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Iron deficiency, or sideropenia, is the state in which a body lacks enough
iron Iron () is a chemical element In chemistry Chemistry is the study of the properties and behavior of . It is a that covers the that make up matter to the composed of s, s and s: their composition, structure, properties, behav ...

iron
to supply its needs. Iron is present in all
cell Cell most often refers to: * Cell (biology) The cell (from Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken in the area around ...
s in the
human body The human body is the structure of a Human, human being. It is composed of many different types of Cell (biology), cells that together create Tissue (biology), tissues and subsequently organ systems. They ensure homeostasis and the life, viabi ...

human body
and has several vital functions, such as carrying
oxygen Oxygen is the chemical element Image:Simple Periodic Table Chart-blocks.svg, 400px, Periodic table, The periodic table of the chemical elements In chemistry, an element is a pure substance consisting only of atoms that all have the same ...

oxygen
to the tissues from the
lung The lungs are the primary organs An organ is a group of tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given organ's tissues can be broadly categorized as parenchyma ...
s as a key component of the
hemoglobin Hemoglobin or haemoglobin (spelling differences Despite the various English dialects Dialect The term dialect (from Latin , , from the Ancient Greek word , , "discourse", from , , "through" and , , "I speak") is used in two distinct wa ...

hemoglobin
protein, acting as a transport medium for electrons within the cells in the form of
cytochrome Cytochromes are redox-active protein Proteins are large biomolecule , showing alpha helices, represented by ribbons. This poten was the first to have its suckture solved by X-ray crystallography by Max Perutz and Sir John Cowdery Kendr ...
s, and facilitating oxygen
enzyme Enzymes () are proteins that act as biological catalysts (biocatalysts). Catalysts accelerate chemical reactions. The molecules upon which enzymes may act are called substrate (chemistry), substrates, and the enzyme converts the substrates in ...

enzyme
reactions in various tissues. Too little iron can interfere with these vital functions and lead to
morbidity A disease is a particular abnormal condition that negatively affects the structure A structure is an arrangement and organization of interrelated elements in a material object or system A system is a group of Interaction, interact ...
and
death Death is the permanent, irreversible cessation of all biological functions that sustain a living Living or The Living may refer to: Common meanings *Life, a condition that distinguishes organisms from inorganic objects and dead organi ...

death
. Total body iron averages approximately 3.8 g in men and 2.3 g in women. In
blood plasma Blood plasma is a yellowish liquid component of blood Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrients and oxygen to the Cell (biology), cells and transports metabolic waste products ...
, iron is carried tightly bound to the protein
transferrin Transferrins are glycoproteins found in Vertebrate, vertebrates which bind to and consequently mediate the transport of Iron (Fe) through blood plasma. They are produced in the liver and contain binding sites for two Iron(III), Fe3+ ions. Human ...

transferrin
. There are several mechanisms that control
iron metabolism Human iron metabolism is the set of chemical reactions that maintain human homeostasis In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical pr ...

iron metabolism
and safeguard against iron deficiency. The main regulatory mechanism is situated in the gastrointestinal tract. The majority of iron absorption occurs in the
duodenum The duodenum is the first section of the small intestine The small intestine or small bowel is an organ (anatomy), organ in the human gastrointestinal tract, gastrointestinal tract where most of the #Absorption, absorption of nutrients from foo ...

duodenum
, the first section of the small intestine. A number of dietary factors may affect iron absorption. When loss of iron is not sufficiently compensated by intake of iron from the diet, a state of iron deficiency develops over time. When this state is uncorrected, it leads to
iron-deficiency anemia Iron-deficiency anemia is anemia caused by a iron deficiency, lack of iron. Anemia is defined as a decrease in the number of red blood cells or the amount of hemoglobin in the blood. When onset is slow, symptoms are often vague such as Fatigue (me ...
, a common type of anemia. Before
anemia Anemia (American and British English spelling differences#ae and oe, also spelled anaemia) is a decrease in the total amount of red blood cells (RBCs) or hemoglobin in the blood, or a lowered ability of the blood to carry oxygen. When anemia c ...

anemia
occurs, the medical condition of iron deficiency without anemia is called
latent iron deficiency Latent iron deficiency (LID), also called iron-deficient erythropoiesis, is a medical condition in which there is evidence of iron deficiency without anemia (normal hemoglobin Hemoglobin or haemoglobin (spelling differences Despite the ...
(LID). Anemia is a condition characterized by inadequate
red blood cells Red blood cells (RBCs), also referred to as red cells, red blood corpuscles (in humans or other animals not having nucleus in red blood cells), haematids, erythroid cells or erythrocytes (from Greek ''erythros'' for "red" and ''kytos'' for "holl ...

