Iron deficiency anaemia (IDA) is a common haematological disorder caused by inadequate iron availability for erythropoiesis, leading to reduced haemoglobin synthesis. It is particularly prevalent among:

• Young children

• Women of reproductive age

• Pregnant women

Etiology:

• Nutritional deficiency: Inadequate dietary iron intake

• Chronic blood loss: Menstrual bleeding, gastrointestinal bleeding (ulcers, polyps, malignancy), parasitic infections

• Increased demand: Pregnancy, rapid growth in infants and adolescents

• Malabsorption: Coeliac disease, bariatric surgery

Pathophysiology:

• Iron is essential for haemoglobin synthesis, myoglobin, and iron-containing enzymes.

• Iron deficiency reduces Hb production → microcytic, hypochromic red blood cells → impaired oxygen delivery to tissues.

• Chronic deficiency may lead to developmental delays in children and reduced work capacity in adults.

Note: In children > 5 years, adult males, and non-menstruating women, iron deficiency anaemia usually suggests occult or overt blood loss until proven otherwise.

2. Risk Factors

• Age: Infants, children under 5 years

• Gender: Women of reproductive age

• Pregnancy: Increased iron demand

• Dietary insufficiency: Vegetarian diets, poverty, poor nutrition

• Blood loss: Menorrhagia, gastrointestinal bleeding

• Malabsorption syndromes: Coeliac disease, post-gastric surgery

• Parasitic infections: Hookworm, schistosomiasis

• Chronic illnesses: Chronic kidney disease, inflammatory bowel disease

3. Signs and Symptoms

General Symptoms

• Fatigue, weakness, lethargy

• Shortness of breath on exertion

• Dizziness, palpitations

• Headache

• Pale skin, especially conjunctiva and palms

Specific Features of Chronic Iron Deficiency

• Brittle nails (koilonychia)

• Glossitis (smooth, inflamed tongue)

• Angular cheilitis

• Pica (craving for non-food substances)

• Cognitive impairment in children

• Poor growth and delayed development

4. Diagnostic Criteria

Additional clues:

• Raised red cell distribution width (RDW)

• Reticulocyte count: low or inappropriately normal

• Consider gastrointestinal workup if adult male or postmenopausal female

5. Investigations

Basic Laboratory Tests

• Complete blood count (CBC)

• Peripheral blood smear

• Serum ferritin

• Serum iron

• Total iron-binding capacity (TIBC)

• Transferrin saturation

• Reticulocyte count

Additional Investigations (if indicated)

• Stool for occult blood

• Endoscopy / colonoscopy (adults with suspected GI bleeding)

• Parasitology (hookworm, schistosomiasis)

• Renal and liver function tests

• Screen for celiac disease in malabsorption

6. Management

A. Non-Pharmacological Measures

1. Identify and Treat Cause

• Exclude other causes of anaemia (B12, folate deficiency, chronic disease)

• Address sources of blood loss

• Treat underlying parasitic infections

2. Dietary Advice

• Increase heme iron sources: liver, kidney, beef, poultry, fish

• Increase non-heme iron sources: green leafy vegetables, dried beans, peas, fortified cereals, wholegrain bread

• Increase iron absorption: vitamin C-rich foods (citrus, strawberries, guavas, broccoli)

• Avoid tea or coffee with meals (polyphenols inhibit absorption)

• For children: ensure age-appropriate iron intake

B. Pharmacological Treatment

i. Children <5 Years

• Oral elemental iron: 1–2 mg/kg/dose, 8-hourly with meals

• Follow-up Hb: After 14 days

• If improving: continue and reassess in 28 days

• Continue for 3 months after Hb normalization to replenish stores

ii. Adults

• Ferrous sulfate BPC (170 mg ≈ 65 mg elemental iron) 8-hourly with meals

• Ferrous fumarate (200 mg ≈ 65 mg elemental iron) 8-hourly with meals

• Expected response: Hb rise ≥2 g/dL in 4 weeks

• Continue for 3–6 months after normalization to restore iron stores

• Avoid iron tablets within 4 hours of calcium supplements

iii. Pregnant Women

• Ferrous sulfate BPC 170 mg 12-hourly

• Supplementation crucial to prevent maternal and fetal anaemia

iv. Infants <6 months (<2.5 kg at birth)

• Ferrous lactate 0.3 mL PO daily until 6 months

• OR Ferrous gluconate syrup 0.8 mL PO daily until 6 months

7. Monitoring

• Hb check: 2–4 weeks after starting therapy

• MCV and ferritin: after 8–12 weeks

• Assess adherence and side effects (constipation, nausea, dark stools)

• If poor response: investigate for other causes (malabsorption, ongoing bleeding)

8. Prevention

• Promote balanced diet rich in iron and vitamin C

• Use fortified cereals and foods

• Routine iron supplementation in pregnancy

• Deworming programs for children in endemic areas

• Screening for occult blood loss in adults at risk

9. Complications if Untreated

• Severe anaemia → heart failure, growth retardation in children

• Developmental delays

• Reduced immunity → increased infections

• Fatigue, poor work capacity