Iron deficiency is the most common nutritional disorder
worldwide; the low blood counts that result can be caused by inadequate iron
intake, decreased iron absorption, increased iron demand and increased iron
loss. Iron is a building block for making new red blood cells.
The diagnosis of iron deficiency is quite straightforward
with some simple blood tests. Once the deficiency is identified, the goal is to
determine the cause. Excessive menstruation is a common cause in premenopausal
women. In men and postmenopausal women blood loss via the gastrointestinal
tract is suspect. The first step in evaluating the GI tract includes upper
endoscopy and colonoscopy. These tests will both look for source of blood loss
and celiac disease. The tests will need to be repeated if initially negative
and the patient doesn’t respond to treatment.
The initial treatment is oral iron, which can truly be a
tough pill to swallow. Common side-effects are chest pain, nausea, diarrhea and
constipation. Side-effects are less when iron is taken with food, but the iron
may not be as well absorbed. Certain medications (stomach acid blockers) are
associated with decreased absorption as well. Intravenous iron may be considered
if oral therapy is not effective in raising the blood count.
Since the red blood cells carry oxygen, a very low blood
count can be life-threatening and the patient will be transfused. There is no
universal guideline as when to transfuse – the clinical condition will
determine the threshold. In pregnancy, the health of the fetus is a concern.
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