red blood cells
(erythrocytes) or hemoglobin. When the body lacks sufficient amounts of iron, production of the protein hemoglobin is reduced. Hemoglobin binds to oxygen, enabling red blood cells to supply oxygenated blood throughout the body. Women of child-bearing age, children, and people with poor diet are most susceptible to the disease. Most cases of iron-deficiency anemia are mild, but if not treated can cause problems like an
irregular heartbeat Arrhythmia, also known as cardiac arrhythmia or heart arrhythmia, is a group of conditions in which the Cardiac cycle, heartbeat is irregular, too fast, or too slow. The heart rate that is too fast – above 100 beats per minute in adults – i ...
,
pregnancy complication Complications of pregnancy are health problems that are related to pregnancy Pregnancy, also known as gestation, is the time during which one or more offspring In biology, offspring are the young creation of living organisms, produced ei ...
s, and
delayed growth Child development involves the biological Biology is the natural science Natural science is a branch of science Science (from the Latin word ''scientia'', meaning "knowledge") is a systematic enterprise that Scientific method, b ...
in infants and children that could affect their cognitive development and their behavior.


Signs and symptoms

Symptoms of iron deficiency can occur even before the condition has progressed to iron deficiency anemia. Symptoms of iron deficiency are not unique to iron deficiency (i.e. not
pathognomonic Pathognomonic (rare synonym ''pathognomic'') is a term, often used in medicine Medicine is the science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity, awareness, or understanding o ...
). Iron is needed for many enzymes to function normally, so a wide range of symptoms may eventually emerge, either as the secondary result of the anemia, or as other primary results of iron deficiency. Symptoms of iron deficiency include: *
fatigue Fatigue describes a state of tiredness that does not resolve with rest or sleep. In general usage, fatigue is synonymous with extreme tiredness or exhaustion that normally follows prolonged physical or mental activity. When it does not resolve ...
*
dizziness Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo Vertigo is a condition where a person has the sensation of moving or of surrounding objects moving when they are not. Often it feels like a spinnin ...

dizziness
/
lightheadedness Lightheadedness is a common and typically unpleasant sensation of dizziness Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to disequilibrium or a non-speci ...
*
pallor Pallor is a pale color of the skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other cuticle, animal coverings, such as ...
*
hair loss Hair loss, also known as alopecia or baldness, refers to a loss of hair Hair is a protein filament In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, ...
* twitches *
irritability Irritability is the excitatory ability that living organisms In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecular b ...
*
weakness Weakness is a symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressu ...
* pica *
brittle A material is brittle if, when subjected to stress, it fracture Fracture is the separation of an object or material into two or more pieces under the action of stress. The fracture of a solid usually occurs due to the development of cer ...
or grooved nails * hair thinning *
Plummer–Vinson syndrome Plummer–Vinson syndrome is a rare disease characterized by Dysphagia, difficulty swallowing, iron-deficiency anemia, glossitis, cheilosis and esophageal webs. Treatment with iron supplementation and mechanical widening of the esophagus generally ...
: painful atrophy of the
mucous membrane A mucous membrane or mucosa is a biological membrane, membrane that lines various cavities in the body and covers the surface of internal organs. It consists of one or more layers of Epithelium, epithelial cells overlying a layer of loose connect ...
covering the
tongue The tongue is a muscular organ (anatomy), organ in the mouth of a typical tetrapod. It manipulates food for mastication and swallowing as part of the digestive system, digestive process, and is the primary organ of taste. The tongue's upper surfa ...

tongue
, the
pharynx The pharynx (plural: pharynges) is the part of the throat behind the human mouth, mouth and nasal cavity, and above the esophagus and trachea – the tubes going down to the stomach and the lungs. It is found in vertebrates and invertebrates, thou ...
and the
esophagus The esophagus (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of variety (linguistics), varieties of the English language native to the United State ...

esophagus
* impaired
immune function The immune system is a network of biological processes that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to parasitic worms, as well as Tumor immunology, cancer cells and objects such ...
* pagophagia *
restless legs syndrome Restless legs syndrome (RLS), now known as Willis-Ekbom Disease (WED), is generally a long-term disorder that causes a strong urge to move one's legs. There is often an unpleasant feeling in the legs that improves somewhat by moving them. This i ...
Continued iron deficiency may progress to
anemia Anemia (American and British English spelling differences#ae and oe, also spelled anaemia) is a decrease in the total amount of red blood cells (RBCs) or hemoglobin in the blood, or a lowered ability of the blood to carry oxygen. When anemia c ...

anemia
and worsening fatigue.
Thrombocytosis Thrombocythemia is a condition of high platelet Platelets, also called thrombocytes (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Re ...

