), i.e. dirt or ice
decreased appetite (especially in children)
headache - frontal
blue tinge to sclerae (whites of eyes)
Hemoglobin and serum ferritin are the most common ways to test for anemia. A new test called serum transferrin receptor is a good way to determine iron deficiency anemia because this test is not affected by inflammation.
Low hematocrit and hemoglobin (red blood cell measures)
Small red blood cells
Low serum ferritin
Low serum iron level
Low percentage of transferrin iron saturation
High iron binding capacity (TIBC) in the blood
High serum transferrin receptor
There are several intervention strategies to reduce the prevalence of iron deficiency anemia. They are:
Improved dietary selection.
Supplementation of vulnerable individuals such as infants and pregnant women
Fortification of staple foods and commonly used condiments with bioavailable iron fortification.
It is widely accepted that food fortification is the most suitable form of intervention strategies. Improving dietary selection may not be practical in the face of economic constraints and religious beliefs. Supplementation of vulnerable individuals only treats the individuals and does not treat the wider population base which may be iron-deficient. Supplementation is relatively more expensive. Food fortification, on the other hand, is cost-effective, sustainable, and reaches wide population base.
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