Iron dificiency anemia status of individuals

 What is iron dificiency

Iron deficiency is the most widespread nutrition disorder in the world and the primary cause of anemia (WHO, 2001). Iron deficiency anemia is rare in industrialized countries but is of high prevalence in developing countries (WHO & FAO 2004). Iron deficiency and iron deficiency anemia are defined as follows (Zimmermann 2005):

-           Iron deficiency is a reduction of iron in the body to the extent that cellular storage iron required for normal metabolic and physiological functions is fully exhausted, with or without anemia.

-           Iron deficiency anemia is defined as iron deficiency and low haemoglobin levels

1.      Indicators and measurements of iron status to evaluate iron dificiency anemia

The five main indicators of iron status (Transferrin, zinc protoporphyrin, haemoglobin, mean corpuscular volume and serum ferritin) outlined by WHO. Concentrations of serum ferritin, haemoglobin and mean corpuscular volume values were used to detect iron deficiency anemia and serum ferritin alone was used to screen for iron deficiency (Hallberg et al. 1993).

Haemoglobin (Hb)

Haemoglobin is the most widely used measure to assess iron status. Because hemoglobin levels drop relatively late in the development of iron deficiency it is usually used as a first factor to detect iron deficiency anemia but it has some limitations if used alone because of low specificity and sensitivity (Cook JD 2005). A lower than normal hemoglobin level indicates anemia. Haemoglobin is frequently used in conjunction with other variables such as mean corpuscular volume, red cell distribution and zinc protoporphyrin, to detect iron deficiency anemia. The cut-off points for haemoglobin (Hb (g/L)) proposed by WHO.                                                

Hb (g/L)

 Children 6 to 59 months          110

 Children 5-11 years                 115

 Children 12-14 years               120

 Non-pregnant women (≥ 15 y) 120

       Pregnant women                     110

       Men (≥ 15 y)                           130

Serum ferritin (SF)

Serum ferritin is considered to be the best single laboratory measure to detect iron status and iron deficiency (Borch-Ionsen 1995). This protein helps store iron in body, and a low level of ferritin usually indicates a low level of stored iron. The cut-off points for serum ferritin (SF (μg/L)) to detect iron deficiency anemia proposed by WHO criteria for the age groups.

                                    SF of male (μg/L)         SF of female (μg/L)

  < 5 years          < 12                             < 15

              ≥ 5 years          <15                              < 15

Table. Clinical findings

	Iron excess		Normal	Iron deficiency
	Stage 2 Iron overload	Stage 1 Positive iron balance	Normal	Stage 1 Early negative iron balance	Stage 2 Iron depletion	Stage 3 Damaged metabolism: iron deficient erythropoiesis	Stage 4 Clinical damage: iron deficiency anemia
Serum ferritin (μg/L)	> 300	> 150	100 ± 60	< 25	20	10	< 10

Krause’s Food and Nutrition Therapy p: 814-815.

     Mean corpuscular Volume

Mean corpuscular volume is a reliable but a relatively late indicator of nutritional iron deficiency that is widely used (Cook 2005). The cut-off points for mean corpuscular volume (MCV (fl)) to detect iron deficiency anemia, used in the NHANES II (Expert scientific working group, 1985).

MCV (fl)

Children 1-2 years                                     73 fl

Children 3-4 years                                     75 fl

Children 5-10 years                                   76 fl

Children and adolescents 11-14 years      78 fl

Adolescents and adults 15-74 years         80 fl

2.      Nutrients which could cause decrease of haemoglobin

Deficiency of nutrients intake such as meat, poultry and fish could cause reduction of haemoglobin. This is due to the primary source of heme iron is derived from hemoglobin and myoglobin found in meat, poultry, fish and seafood. The primary source of heme iron is derived from hemoglobin and myoglobin found in meat, poultry and fish. Non-heme iron is mainly found in plant-based foods such as cereals, pulses, fruits and vegetables [9].