Thrombocytosis
, or an elevated
platelet Platelets, also called thrombocytes (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. ...

platelet
count, can also result. A lack of sufficient iron levels in the blood is one reason that some people cannot donate blood.


Signs and symptoms in children

*
pale skin Pallor is a pale color of the skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other cuticle, animal coverings, such as ...
*
fatigue Fatigue describes a state of tiredness that does not resolve with rest or sleep. In general usage, fatigue is synonymous with extreme tiredness or exhaustion that normally follows prolonged physical or mental activity. When it does not resolve ...

fatigue
* slowed growth and development *
poor appetite Anorexia is a decreased appetite. While the term in non-scientific publications is often used interchangeably with anorexia nervosa, many possible causes exist for a decreased appetite, some of which may be harmless, while others indicate a serio ...
*
behavioral problems ''Behavioral Problems'' is an album and DVD by American comedian Ron White. The album was released by Capitol Records on April 21, 2009 and peaked at number 1 on the ''Billboard (magazine), Billboard'' Top Comedy Albums chart. The DVD was also re ...
* abnormal rapid breathing * frequent
infection An infection is the invasion of an organism's body tissues by disease-causing agents, their multiplication, and the reaction of host A host is a person responsible for guests at an event or for providing hospitality during it. Host may ...

infection


Iron requirements in young children to teenagers


Causes

* blood loss (
hemoglobin Hemoglobin or haemoglobin (spelling differences Despite the various English dialects Dialect The term dialect (from Latin , , from the Ancient Greek word , , "discourse", from , , "through" and , , "I speak") is used in two distinct wa ...

hemoglobin
contains iron) ** donation ** excessive menstrual bleeding ** non-menstrual
bleeding Bleeding, also known as a hemorrhage, haemorrhage, or simply blood loss, is blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid A liquid is a nearly incompressible In fluid mechanics or more generally ...

bleeding
** bleeding from the
gastrointestinal tract The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system The human digestive system consists of the gastrointestinal tract The gastrointestinal tract, (GI tract, GIT, d ...
(
ulcers An ulcer is a discontinuity or break in a bodily membrane that impedes normal function of the affected organ. According to Robins's pathology, "ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing ou ...

ulcers
,
hemorrhoid Hemorrhoids (or haemorrhoids), also known as piles, are vascular The blood vessels are the components of the circulatory system The circulatory system, also called the cardiovascular system or the vascular system, is an Biological sys ...

hemorrhoid
s,
ulcerative colitis Ulcerative colitis (UC) is a long-term condition that results in inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogen In biology Biology i ...

ulcerative colitis
,
stomach The stomach is a muscular, in the of humans and many other animals, including several s. The stomach has a dilated structure and functions as a vital organ. In the digestive system the stomach is involved in the second phase of digestion, ...
or
colon cancer Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of th ...

colon cancer
, etc.) ** rarely, laryngological bleeding or from the
respiratory tract The respiratory tract is the subdivision of the respiratory system The respiratory system (also respiratory apparatus, ventilatory system) is a biological system A biological system is a complex network Network and networking may refer to: ...

