Risk groups and causes of iron deficiency

Iron deficiency and iron deficiency anaemia can occur at all stages of life, being most prevalent among at risk groups due to physiological, nutritional or social factors:

  • premature or low birth weight babies, toddlers and preschool children
  • adolescents
  • menstruating women
  • pregnant and breastfeeding women
  • endurance athletes
  • regular blood donors
  • refugees and recent migrants from economically poor countries
  • some indigenous populations
  • hospitalised and institutionalised patients, including elderly people in aged-care homes
  • restrictive diets, eg, vegetarians and vegans
  • malabsorption disorders, eg, Coeliac disease
     

Causes of iron deficiency

Iron deficiency results when iron losses or demands exceed iron absorption and is often multifactorial. Factors contributing to negative iron balance are outlined below:

Growing infants, children and adolescents

Menstruating women

Pregnancy

Lactation

Multiparity

Parturition/childbirth

Gastrointestinal blood loss:

  • medication related, eg, aspirin, NSAIDs
  • malignancy, eg, colon, gastric
  • peptic ulcer
  • infection, eg, intestinal parasites
  • angioectaisa (angiodysplasia)

Non-gastrointestinal blood loss:

  • menorrhagia
  • blood donation
  • post-op patients with significant blood loss
  • haematuria
  • intravascular haemolysis: haemoglobinuria
  • extreme physical exercise (endurance athletes)

Low socioeconomic status

Vegetarian or vegan diets

Lack of balanced diet or poor oral intake

Excessive alcohol intake

Older age

Dietary factors

Chronic renal failure

Medications that decrease gastric acidity or bind iron

Malabsorption resulting from:

  • disease, eg, Coeliac disease, H. pylori colonisation
  • surgery, eg, gastrectomy or intestinal bypass
  • inflammation, eg, chronic gastritis

Genetic- Iron refractory iron-deficiency anaemia

 
References
  1. British Columbia Medical Association. Iron Deficiency – Investigation and Management, June 2010. Available from:http://www.bcguidelines.ca.
  2. Gastroenterological Society of AustraliaClinical update: Iron deficiency, Updated 2015. SydneyAustralia, Digestive Health Foundation, 2015. Available from: http://www.gesa.org.au.
  3. Pasricha SR, Flecknoe-Brown SC, Allen KJ, Gibson PR, McMahon LP, Olynyk JK, et al. Diagnosis and management of iron deficiency anaemia: a clinical update. MJA 2010;193:525–532. Available from: http://www.mja.com.au.
  4. Goddard AF, James MW, McIntyre AS, Scott BB on behalf of the British Society of GastroenterologyGuidelines for the management of iron deficiency anaemia. Gut 2011;60:1309–1316. Available from: http://www.bsg.org.uk.

 

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