Low Iron Levels (anaemia)

Anaemia occurs in many ways:

Anaemia is when an abnormally low level of red blood cells and/or when does not have enough haemoglobin (in the red blood cells ) to carry oxygen to meet  the bodies requirements.

• Iron also gets absorbed in the intestine  by a protein called an intrinsic factor produced by parietal cells found in the stomach ,this then binds to the iron.
• A lack of these cells leads to anaemia.

• Red blood cells are produced in the bone marrow and then released into the blood and travel to the lungs and pick up oxygen and remove carbon dioxide.
• Red blood cells normally  live for 110 to 120 days and after that  these ‘older red blood cells’ are removed from the blood by the spleen and liver.
• Anaemia can occur when the bone marrow does not produce enough red blood cells to replace those that have died or  it can occur if the red blood cells die or are destroyed more quickly than usual hence the spleen and the liver as well as the bone marrow , haemoglobin play a major role in anaemia.

Harvard Health publications 

In this chapter we we will concentrate on Iron deficiency anaemia:

When there is a lack of iron in the body.

• Iron is needed for haemoglobin (Haemoglobin carries oxygen in the blood and delivers it around the body).
• Needed by muscles.
• Needed for reactions in the body.

• Most iron is ab­sorbed in the duodenum and jejunum parts of the intestine.
• The human body contains about 50mg/kg of iron.
• Of this, approximately 60 per cent is in the haemoglobin of red blood cells and 5 per cent is in the myoglobin of muscle cells.
• A further 30 per cent is found in body stores as ferritin (20 per cent) and haemosiderin (10 per cent), which are the two major iron-storage proteins and are found mainly in the liver.
• The remaining 5 per cent or so of the body’s iron is distributed among various enzymes.
• A small amount (<0.1 per cent) is in transit in the circulation bound to transferrin, the main iron transport protein in the body.

Iron has several functions. It is:

• Necessary for the formation of haemo­globin and hence for the transport of oxygen and cell respiration
• Responsible for oxygen storage in the muscle (as a component of myoglobin)
• A component of cytochromes (which are critical for the electron transport chain) and, therefore, involved in energy production (by virtue of its redox activity)
• A component of enzymes necessary for immune function (Iron deficiency may compromise immune function while iron overload may predispose to infection be­cause iron is an essential growth factor for microorganisms.)

Iron intake

• Iron intake is required to replace normal losses from the body.
• Each day, 0.5-1mg of iron is lost in the faeces, urine and sweat, and menstruating women lose an additional 0.5-0.7mg of iron per day (averaged over a month).
• Heavy menstrual blood loss can result in iron deficiency.
• During pregnancy, iron is needed to form additional haemoglobin (equivalent to 1-2mg of iron per day) and, during childhood, intake is needed to develop stores for growth (equivalent to about 0.6mg of iron per day).

The Pharmaceutical Journal, PJ, July 2008;()::DOI:10.1211/PJ.2021.1.90541

Table of normal iron readings

Source :World health organization

Anemia can also be caused by:

• Vitamin B12 deficiency
• Folic acid deficiency
• Other types of  Anaemia

• Patients with suspected iron deficiency anaemia should be referred to their GP, who will order blood tests (full blood count, iron profile, C-reactive protein and liver function test) and rule out more serious conditions.
• The British Society of Gastroenterology states that the following results are indicative of iron deficiency anaemia:
  • Reduced mean cell haemoglobin
  • Reduced mean cell volume
  • Low ferritin
  • Raised total iron binding capacity
  • Low reticulocyte haemoglobin.

Low ferritin is the most consistently reliable indicator of iron deficiency anaemia except if there is co-existent inflammatory disease (e.g. rheumatoid arthritis, liver disease or infection), which can cause ferritin levels to rise and mask iron deficiency anaemia.

Frewin R, Henson A, Proven D et al. Iron deficiency anaemia. Clinical Review. BMJ 1997;314:360–364.