Iron-Deficiency Anemia: What You Need to Know

If you were to take a university course in nutrition in Scandinavia or central Europe, you might study a topic roughly entitled “Great Mistakes in Clinical Nutrition.”
One of the most tragic mistakes in modern nutrition occurred in Ethiopia in the 1970’s, when a well-intentioned team of British aid workers noticed that most of the children in their refeeding camp suffered iron-deficiency anemia. They did the logical thing. They gave all the children iron pills. To their horror, less than a month later, almost all the children died of malaria.

Through much of human history, “doctors” treated almost any kind of illness with bloodletting or leeches. More often than not, the primitive treatment helped. Microbes, like humans, need iron for health. In many instances, getting iron supplies down to the lowest level for normal oxygenation of the blood allowed the immune system to eliminate an infectious disease.

In the twenty-first century, iron-deficiency anemia is a condition that should not always be treated. It should never be treated without medical confirmation that iron deficiency anemia in fact exists. Never self-diagnose iron-deficiency anemia, unless you happen to be able to analyze your own blood work.

Anemia is a shortage of red blood cells, an unusually low concentration of oxygen-carrying hemoglobin in the blood, or a low value of a laboratory index called the hematocrit, which measures the volume of red blood cells in a sample of blood after they have been placed in a centrifuge. These three values are measured with a “complete blood count,” more commonly referred to as a CBC. There are several deficiency diseases that cause anemia, but iron-deficiency anemia is easily identified by the fact that it causes red blood cells to appear pale and small when examined under a microscopic.
The Crohn’s and Colitis Foundation of America estimates that between 30 and 70 percent of people who have inflammatory bowel disease will develop iron-deficiency anemia. The condition is also a common complication of bleeding ulcers, heavy periods, hemorrhoids, peptic ulcer disease, too-frequent donations of blood, and daily use of aspirin. It can also result from inadequate nutrition. Iron-deficiency anemia in men in North America, Australia, New Zealand, and Europe is almost always caused by blood loss.

Iron-deficiency anemia develops in three stages. The first is negative iron balance. In this stage the body’s demands for iron exceed its ability to absorb it from food. Negative iron balance can result from blood loss, pregnancy (in which the demands for red blood cell production by the fetus outpace the mother’s ability to provide iron), growth spurts during adolescence, or inadequate iron in the diet. During the depletion of iron there may be a general feeling of fatigue, but a blood test will not show iron deficiency.

The second step in the development of iron-deficiency anemia is iron-deficient erythropoiesis, or the production of red blood cells without sufficient iron. Red blood cells produced during iron-deficient erythropoiesis tend to be small and pale. They fail to carry adequate amounts of hemoglobin. This sets off changes in the bone marrow to cause the third stage of iron-deficiency anemia, hypoproliferation. When hemoglobin levels fall too low, the marrow begins to produce cigar- or pencil-shaped poikilocytes instead of round, full erythrocytes.

Very advanced iron-deficiency anemia causes easily recognized cracks and fissures at the corners of the mouth and spooning of the fingernails. As mentioned earlier, however, this condition can only be diagnosed by a blood test. Measurement of ferritin levels is essential to determine that iron deficiency, rather than some other problem, is the cause of the anemia.