Iron deficiency anemia is a condition where the body's iron stores are insufficient to meet the needs of normal red blood cell production. It is caused by inadequate iron intake, reduced absorption, increased demand, impaired iron utilization, or excessive loss. Morphologically, it presents as microcytic hypochromic anemia. Iron deficiency anemia is not a disease itself but rather a symptom of an underlying condition, with symptoms correlating to the severity of anemia and the speed of onset.

bubble_chart Diagnosis

1. Medical History and Symptoms

(1) History Inquiry: Note ① Dietary habits, whether there is picky eating or infantile paroxia. ② Whether there are digestive system diseases (atrophic gastritis, gastric ulcer or duodenal ulcer, etc.), hookworm disease; whether women have hypermenorrhea; whether gastrointestinal surgery has been performed. For men and postmenopausal women, consider whether it is the initial symptom of gastrointestinal tumors.

(2) Clinical Symptoms: Generally include fatigue, irritability, palpitation, shortness of breath, dizziness, and headache. Children may exhibit delayed growth and development, and difficulty concentrating. Some patients may have gastrointestinal symptoms such as anorexia, heartburn, bloating, nausea, and constipation. A few severe cases may present with dysphagia, angular cheilitis, and glossitis.

2. Physical Examination Findings

In addition to an anemic appearance, there may be dry and wrinkled skin, dry and brittle hair that falls out easily. Nails may be thin, flat, rough, and prone to breaking, or even spoon-shaped (seen in long-term severe cases).

3. Auxiliary Examinations

4. Differential Diagnosis

Thalassemia: Family history is present, blood smear shows numerous target cells, hemoglobin A2 is increased, serum iron and common bletilla tuber, and bone marrow iron staining shows increased iron.

Chronic inflammatory anemia: Total iron-binding capacity is normal or decreased, serum ferritin is elevated.

Sideroblastic anemia: Ringed sideroblasts may be seen, serum iron and ferritin are increased, and total iron-binding capacity is decreased.

bubble_chart Treatment Measures

1. Remove disease cause:

Try to identify the disease cause as much as possible and treat it accordingly. For example: treating ulcer bleeding, women with hypermenorrhea, etc.

2. Oral iron supplements:

Ferrous sulfate is effective and economical. Usage: 0.3, 3 times/day, taken with meals. If gastrointestinal symptoms are significant, start with 0.1 daily and gradually increase the dose to alleviate symptoms. Ferrous fumarate: 0.2, orally, 3 times/day; Ferrous succinate: 1 tablet orally, once/day; Ferrous succinate tablets: 0.1, orally, twice/day, etc.

3. Injectable iron supplements:

The following patients may receive injectable iron therapy: (1) Intolerance to oral iron;

(2) Excessive blood loss that cannot be compensated by oral iron;

(3) Patients with ulcerative colitis or regional enteritis who show no response to oral iron therapy;

(4) Patients unable to absorb iron from the gastrointestinal tract, such as those who have undergone gastrointestinal surgery. Usage: The total dose for correcting anemia and replenishing iron stores is calculated by the formula: Iron (mg) = [15 - patient's hemoglobin (g/dl)] × weight (kg) × 3. A sensitivity test should be performed before intravenous administration. Iron dextran: 100mg, once/day, deep intramuscular injection (initial dose 50mg, observe for allergic reactions). Alternatively, iron dextran: 500mg, once/day, undiluted intravenous injection within 5 minutes; or calculate the single intravenous iron dose and administer it once, diluted with saline at a ratio of 1:20 for intravenous infusion. Start at 20 drops per minute, observe for 5 minutes for side effects, then increase to 40–60 drops per minute. Intravenous administration has more severe reactions and is rarely used clinically.