respiratory tract
* inadequate intake (see below) * substances (in diet or drugs) interfering with iron absorption ** Fluoroquinolone antibiotics *
malabsorption Malabsorption is a state arising from abnormality in absorption Absorption may refer to: Chemistry and biology *Absorption (chemistry), diffusion of particles of gas or liquid into liquid or solid materials *Absorption (skin), a route by which s ...
syndromes *
inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogen In biology Biology is the natural science that studies life and living organisms, including their anato ...
where it is
adaptive Adaptation, in biology, is the process or trait by which organisms or population better match their environment Adaptation may also refer to: Arts * Adaptation (arts), a transfer of a work of art from one medium to another ** Film adaptation, a ...
to limit bacterial growth in infection, but is also present in many other chronic diseases such as
Inflammatory bowel disease Inflammatory bowel disease (IBD) is a group of inflammatory Inflammatory may refer to: * Inflammation, a biological response to harmful stimuli * The word ''inflammatory'' is also used to refer literally to fire and flammability, and figuratively ...
and
rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and ...
* parasitic infection Though
genetic defects A genetic disorder is a health problem caused by one or more abnormalities in the genome. It can be caused by a mutation in a single gene (monogenic) or multiple genes (polygenic) or by a chromosomal abnormality. Although polygenic disorders are ...
causing iron deficiency have been studied in rodents, there are no known genetic disorders of
human iron metabolism Human iron metabolism is the set of chemical reactions that maintain human homeostasis of iron Iron () is a chemical element with Symbol (chemistry), symbol Fe (from la, Wikt:ferrum, ferrum) and atomic number 26. It is a metal that belongs to ...
that directly cause iron deficiency.


Athletics

Possible reasons that athletics may contribute to lower iron levels includes mechanical
hemolysis Hemolysis or haemolysis (), also known by several other names, is the rupturing (lysis Lysis ( ; Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the ...

hemolysis
(destruction of red blood cells from physical impact), loss of iron through sweat and urine, gastrointestinal blood loss, and haematuria (presence of blood in urine). Although small amounts of iron are excreted in sweat and urine, these losses can generally be seen as insignificant even with increased
sweat Perspiration, also known as sweating, is the production of fluids secreted by the sweat gland Sweat glands, also known as sudoriferous or sudoriparous glands, , are small tubular structures of the skin Skin is the layer of usually soft, f ...

sweat
and
urine Urine is a liquid by-product A by-product or byproduct is a secondary product derived from a production process, process or ; it is not the primary product or service being produced. A by-product can be useful and marketable or it can be cons ...

urine
production, especially considering that athletes' bodies appear to become conditioned to retain iron better. Mechanical hemolysis is most likely to occur in high-impact sports, especially among long-distance runners who experience "foot-strike hemolysis" from the repeated impact of their feet with the ground. Exercise-induced
gastrointestinal bleeding Gastrointestinal bleeding (GI bleed), also called gastrointestinal hemorrhage (GIB), is all forms of bleeding in the Human gastrointestinal tract, gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a sh ...
is most likely to occur in endurance athletes. Haematuria in athletes is most likely to occur in those that undergo repetitive impacts on the body, particularly affecting the feet (such as running on a hard road, or Kendo) and hands (e.g.
Conga The conga, also known as tumbadora, is a tall, narrow, single-headed drum from Cuba. Congas are stave (wood), staved like barrels and classified into three types: quinto (drum), quinto (lead drum, highest), tres dos or tres golpes (middle), and ...

Conga
or
Candombe ''Candombe'' is a style of music and dance that originated in Uruguay among the descendants of liberated Atlantic slave trade, African slaves. In 2009, the UNESCO, United Nations Educational, Scientific and Cultural Organization (UNESCO) inscrib ...
drumming). Additionally, athletes in sports that emphasize weight loss (e.g.
ballet Ballet () is a type of performance dance that originated during the Italian Renaissance in the fifteenth century and later developed into a concert dance form in France and Russia. It has since become a widespread and highly technical form of ...

ballet
,
gymnastics Gymnastics is a sport Sport pertains to any form of competitive Competition is a rivalry A rivalry is the state of two people or groups engaging in a lasting competitive relationship. Rivalry is the "against each other" spirit bet ...

gymnastics
,
marathon running The marathon is a long-distance foot race with a distance of , usually run as a road race, but the distance can be covered on trail routes. The marathon can be completed by running or with a run/walk strategy. There are also wheelchair ...
, and
cycling Cycling, also called bicycling or biking, is the use of bicycles for transport, recreation, Physical exercise, exercise or sport. People engaged in cycling are referred to as "cyclists", "bicyclists", or "bikers". Apart from two-wheeled bic ...
) as well as sports that emphasize high-
carbohydrate A carbohydrate () is a biomolecule , showing alpha helices, represented by ribbons. This poten was the first to have its suckture solved by X-ray crystallography by Max Perutz and Sir John Cowdery Kendrew in 1958, for which they received a ...
, low-
fat In nutrition Nutrition is the biochemical Biochemistry or biological chemistry, is the study of chemical processes within and relating to living organisms. A sub-discipline of both chemistry and biology, biochemistry may be divided ...

fat
diets, may be at an increased risk for iron deficiency.


