I ron deficiency anemia (IDA), the most common form of anemia, is a condition in which there is a decrease in normal body stores of iron and hemoglobin levels. IDA is caused by inadequate intake of iron, inadequate storage of iron, excessive loss of iron, or some combination of these conditions. The red blood cells (RBCs), which become pale (hypochromic) and small (microcytic), have a decreased ability to transport oxygen in sufficient quantities to meet body needs. Anemia is defined as a decrease in circulating RBC mass; the usual criteria for anemia are hemoglobin of less than 12 g/dL with a hematocrit less than 36% in women and hemoglobin less than 14 g/dL with a hematocrit less than 41% in men.
Generally, IDA is more common in people who are economically disadvantaged because of the high cost of a well-balanced diet with iron-rich foods. Complications from IDA include infection and pneumonia. For patients suffering from pica (the urge to eat clay and other inappropriate items), lead poisoning may result from increased intestinal absorption of lead. Although it is a rare condition, Plummer-Vinson syndrome (IDA associated with difficulty swallowing, enlarged spleen, and spooning of the nails) may occur in severe cases of IDA, especially in middle-aged women who have recently had their teeth extracted.
The most common causes of IDA are menstrual blood loss and the increased iron requirements of pregnancy. Pathological bleeding, particularly gastrointestinal (GI) bleeding, is a common cause of iron depletion in men. Iron malabsorption can lead to IDA. Pathological causes include GI ulcers, hiatal hernias, malabsorption syndromes such as celiac disease, chronic diverticulosis, varices, and tumors. Other causes include surgeries such as partial gastrectomy and the use of prosthetic heart valves or vena cava filters.
There are no documented heritable syndromes that cause an isolated iron deficiency, but the possibility has not been excluded. There are known causes of iron overload including hereditary hemochromatosis (HHC), which follows an autosomal recessive transmission pattern.
Infants under the age of 2 years may develop IDA in situations of prolonged unsupplemented breastfeeding or bottle-feeding; breast milk has some iron, but cow's milk yields none. During periods of rapid growth in childhood, adolescence, and pregnancy, patients may ingest inadequate supplies of iron. Young women, in particular, are at risk as a result of heavy menses or unwise weight-reduction plans, and in the United States, females have a higher incidence of IDA than do males. During child-bearing years, adult females lose an average of 2 mg of iron daily that must be replaced nutritionally, whereas men lose only 1 mg of iron per day. Women at highest risk for IDA are minority women who live in urban poverty. Elderly patients with a poor diet and people who are alcohol dependent who fail to eat a well-balanced diet may also ingest inadequate supplies of iron.
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