What causes iron deficiency anaemia?

“Even after engaging in a simple activity such as cooking or walking to a shop just outside my house, my heart would beat as though I had just run a marathon,” she says.

For a very long time, Catherine Nabwire suffered from extreme heart palpitations. After several tests at the hospital, the doctor attributed Nabwire’s heart palpitations to a condition known as iron deficiency anaemia and with treatment, she has since recovered. 

According to World Health Organisation (WHO), anaemia is a global public health problem that mainly affects young children and pregnant women. WHO estimates that about 42 percent of children under the age of five and 40 percent of pregnant women worldwide are anaemic. 

The most common causes of anaemia include nutritional deficiencies, particularly iron deficiency and deficiencies in folate, vitamins B12 and A. 

Inadequate red blood cells
According to Dr Vincent Karuhanga, a general physician at Friends Polyclinic and Ambulance Service in Kampala, iron deficiency anaemia is when one’s blood lacks adequate healthy red blood cells. 

“Red blood cells are responsible for storing and carrying oxygen from the lungs to the body tissues that require it. Iron is used to produce these red blood cells. If you have fewer red blood cells, your organs and tissues will not get the oxygen they require, which leads to fatigue and shortness of breath, among other symptoms.

Doctor Franklin Wasswa, a general physician at Entebbe General Hospital, says blood is made up of cells that you can divide into three; white blood cells for body defense, red blood cells for oxygen transportation and platelets for clotting of blood to stop blood loss. Within the red blood cells is haemoglobin, a pigment that not only gives blood its red colour but is also responsible for the transportation of blood from the lungs to the blood tissues 

“When broken down, haemoglobin contains molecules called heme, an iron-containing molecule that is important for many biological processes. It combines with globin proteins to form haemoglobin, which carries oxygen in red blood cells from the lungs to the rest of the body. So, iron is a carrying component in the transportation of oxygen molecules in blood. If you have less of it, you will carry less oxygen and your red blood cells will be abnormal,” Dr Wasswa explains. 

Signs
Iron deficiency anaemia can be so mild that it goes unnoticed. But as the body becomes more deficient, the signs and symptoms intensify. Iron deficiency signs and symptoms include fatigue, dizziness (because there is less blood going to the brain). Also, instead of the patient’s palms having a pinkish reddish colour, they will be whiter and pale, just like the tongue and eyes,” Dr Wasswa notes, adding that a fast heartbeat as was the case with Nabwire is also a common symptom.

This is because when you are anaemic, your heart pumps more blood to make up for the lack of oxygen in the blood.

Causes
Malnutrition, according to Dr Wasswa, is one of the most common causes of iron deficiency anemia. 

“When a person does not eat iron-rich foods or if the iron is not properly absorbed because say part of the intestine has an illness or was cut out, then not enough iron will be absorbed, resulting in iron deficiency anemia,” he says

According to healthline.com, pregnancy or blood loss due to heavy menstrual bleeding are also common causes of iron-deficiency anaemia in women of childbearing age. Because iron is essential during times of rapid growth and development, pregnant women and young children may need even more iron-rich foods in their diet. 

“One of the biggest problems in Uganda is short spaced pregnancies and child births. Much as iron supplements are given during pregnancy, short spaced pregnancies and child births will lead to anaemia in many cases since making blood for a baby and replacing lost blood during delivery may not properly be balanced by taking iron supplements during pregnancy. Use of contraception to help space pregnancies and child births together with taking iron supplements usually helps,” says Dr Karuhanga. 

Internal bleeding is also a common cause. Certain medical conditions can cause internal bleeding which can lead to iron-deficiency anaemia. These include a stomach ulcer, polyps in the colon or intestines, or colon cancer. Others are bleeding from the womb related to say fibroids or endometriosis. Also, regular use of certain pain relievers such as aspirin can lead to bleeding in the stomach. 

The inability to absorb iron can also lead to iron deficiency anaemia, certain disorders or surgeries that affect the intestines can also interfere with how your body absorbs iron. Even if you get enough iron in your diet, celiac disease or intestinal surgery such as gastric bypass may limit the amount of iron one’s body can absorb. 

Diagnosis 
According to Dr Karuhanga, iron deficiency anaemia is diagnosed first, through a complete blood count test. A serum iron test is then done to ascertain the amount of iron in the blood, a ferritin blood test, to measure how much iron is stored in the body and lastly, a transferrin test to measure a protein that transports iron in the body and total iron-binding capacity (how well iron attaches to transporting proteins). 

Dr Karuhanga adds that when one is found to have iron deficiency anaemia, additional tests are carried out to identify the underlying cause. 

These tests include a gastro-endoscopy to rule out blood loss through bleeding peptic ulcers, a colonoscopy to rule out big intestinal bleeding, especially due to cancer of the colon, or an ultrasound to look for the cause of excess uterine bleeding, such as uterine fibroids.
“Treating the cause of iron deficiency is necessary to once and for all control the deficiency,” he says. 

Who is likely to develop iron-deficiency anemia?
Almost anyone can develop iron-deficiency anaemia. However, women who have menstrual cycles or who are pregnant or breastfeeding are more likely to develop iron-deficiency anaemia than women who have gone through menopause or men. Here are other groups of people who have an increased risk of developing iron-deficiency anemia:
● Some infants between ages six months and 12 months: Babies are born with iron they received during pregnancy. That iron supply runs out after four to six months. Babies who are breastfed only or drink unfortified formula may not get enough iron.
● Children between ages one year and two years: Many times, young children who drink a lot of cow’s milk may not get enough iron.
● Teenagers: Growth spurts may use up iron reserves more quickly, causing iron deficiency.
● Adults more than 65 years of age: Older people may not get as much iron as they need because they are eating less food.
● Individuals with certain chronic medical conditions, bone marrow disorders or autoimmune disorders.

Treatment
Dr Vincent Karuhanga, a general physician, says treatment involves eating foods rich in iron together with taking oral iron supplements or injectable iron in cases of severe anaemia or if one has a problem absorbing iron. Foods rich in iron include meat, liver, eggs and leafy green vegetables, among others. 

Besides prescribing supplements and iron-rich foods, Dr Karuhanga also urges investigating and treating the cause of blood loss and properly managing it apart from giving iron supplements as may be deemed fit by a doctor. 

Once the iron deficiency and its primary cause are treated, Dr Karuhanga advices the patient to continue going for tests to avoid a reoccurrence.