Inadequate intake

A U.S. federal survey of food consumption determined that for women and men over the age of 19, average iron consumption from foods and beverages was 13.1 and 18.0 mg/day, respectively. For women, 16% in the age range 14–50 years consumed less than the Estimated Average Requirement (EAR), for men ages 19 and up, fewer than 3%. Consumption data were updated in a 2014 U.S. government survey and reported that for men and women ages 20 and older the average iron intakes were, respectively, 16.6 and 12.6 mg/day. People in the U.S. usually obtain adequate amounts of iron from their diets. However, subgroups like infants, young children, teenaged girls, pregnant women, and premenopausal women are at risk of obtaining less than the EAR. Socio-economic and racial differences further affect the rates of iron deficiency.


Bioavailability

Iron is needed for
bacterial growth 250px, Growth is shown as ''L'' = log(numbers) where numbers is the number of colony forming units per ml, versus ''T'' (time.) Bacterial growth is proliferation of bacterium Bacteria (; common noun bacteria, singular bacterium) are ubi ...

bacterial growth
making its
bioavailability In pharmacology, bioavailability (''BA or F'') is a subcategory of absorption and is the fraction (%) of an administered medication, drug that reaches the systemic circulation. By definition, when a medication is administered intravenously, its ...
an important factor in controlling
infection An infection is the invasion of an organism's body tissues by disease-causing agents, their multiplication, and the reaction of host A host is a person responsible for guests at an event or for providing hospitality during it. Host may ...

infection
.
Blood plasma Blood plasma is a yellowish liquid component of blood Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrients and oxygen to the Cell (biology), cells and transports metabolic waste products ...
as a result carries iron tightly bound to
transferrin Transferrins are glycoproteins found in Vertebrate, vertebrates which bind to and consequently mediate the transport of Iron (Fe) through blood plasma. They are produced in the liver and contain binding sites for two Iron(III), Fe3+ ions. Human ...

transferrin
, which is taken up by cells by endocytosing transferrin, thus preventing its access to bacteria. Between 15 and 20 percent of the protein content in
human milk Humans (''Homo sapiens'') are the most abundant and widespread species In biology, a species is the basic unit of biological classification, classification and a taxonomic rank of an organism, as well as a unit of biodiversity. A speci ...
consists of
lactoferrin Lactoferrin (LF), also known as lactotransferrin (LTF), is a multifunctional protein Proteins are large biomolecule , showing alpha helices, represented by ribbons. This poten was the first to have its suckture solved by X-ray crystallog ...

lactoferrin
that binds iron. As a comparison, in cow's milk, this is only 2 percent. As a result, have fewer infections. Lactoferrin is also concentrated in tears, saliva and at wounds to bind iron to limit bacterial growth.
Egg white Egg white is the clear liquid (also called the albumen or the glair/glaire) contained within an egg An egg is the organic vessel containing the in which an develops until it can survive on its own, at which point the animal hatches. An ...
contains 12% conalbumin to withhold it from bacteria that get through the egg shell (for this reason, prior to antibiotics, egg white was used to treat infections). To reduce bacterial growth, plasma concentrations of iron are lowered in a variety of systemic inflammatory states due to increased production of
hepcidin Hepcidin is a protein Proteins are large biomolecule , showing alpha helices, represented by ribbons. This poten was the first to have its suckture solved by X-ray crystallography by Max Perutz and Sir John Cowdery Kendrew in 1958, f ...
which is mainly released by the liver in response to increased production of pro-inflammatory cytokines such as
interleukin-6 Interleukin 6 (IL-6) is an interleukin Interleukins (ILs) are a group of cytokines (secreted proteins and signal molecules) that were first seen to be expressed by white blood cell White blood cells (WBCs), also called leukocytes or leucocy ...
. This functional iron deficiency will resolve once the source of inflammation is rectified; however, if not resolved, it can progress to anaemia of chronic inflammation. The underlying inflammation can be caused by
fever Fever, also referred to as pyrexia, is defined as having a temperature Temperature ( ) is a physical quantity that expresses hot and cold. It is the manifestation of thermal energy Thermal radiation in visible light can be seen on th ...

