# Iron Deficiency --- **[[Iron]] deficiency** or **sideropenia** is a [[malnutrition|primary nutrient deficiency]] of iron. This can be caused either from poor dietary intake or absorption of iron, or from excessive loss of iron. ## Risk Factors Risk factors for iron deficiency are: - lack of iron in in the diet - lack of enough [[nutrient absorption|absorption]] of iron - [[vitamin B12]] deficiency - partial gastrectomy - malabsorption disease - using up iron much too fast - adolescence - [[pregnancy]] - infection ## Stages of Iron Depletion Iron deficiency progresses through three stages, depletion, erythropoiesis, and anemia. ### Stage 1: Iron Depletion **Iron depletion** is the first stage of iron deficiency, and it is characterized by a decrease in iron stores. This can be detected by reduced levels of ferritin in the blood, but does not show symptoms as [[iron|hemoglobin]] has not yet been affected. ### Stage 2: Erythropoiesis **Erythropoiesis** is the second stage of iron deficiency, which is characterized by the decrease in iron transport. Since there is less iron around, [[iron#Iron Transport|transferrin]] becomes even *more* able to bind to the iron that there is around. This capacity of transferrin to bind to iron is called the **total iron binding capacity** or **TIBC**. This low iron combination of low blood iron levels and high TIBC causes [[iron#Heme|heme]] production—and thus red blood cell production—fall. Symptoms at this stage include reduced work capacity. ### Stage 3: Anemia **[[Anemia]]** is the third and final stage of iron deficiency. By this stage [[red blood cells]] become smaller and cannot bind to oxygen adequately. and [[iron#Hemoglobin Myoglobin|hemoglobin]] levels are too low. Red blood cells that are too small are called *microcytic*, and as the normal life cycles of blood cells continue, more and more are replaced by microcytic cells—on top of which fewer and fewer are being made in the first place. Symptoms at this stage include - fatigue - pale skin - weakened immune function - impaired cognitive and nerve function - work and memory performance - spoon nails, or distinctive, scooped out shaped [[nails#Problems with Nails|nails]] ## Prevention & Treatment Prevention for iron deficiency consists of getting enough dietary iron. This can be done from iron rich foods or even by cooking on cast iron cookware. Some iron rich foods are: - dark leafy greens - seafood - beans - peanut butter - fish/red meat/poultry/pork - dried fruit - peas - **oral iron supplementation** - we want to do this first before parenteral sources - usually in the form of a liquid suspension - for best results - have fewer, smaller doses on an empty stomach - have with orange juice or some other form of [[vitamin C]] - helps with absorption - avoid having with milk or other [[calcium]] containing foods - hinders absorption - normal side effects - constipation - dark green or black, tarry stools - Parenteral iron sources - **iron sucrose** (brand name: Venofer) ___