Signs and Symptoms of Iron Deficiency Anemia (IDA)[1-6]
- Pale skin
- An elevated platelet count
- Inflamed tongue (glossitis)
- Spoon nails
- Blue sclerae
- Restless leg syndrome
- Pica -A craving for peculiar substances such as soil or clay or an
abnormal appetite for foods such as cornstarch, tomatoes, lemons, and ice.
The U.S. Preventive Services Task Force (USPSTF)  and the Centers for Disease
Control and Prevention (CDC) recommend routine screening for iron deficiency
anemia in pregnant women . During pregnancy the hemoglobin concentration
declines during the first and second trimesters because of an increase in blood
volume . Therefore, it is recommended anemia criteria for the specific stage
of pregnancy be used .
|| Hemoglobin (g/dL)
For African-American adults, the Institute
of Medicine recommends lowering the cutoff levels for Hgb and Hct by 0.8
g/dL and 2%, respectively (12).
In women who are otherwise healthy anemia may be treated by prescribing an oral
dose of 60-120 mg/day of iron. Counsel pregnant women about
iron-deficiency anemia through diet.
If after 4 weeks the anemia does not
respond to iron treatment (the woman remains anemic for her stage of pregnancy
and Hb concentration does not increase by 1 g/dL or Hct by 3%) despite
compliance with an iron supplementation regimen and the absence of acute
illness, further evaluate the anemia by using other tests, including serum
ferritin concentration, RDW, and MCV
|Serum Ferrtin value
|<=45 ng per mL
||Not likely to be
Evaluate for other causes of anemia.
|= 46 to 99
iron-binding capacity ( TIBC) ,serum
iron (FE), and transferrin saturation (TSAT)
TIBC is increased, serum iron is decreased , and transferrin saturation is
decreased then most likely iron deficiency.
Probable iron deficiency
TIBC is decreased, serum iron is increased , and transferrin saturation is
increased then not likely to be iron deficiency.
Evaluate for other causes of anemia
Red blood cell distribution width (RDW)
The RDW is usually elevated early in iron deficiency , but may also occur
with vitamin B12 or folic acid deficiency . However,
vitamin B12 or folic acid deficiency results in blood cells that are
larger than normal (macrocytic anemia) whereas, iron deficiency leads to the
production of small red blood cells with an MCV of less than 80 fL (microcytic
Mean corpuscular volume (MCV)
An MCV of less than 80 fL (microcytic anemia) is consistent with iron
deficiency, but is not specific for iron deficiency. A low MCV may also be
seen with beta thalassemia trait
and α-thalassemia-1 trait, anemia of chronic disease , and acquired or
hereditary sideroblastic anemia.
- Anemia of chronic
disease (ACD) is the second most common form of anemia, next to iron
deficiency anemia. Although the red blood cells in ACD are usually
normal sized (normocytic), the cells may sometimes be microcytic. In
ACD the serum ferritin will be normal or increased and the the serum iron and
TIBC will be low, because underlying long standing systemic inflammatory disease
or malignancy causes an increase in the production of ferritin by
macrophages (white blood cells) and suppresses the production of red blood
cells by the bone marrow. Iron becomes trapped in the macrophages and is
unavailable for hemoglobin synthesis.
- In patients with thalassemia minor, the RDW is usually normal. The
American College of Obstetricians and Gynecologists
recommends that women of Southeast Asian or Mediterranean ancestry with a low
MCV and normal iron status should be offered
hemoglobin electrophoresis. All individuals of African descent should be
offered hemoglobin electrophoresis regardless of their red blood cell indices.
Acquired or hereditary sideroblastic
anemia may also present with an elevated RDW and low MCV. However, serum iron
and serum ferritin are increased in sideroblastic anemia, because red blood
cells are unable to use available iron to make hemoglobin. Instead the iron
accumulates in the red cell mitochondria producing sideroblasts.
Once the diagnosis of iron deficiency has been made the evaluation
should continue to determine its cause.
Causes of Iron
Sources of Dietary Iron
1.Brittenham GM.Disorders of iron metabolism: iron deficiency and overload.In: Hoffman R, Benz EJ
Jr, Skikne B, et al, eds. Hematology: Basic Principles and Practice. 4th ed. New York, NY: Churchill Livingstone; 2004:481-487.
2. Sun ER, Chen CA, Ho G, Earley CJ, Allen RP. Iron and
the restless legs syndrome. Sleep. 1998;21(4):371–377.
3. O’Keeffe ST, et al.. Iron status and
restless legs syndrome in the elderly.Age Ageing.
4.Kettaneh A.,et al, Pica and food craving in patients with iron deficiency
anemia: a case-control study in France.Am J Med 118.185-188.2005
5.&Mills M.E.Craving more than food: the implications of pica in pregnancy. Nurs Womens Health 11.:
6. Kathula SK Am J Med - 01-JUL-2008;Craving
Lemons: Another Form of Pica in Iron Deficiency
7. U.S. Preventive Services Task Force. Screening for Iron Deficiency
Anemia—Including Iron Supplementation for Children and Pregnant Women:
Recommendation Statement. Publication No. AHRQ 06-0589, May 2006. Agency
for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf06/ironsc/ironrs.htm
Centers for Disease Control and Prevention. Recommendations to prevent and
control iron deficiency in the United States.MMWR Recomm Rep.1998 47(RR-3):1>–29.
9. Hytten FE, Paintin DB. Increase in plasma
volume during normal pregnancy. J Obstet Gynaecol Br Commonw 1963;70:402-7.
10. Ginder GD. Microcytic and hypochromic anemias.
In: Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 23rd
ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 163.
11.Dugdale M. Obstet Gynecol Clin North Am.
2001;28:363-381; Jacobs, DS, et al. Jacobs & DeMott Laboratory Test Handbook
With Key Word Index. 5th ed. Cleveland, OH: Lexi-Comp, Inc; 2001.
12. Institute of Medicine (US). Iron deficiency anemia: recommended guidelines
for the prevention, detection, and management among U.S. children and women of
childbearing age. Washington, DC: National Academy Press; 1993.
13. Hemoglobinopathies in pregnancy. ACOG Practice Bulletin No. 78. American
College of Obstetricians and Gynecologists. Obstet Gynecol 2007;109:229–37.
14. Helms RA, Herfindal ET, et al. Textbook of Therapeutics: Drug and Disease Management. Lippincott Williams & Wilkins, 2006. p 800
15. Killip S , et al., Iron deficiency anemia.Am Fam Physician.
2007 Mar 1;75(5):671-8. PMID:17375513
16. Ioannou GN, et al. ,Prospective evaluation of a clinical guideline for the diagnosis and
management of iron deficiency anemia.Am J Med. 2002 Sep;113(4):281-7.
17. Ontario Association of
Medical Laboratories. Guidelines for the use of serum tests for iron
deficiency. Guidelines for Clinical Laboratory Practice CLP 002. North York
(ON): OAML; 1995. Available at: http://www.oaml.com/ PDF/CLP002.pdf. Retrieved
April 4, 2008.