fever
,
inflammatory bowel disease Inflammatory bowel disease (IBD) is a group of inflammatory Inflammatory may refer to: * Inflammation, a biological response to harmful stimuli * The word ''inflammatory'' is also used to refer literally to fire and flammability, and figuratively ...
, infections,
chronic heart failure Heart failure (HF), also known as congestive heart failure (CHF) and (congestive) cardiac failure (CCF), is a set of manifestations caused by the failure of the heart The heart is a muscular MUSCULAR (DS-200B), located in the United Ki ...
(CHF), carcinomas, or following surgery. Reflecting this link between iron bioavailability and bacterial growth, the taking of oral
iron supplement Iron supplements, also known as iron salts and iron pills, are a number of iron Iron () is a chemical element In chemistry Chemistry is the study of the properties and behavior of . It is a that covers the that make up ma ...
s in excess of 200 mg/day causes a relative overabundance of iron that can alter the types of bacteria that are present within the gut. There have been concerns regarding
parenteral iron Iron supplements, also known as iron salts and iron pills, are a number of iron Iron () is a chemical element In chemistry Chemistry is the study of the properties and behavior of . It is a that covers the that make up ma ...
being administered whilst
bacteremia Bloodstream infections (BSIs), which include bacteremias when the infections are bacterial and fungemia Fungemia is the presence of fungi or yeasts in the blood. The most common type, also known as candidemia, candedemia, or systemic candi ...
is present, although this has not been borne out in clinical practice. A moderate iron deficiency, in contrast, can provide protection against acute infection, especially against organisms that reside within hepatocytes and macrophages, such as
malaria Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign fo ...

malaria
and
tuberculosis Tuberculosis (TB) is an infectious disease An infection is the invasion of an organism's body Tissue (biology), tissues by Pathogen, disease-causing agents, their multiplication, and the reaction of host (biology), host tissues to the in ...

tuberculosis
. This is mainly beneficial in regions with a high prevalence of these diseases and where standard treatment is unavailable.


Diagnosis

* A
complete blood count A complete blood count (CBC), also known as a full blood count (FBC), is a set of medical laboratory A medical laboratory or clinical laboratory is a laboratory where tests are carried out on clinical specimens to obtain information about the ...
can reveal
microcytic anemia Microcytic anaemia is any of several types of anaemia characterized by small red blood cells (called microcytes). The normal mean corpuscular volume (abbreviated to MCV on complete blood count, full blood count results, and also known as mean cell ...
, although this is not always presenteven when iron deficiency progresses to iron-deficiency anemia. * Low serum
ferritin Ferritin is a universal intracellular protein that stores iron and releases it in a controlled fashion. The protein is produced by almost all living organisms, including archaea, bacteria, algae, higher plants, and animals. It is the primary ' ...

ferritin
(''see below'') * Low
serum iron Serum iron is a medical Medicine is the science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity, awareness, or understanding of someone or something, such as facts ( descriptive ...
* High
TIBC Total iron-binding capacity (TIBC) or sometimes transferrin iron-binding capacity is a medical laboratory test that measures the blood's capacity to bind iron Iron () is a chemical element In chemistry Chemistry is the study o ...
(total iron binding capacity), although this can be elevated in cases of anemia of chronic inflammation. * It is possible that the
fecal occult blood Fecal occult blood (FOB) refers to blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid A liquid is a nearly incompressible In fluid mechanics or more generally continuum mechanics, incompressible flow ( ...
test might be positive, if iron deficiency is the result of
gastrointestinal bleeding Gastrointestinal bleeding (GI bleed), also called gastrointestinal hemorrhage (GIB), is all forms of bleeding in the Human gastrointestinal tract, gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a sh ...
; although the sensitivity of the test may mean that in some cases it will be negative even with enteral blood loss. As always, laboratory values have to be interpreted with the lab's
reference values In health Health, according to the World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations United Nations Specialized Agencies are autonomous organizations working with the United Natio ...
in mind and considering all aspects of the individual clinical situation. Serum ferritin can be elevated in inflammatory conditions; so a normal serum ferritin may not always exclude iron deficiency, and the utility is improved by taking a concurrent C-reactive protein (CRP). The level of serum ferritin that is viewed as "high" depends on the condition. For example, in
inflammatory bowel disease Inflammatory bowel disease (IBD) is a group of inflammatory Inflammatory may refer to: * Inflammation, a biological response to harmful stimuli * The word ''inflammatory'' is also used to refer literally to fire and flammability, and figuratively ...
the threshold is 100, where as in
chronic heart failure Heart failure (HF), also known as congestive heart failure (CHF) and (congestive) cardiac failure (CCF), is a set of manifestations caused by the failure of the heart The heart is a muscular MUSCULAR (DS-200B), located in the United Ki ...
(CHF) the levels are 200.


