Pathogenesis and Management of Iron Deficiency Anemia: Emerging Role of Celiac Disease, Helicobacter pylori, and Autoimmune Gastritis
Section snippets
Causes of Iron Deficiency
Although recent evidence suggests that the iron status of developed populations is improving and the incidence of IDA is declining, the worldwide prevalence of iron deficiency continues to be a significant problem. Populations residing in developing countries are especially vulnerable. Even within developed countries, certain population subgroups are at increased risk for developing iron deficiency due to increased physiological requirements. These include infants, growing children, adolescents
Gastrointestinal Blood Loss
Blood loss is the most common cause of iron deficiency in adults, and the various causes are described in detail in standard textbooks. When physiologic causes of iron deficiency are unlikely, it is mandatory to exclude pathological causes of iron deficiency, in particular GI blood loss. Ingestion of aspirin and nonsteroidal anti-inflammatory drugs should not be overlooked as a cause, because even low doses of aspirin taken to prevent the complications of atherosclerosis may cause significant
Decreased Iron Absorption
In recent years, there has been an increasing awareness of subtle, non-bleeding GI conditions that may result in abnormal iron absorption leading to IDA in the absence of GI symptoms. Thus, the importance of celiac disease as a possible cause of IDA refractory to oral iron treatment, without other apparent manifestations of malabsorption syndrome,24 is increasingly recognized. In addition, Helicobacter pylori has been implicated in several recent studies as a cause of IDA refractory to oral
Therapy of Iron Deficiency Anemia
The most desirable treatment of iron deficiency is cure of the underlying disease. This is of critical importance when the cause of anemia is malignant or non-malignant bleeding diseases of the gastrointestinal tract, in celiac disease responsive to gluten-free diet, or in H pylori gastritis where H pylori eradication will often result in the cure of anemia even without the addition of iron therapy. However, in the vast majority of cases and particularly in women with excessive menstrual blood
Conclusions
Iron deficiency is the consequence of an imbalance between increased requirements, limited supply, or abnormal blood loss. In adults, anemia is traditionally attributed to blood loss and, importantly, iron deficiency may on occasion be heralding an underlying malignancy associated with occult GI bleeding. Consequently, a GI diagnostic workup is mandatory in adult males and in postmenopausal females. However, GI studies fail to establish the cause of iron deficiency in about one third of
References (92)
- et al.
Erythropoietin, iron, and erythropoiesis
Blood
(2000) - et al.
Dietary determinants of iron stores in a free-living elderly populationThe Framingham Heart Study
Am J Clin Nutr
(1998) - et al.
Calcium supplementation: effect on iron absorption
Am J Clin Nutr
(1991) - et al.
Calcium: effect of different amounts on nonheme– and heme-iron absorption in humans
Am J Clin Nutr
(1991) - et al.
Initial uptake and absorption of nonheme iron and absorption of heme iron in humans are unaffected by the addition of calcium as cheese to a meal with high iron bioavailability
Am J Clin Nutr
(2002) Iron requirements in adolescent females
Am Soc Nutr Sci
(2000)- et al.
Menstrual blood loss in women using the frameless FibroPlant LNG-IUS
Contraception
(2009) - et al.
Markers of masked iron deficiency and effectiveness of EPO therapy in chronic renal failure
Am J Kidney Dis
(1997) - et al.
Effects of erythropoietin therapy on iron absorption in chronic renal failure
J Lab Clin Med
(2000) - et al.
Prevalence of celiac disease and its endoscopic markers among patients having routine upper gastrointestinal endoscopy
Am J Gastr
(1999)
Helicobacter pylori-associated iron-deficiency anemia in adolescent female athletes
J Pediatrics
Gastrointestinal causes of refractory iron deficiency anemia in patients without gastrointestinal symptoms
Am J Med
Hematologic manifestations of celiac disease
Blood
The clinical pattern of subclinical/silent celiac disease: an analysis on 1026 consecutive cases
Am J Gastroenterol
Serum ferritin, hemoglobin, and Helicobacter pylori infection: a seroepidemiologic survey comprising 2794 Danish adults
Gastroenterology
A hematologist's view of unexplained iron deficiency anemia in males: impact of Helicobacter pylori eradication
Blood Cells Mol Dis
Helicobacter pylori impairs iron absorption in infected individuals
Dig Liver Dis
Variable hematologic presentation of autoimmune gastritis: age-related progression from iron deficiency to cobalamin depletion
Blood
The gastric H+,K+-ATPase is a major autoantigen in chronic Helicobacter pylori gastritis with body mucosa atrophy
Gastroenterology
Antigenic mimicry between Helicobacter pylori and gastric mucosa in the pathogenesis of body atrophic gastritis
Gastroenterology
Molecular mimicry between Helicobacter pylori and the host
Trends Microbiol
Helicobacter pylori, iron deficiency, and gastric autoimmunity
Blood
The safety of intravenous iron dextan in hemodialysis patients
Am J Kidney Dis
Sodium ferric gluconate complex in hemodialysis patients: adverse reactions compared to placebo and iron dextran
Kidney Int
A comprehensive vision for intravenous iron therapy
Am J Kidney Dis
Gastric delivery system for iron supplementation
Lancet
Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship
J Nutr
Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States
Pediatrics
Iron deficiency anemia in infancy: long-lasting effects on auditory and visual system functioning
Pediatr Res
Iron supplementation for unexplained fatigue in non-anemic women: double blind randomized placebo controlled trial
BMJ
Audit of the investigation of iron deficiency anemia in a district general hospital, with sample guidelines for future practice
Postgrad Med J
Reticulocyte hemoglobin equivalent (ret he) and assessment of iron-deficient states
Clin Lab Haematol
European Best Practice Guidelines 6-8: assessing and optimizing iron stores
Nephrol Dial Transplant
Calcium and iron absorption: mechanism of action and nutritional importance
Eur J Clin Nutr
Iron requirements, iron balance and iron deficiency in menstruating and pregnant women
Menstrual blood loss—a population studyVariation at different ages and attempts to define normality
Acta Obstet Gynecol Scand
Assessment of the iron nutritional status of a population
Prog Clin Biol Res
Efficacy and tolerability of low-dose iron supplements during pregnancy: a randomized controlled trial
Am J Clin Nutr
What proportion of patients referred to secondary care with iron deficiency anemia have colon cancer?
Dis Colon Rectum
Iron deficiency anemia and delay in the diagnosis of colorectal cancer
Colorectal Dis
Reversal of iron deficiency anemia after Helicobacter pylori eradication in patients with asymptomatic gastritis
Ann Intern Med
Gastric as well as duodenal biopsies may be useful in the investigation of iron deficiency anaemia
Scand J Gastroenterol
Mechanisms of iron regulation and of iron deficiency
Haematologica
Subclinical coeliac disease is a frequent cause of iron-deficiency anaemia
Scand J Gastroenterol
Sideropenic anemia and celiac disease: one study, two points of view
Dig Dis Sci
A prospective study of the prevalence of undiagnosed coeliac disease in laboratory defined iron and folate deficiency
J Clin Pathol
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2014, Blood ReviewsCitation Excerpt :Iron deficiency, among the most common of anemias, results from poor intake combined with increased physiological losses of blood related to menstruation, pregnancy, and growth during childhood in developing countries [177,178]. In men and post-menopausal women, including those in developed countries with iron fortification of food, iron deficiency is caused by blood loss, most frequently from the GI tract [178]. About two-thirds of the body's iron is in hemoglobin, and with approximately 0.5 mg iron/mL of blood, average daily blood losses that exceed 4 mL can lead to iron deficiency [68].