Iron Deficiency: Recognize Early and Treat Correctly

Iron deficiency anemia is one of the most common causes of anemia. In the case of anemia, the organs are not supplied with enough oxygen. Typical symptoms are tiredness and a general feeling of weakness.

About 30 percent of the world’s population is affected by iron deficiency anemia. Due to a lack of iron, the body cannot produce enough red blood pigment (hemoglobin). The hemoglobin is in the red blood cells – and its job is to bind oxygen and deliver it to the cells when needed.

How much iron does a person need?

Humans must absorb iron with food. A balanced diet usually contains enough iron to cover the daily requirement. Meat, fish, and nuts in particular contain a lot of iron. Vegetarians should make sure to include iron-rich plant foods in their diet. These include, among other things:

• soybeans
• White beans
• Beetroot
• millet
• amaranth
• cocoa
• Herbs (e.g. thyme, basil)
• Black and Red Currants
• elderberries
• blackberries
• mulberries

A balanced diet contains about 10 to 15 milligrams of iron per day. But the body can only absorb five to ten percent of the iron from food via the cells in the intestine. The rest is excreted in the stool. How much iron the body loses and has to replace per day depends, among other things, on age and gender. Postmenopausal men and women lose about a milligram of iron every day. Women with monthly periods lose up to three milligrams. There is also an increased need for iron during pregnancy and breastfeeding as well as during growth. The German Society for Nutrition, therefore, recommends consuming iron every day through food:

• Men aged 19 and over and menopausal women: 10 milligrams of iron
• Girls aged 10 and over and women with menstrual periods: 15 milligrams of iron
• Breastfeeding: 20 milligrams of iron
• Pregnant women: 30 milligrams of iron

Symptoms of anemia

In the case of anemia, the organs are insufficiently supplied with oxygen.

Typical complaints are:

• paleness
• fatigue
• dizziness
• a general feeling of weakness associated with exhaustion and loss of performance
• Shortness of breath, especially under exertion
• palpitations

The following are less common complaints:

• rough, cracked skin
• cracked corners of the mouth
• brittle nails
• nails bent inwards (hollow nails)
• dull, brittle hair
• Burning tongue with pain when swallowing
• unusual cravings, for example, lime, earth, or ice cubes

Diagnosis of iron deficiency anemia

Doctors often diagnose iron-deficiency anemia by accident during routine blood count checks. When there is an iron deficiency, the body first empties its iron stores. Only when these reserves are exhausted does anemia develop.

If you suspect iron deficiency, you should seek advice from your family doctor in order to initiate a diagnosis and clarify the causes. Above all, it is important to take a detailed medical history (anamnesis) with documentation of lifestyle and eating habits, previous illnesses, and medication intake. In young women, the frequency, duration, and severity of menstrual bleeding should be documented, and in older people, questions should be asked about bleeding from the gastrointestinal tract or urinary and genital organs.

A blood test and test provides definitive information about the iron balance. Are measured:

• A number of red blood cells (erythrocytes): If there are too few of them, this indicates anemia.
• Amount of the red blood pigment (hemoglobin value, Hb value): If it is reduced, there is anemia.
• Hematocrit value (Hkt): This quantifies the proportion of solid components or cells in the blood in the blood volume. Since most of the cells in the blood are erythrocytes, the hematocrit also provides indirect information about the number of red blood cells. However, changes in the fluid balance also have a decisive influence on it. A reduced hematocrit value can indicate anemia, but can also have other causes.
• Mean erythrocyte volume (MCV): The MCV quantifies the volume of the individual red blood cells. In iron-deficiency anemia, the MCV is reduced.
• Mean erythrocyte hemoglobin (MCH): The MCH value indicates how much red blood pigment is present in an erythrocyte on average. In iron-deficiency anemia, the MCH is reduced.
• Reticulocytes are immature precursors of red blood cells in the blood. To make up for a lack of red blood cells, the body releases red blood cells from its reserves in the bone marrow. If there are not enough mature cells available there, the not fully mature precursors, the reticulocytes, are also released into the blood. So, a high number of reticulocytes in the blood indicates that many red blood cells are being lost and the body is trying to replenish them quickly. Iron deficiency anemia results in an increase in reticulocytes after the administration of iron.
• Transferrin/transferrin saturation: Transferrin is a transport protein for iron. It carries iron from the enterocytes, which are responsible for absorbing iron from the intestine to the body’s stores. Decreased transferrin saturation can indicate a lack of iron supply, provided there is no inflammation since transferrin also decreases due to inflammation.
• Soluble transferrin receptor (sTfR): The iron bound to transferrin in the blood is absorbed into the red blood cells via special receptors, the transferrin receptors, via the cell wall. This is why the number of receptors in the blood increases in iron deficiency anemia.
• Ferritin (storage iron): This water-soluble protein stores iron and protects the cells from the damaging effects of free iron. It is mainly found in the cells of the liver, bone marrow, and spleen, but also in other tissues such as muscles. The ferritin measured in the blood indicates how well the body’s iron stores are filled. A reduced ferritin level is the most important indicator of iron deficiency anemia. However, if there is inflammation at the same time, it can also be elevated.

If an iron deficiency is determined, it is important to find the cause. Depending on the suspected diagnosis and the age of the person concerned, the doctor initiates appropriate diagnostic measures. Blood loss is often behind the diagnosis of iron deficiency anemia – in this case, bleeding must be ruled out as the cause. First, the stool is checked for blood. Depending on the result, a gastrointestinal endoscopy may be necessary to eliminate or confirm the suspicion of bleeding. In addition, the urine should be examined for blood and, in the case of women, a gynecological examination may also be carried out. An examination by the ear, nose, and throat doctor can also be part of the diagnostics to find the cause of the chronic blood loss. An iron absorption test to rule out a disturbance in the absorption of iron from the intestine is now usually dispensed with due to the lack of meaningfulness.