Treatment

Before commencing treatment, there should be definitive diagnosis of the underlying cause for iron deficiency. This is particularly the case in older patients, who are most susceptible to
colorectal cancer Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of th ...
and the gastrointestinal bleeding it often causes. In adults, 60% of patients with iron-deficiency anemia may have underlying gastrointestinal disorders leading to chronic blood loss. It is likely that the cause of the iron deficiency will need treatment as well. Upon diagnosis, the condition can be treated with
iron supplements Iron supplements, also known as iron salts and iron pills, are a number of iron Iron () is a chemical element In chemistry Chemistry is the study of the properties and behavior of . It is a that covers the that make up ma ...
. The choice of supplement will depend upon both the severity of the condition, the required speed of improvement (e.g. if awaiting elective surgery) and the likelihood of treatment being effective (e.g. if the patient has underlying IBD, is undergoing
dialysis In medicine, dialysis (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. Its populatio ...

dialysis
, or is having
ESA , owner = , headquarters = Paris, Île-de-France, France , coordinates = , spaceport = Guiana Space Centre , seal = File:ESA emblem seal.png , seal_size = 130px , image = ESA Headquarters in Paris, France, 2 ...
therapy). Examples of oral iron that are often used are
ferrous sulfate Iron(II) sulfate (British English British English (BrE) is the standard dialect A standard language (also standard variety, standard dialect, and standard) is a language variety that has undergone substantial codification of grammar and ...

ferrous sulfate
, , or amino acid chelate tablets. Recent research suggests the replacement dose of iron, at least in the elderly with iron deficiency, may be as little as 15 mg per day of elemental iron.


Food sources

Mild iron deficiency can be prevented or corrected by eating iron-rich foods and by cooking in an iron skillet. Because iron is a requirement for most plants and animals, a wide range of foods provide iron. Good sources of dietary iron have
heme Heme, or haem, is a precursor Precursor or Precursors may refer to: *Precursor (religion), a forerunner, predecessor ** The Precursor, John the Baptist Science and technology * Precursor (bird), a hypothesized genus of fossil birds that was comp ...

heme
-iron, as this is most easily absorbed and is not inhibited by medication or other dietary components. Three examples are
red meat In gastronomy 200px, Fine food, the principal study of gastronomy Gastronomy is the study of the relationship between food Food is any substance consumed to provide Nutrient, nutritional support for an organism. Food is usually of plan ...
,
poultry Poultry () are domesticated Domestication is a sustained multi-generational relationship in which one group of organisms assumes a significant degree of influence over the reproduction and care of another group to secure a more predictable ...

poultry
, and
insects Insects (from Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken in the area around Rome, known as Latium. Through the power of the ...
. Non-heme sources do contain iron, though it has reduced bioavailability. Examples are
lentil The lentil (''Lens culinaris'' or ''Lens esculenta'') is an edible legume A legume () is a plant Plants are predominantly photosynthetic Photosynthesis is a process used by plants and other organisms to Energy transformation, co ...
s,
bean A bean is the seed of one of several of the , which are used as vegetables for human or animal food. They can be cooked in many different ways, including boiling, frying, and baking, and are used in many traditional dishes throughout th ...

bean
s,
leafy vegetable Leaf vegetables, also called leafy greens, salad greens, pot herbs, vegetable greens, or simply greens, are plant leaves A leaf (plural leaves) is the principal lateral appendage of the vascular plant Vascular plants (from Latin '' ...
s,
pistachio The pistachio (, ''Pistacia vera''), a member of the cashew family, is a small tree originating from Central Asia Central Asia is a region in Asia which stretches from the Caspian Sea in the west to China and Mongolia in the east, and from A ...

pistachio
s,
tofu Tofu, also known as bean curd, is a food Food is any substance consumed to provide nutritional Nutrition is the biochemical Biochemistry or biological chemistry, is the study of chemical processes within and relating to living orga ...