Factors known to enhance absorption of non-heme iron are ascorbic acid (Vitamin C), the meat factor (meat, poultry, fish and other seafood) and alcohol. Factors known to inhibit iron absorption are phytate or inositol hexaphosphate (mostly found in bran products, seeds, cereals, legumes, fruits and vegetables), certain polyphenols (mostly found in tea, coffee, red wines, cocoa, spices, fruits and vegetables), calcium, eggs and soy proteins [4].

3.      Groups of people may be at higher risk of iron deficiency anemia [10]

Women

Because women lose blood during menstruation, women in general are at greater risk of iron deficiency anemia.

Infants and children

Infants, especially those who were low birth weight or born prematurely, who don't get enough iron from breast milk or formula may be at risk of iron deficiency. Children need extra iron during growth spurts, because iron is important for muscle development. If your child isn't eating a healthy, varied diet, he or she may be at risk of anemia.

Vegetarians

Because vegetarians don't eat meat, they're at greater risk of iron deficiency anemia. Iron that comes from grains and vegetables isn't absorbed by the body as well as is iron that comes from meat.

4.      Iron status of individuals

Individual 1 is a 60 years old man was diagnosed positive iron balance with Hb 140 g/L > 130 (normal), MCV 88 fl > 80 (normal) and SF 200 μg/L > 150 (high, see table 1).

Individual 2 is a 67 years old woman was diagnosed normal iron status with Hb 135 g/L > 120 (normal), MCV 86 fl > 80 (normal) and SF 150 μg/L (normal, see table 1).

Individual 3 is a 20 years old woman was diagnosed in status of iron deficiency anemia and iron deficiency in stage 4 with Hb 120 g/L (the cut-off points for haemoglobin to defect iron deficiency anemia), MCV 77 fl < 80 (low) and SF 9 μg/L < 10 (very low, iron deficiency stage 4, iron deficiency anemia and clinical damage).

Individual 4 is a 60 years old man was diagnosed iron overload status with Hb 150 g/L > 130 (normal), MCV 95 fl > 80 (normal) and SF 420 μg/L > 300 (very high, see table 1).

References

1.      WHO & FAO (2004): Vitamin and mineral requirements in human nutrition. 2nd ed. Iron: 246-278. Geneva: WHO.

2.      WHO (2001): Iron deficiency anaemia. Assessment, prevention and control. A guide for programme managers. WHO/NHD/01.3, Geneva: WHO.

3.      Zimmermann MB, Chaouki N & Hurrell RF (2005): Iron deficiency due to consumption of a habitual diet low in bioavailable iron: a longitudinal cohort study in Moroccan children. Am. J. Clin. Nutr. 81, 115-121.

4.      Hallberg L, Bengtsson C, Lapidus L, Lundberg P-A & Hulthén L (1993): Screening for iron deficiency: an analysis based on bone marrow examination and serum ferritin determinations in a population sample of women. Brit. J. Haematol. 85, 787-98.

5.      Cook JD (2005): Diagnosis and management of iron-deficiency anemia. Best Pract. Res. Clin. Haematol. 18, 319-322.

6.      Borch-Ionsen B (1995): Determination of iron status: brief review of physiologic effects on iron measures. Analyst 230, 891-893.

7.      Expert Scientific Working Group. (1985) Summary of a report on assessment of the iron nutritional status of the United States population. Am. J. Clin. Nutr. 42: 1318−1330.

8.      L. Kathleen Mahan, Sylvia ES. Krause’s Food and Nutrition Therapy. Edition 12, 2008.

9.      Hallberg L, Hulthen L & Gramatkovski E (1997): Iron absorption from the whole diet in men: how effective is the regulation of iron absorption? Am J. Nutr. 66, 347-56.

10. http://www.mayoclinic.com/health/iron-deficiency-anemia/DS00323/DSECTION=risk-factors