Iron deficiency anemia: Clinical sciences

Iron deficiency anemia is a condition that occurs when the body lacks sufficient iron to produce enough healthy red blood cells.

Iron plays a vital role in the production of hemoglobin, which is the protein responsible for carrying oxygen in red blood cells. So, when iron levels are low, the body is unable to produce an adequate amount of hemoglobin, leading to a decrease in red blood cell production, and subsequent anemia. While history and physical examination findings can provide hints to iron deficiency anemia, confirming the diagnosis requires laboratory tests, primarily iron studies and a peripheral blood smear.

Now, if your patient presents with a chief concern suggestive of iron deficiency anemia, first, you should start with a focused history and physical examination.

History typically reveals vague symptoms like fatigue and dizziness, as well as palpitations and dyspnea on exertion, which manifest as compensatory responses to inadequate tissue oxygen supply.

Other symptoms may include pica, which is the compulsive consumption of non-nutritive substances like dirt or ice. Some patients may also develop Plummer-Vinson syndrome, which is characterized by the triad of iron deficiency anemia, esophageal webs, and dysphagia.

Additionally, some patients with iron deficiency may experience restless leg syndrome. Be sure to assess your patient’s nutritional history, since they might have a diet deficient in iron-rich foods. For example, the patient might report that they seldom eat red meat, leafy greens, and fortified grains, which are all rich in iron!

Next, your patient may have a history of gastrointestinal absorption problems that would prevent them from absorbing adequate dietary iron. These include inflammatory bowel disease, Helicobacter pylori infection, celiac disease, or a history of gastrointestinal surgery, such as bariatric surgery.