tofu
, fortified bread, and fortified breakfast cereals. Iron from different foods is absorbed and processed differently by the body; for instance, iron in meat (heme-iron source) is more easily absorbed than iron in grains and vegetables ("non-heme" iron sources). Minerals and chemicals in one type of food may also inhibit absorption of iron from another type of food eaten at the same time. For example,
oxalate Oxalate (IUPAC: ethanedioate) is an anion An ion () is an atom An atom is the smallest unit of ordinary matter In classical physics and general chemistry, matter is any substance that has mass and takes up space by having volume. A ...
s and
phytic acid Phytic acid is a six-fold dihydrogenphosphate ester An ester is a derived from an (organic or inorganic) in which at least one –OH group is replaced by an –O– () group, as in the substitution reaction of a and an . s are s of ; they ...

phytic acid
form insoluble complexes which bind iron in the gut before it can be absorbed. Because iron from plant sources is less easily absorbed than the heme-bound iron of animal sources,
vegetarian Vegetarianism is the practice of abstaining from the consumption of meat (red meat, poultry, seafood, and the flesh of any other animal), and it may also include abstaining from by-products of animal slaughter. Vegetarianism may be adopted for v ...

vegetarian
s and
vegan Veganism is the practice of abstaining from the use of animal product An animal product, also known as lacticinia, is any material derived from the body of an animal Animals (also called Metazoa) are organisms that form the A ...

vegan
s should have a somewhat higher total daily iron intake than those who eat meat, fish or poultry.
Legume A legume () is a plant Plants are predominantly photosynthetic Photosynthesis is a process used by plants and other organisms to Energy transformation, convert light energy into chemical energy that, through cellular respiration, can ...

Legume
s and dark-green leafy vegetables like
broccoli Broccoli (''Brassica oleracea ''Brassica oleracea'' is a plant species that includes many common foods as cultivars, including cabbage, broccoli, cauliflower, kale, Brussels sprouts, collard greens, Savoy cabbage, kohlrabi, and gai lan. In ...

broccoli
,
kale Kale (), or leaf cabbage, belongs to a group of cabbage (''Brassica oleracea ''Brassica oleracea'' is a plant species that includes many common foods as cultivars, including cabbage, broccoli, cauliflower, kale, Brussels sprouts, collard gre ...

kale
and Asian greens are especially good sources of iron for vegetarians and vegans. However,
spinach Spinach (''Spinacia oleracea'') is a leafy LEAFY (abbreviated LFY) is a plant Plants are predominantly photosynthetic Photosynthesis is a process used by plants and other organisms to Energy transformation, convert light energy int ...

spinach
and Swiss chard contain oxalates which bind iron, making it almost entirely unavailable for absorption. Iron from non-heme sources is more readily absorbed if consumed with foods that contain either heme-bound iron or vitamin C. This is due to a hypothesised "meat factor" which enhances iron absorption. Following are two tables showing the richest foods in heme and non-heme iron. In both tables, . Arbitrarily, the guideline is set at 18 mg, which is the USDA Recommended Dietary Allowance for women aged between 19 and 50.


Food recommendations for children

Children at 6 months should start having solid food that contains enough iron, which could be found in both heme and non-heme iron Heme iron: * Red meat (for example, beef, pork, lamb, goat, or venison) * Fatty fish * Poultry (for example, chicken or turkey) * Eggs Non-heme iron: * Iron-fortified infant cereals * Tofu * Beans and lentils * Dark green leafy vegetables Iron deficiency can have serious health consequences that diet may not be able to quickly correct; hence, an
iron supplement Iron supplements, also known as iron salts and iron pills, are a number of iron Iron () is a chemical element In chemistry Chemistry is the study of the properties and behavior of . It is a that covers the that make up ma ...
is often necessary if the iron deficiency has become symptomatic.


Blood transfusion

Blood transfusion is sometimes used to treat iron deficiency with hemodynamic instability., which cites * * Sometimes transfusions are considered for people who have chronic iron deficiency or who will soon go to surgery, but even if such people have low hemoglobin, they should be given oral treatment or intravenous iron. Intravenous iron therapy for non-anaemic, iron-deficient adults Current evidence is limited to base any recommendations that intravenous iron therapy is beneficial for treating non-anaemic, iron-deficient adults. Further research in this area is needed as current body of evidence is very low quality.  


See also

* Bahima disease * CO2 fertilization effect


Notes


References


Further reading

* * * Nutrition,Iron (2018).Centers for Disease Control and Prevention. *


External links

* * {{Nutritional pathology Mineral deficiencies Iron metabolism, Deficiency Red blood cell disorders