الفهرس | Only 14 pages are availabe for public view |
Abstract Iron is essential to virtually all living organisms and is integral to multiple metabolic functions. The most important function is oxygen transport in hemoglobin. Iron deficiency anemia is usually caused by chronic blood loss Severe iron deficiency is characterized by a microcytic, hypochromic, potentially severe anemia with a variable regenerative response. Iron metabolism and homeostasis was reviewed, followed by a discussion of diagnostic testing and therapeutic recommendations for patients with iron deficiency anemia. Iron deficiency is one of the most common nutritional problems of the human race. It is associated with serious health risks including abnormal mental and motor development in infancy, impaired work capacity, increased risk of premature delivery, and, in severe anemia, increased maternal and infant mortality. The development of iron deficiency is the consequence of an interaction of 3 distinct risk factors: increased host requirements, limited supply, and increased blood loss. Studies in the late 90s have established celiac disease as a possible cause of IDA refractory to oral iron treatment, without other apparent manifestations of malabsorption syndrome. In addition, Helicobacter pylori has been implicated in several earlier studies as a cause of IDA refractory to oral iron treatment, with a favorable response to H pylori eradication. Likewise, autoimmune atrophic gastritis, a condition associated with chronic idiopathic iron deficiency, has been shown to be responsible for refractory IDA in over 20% of patients with no evidence of gastrointestinal blood loss. The availability of convenient, noninvasive screening methods for identifying celiac disease (anti-tissue transglutaminase [TTG] antibodies), autoimmune atrophic gastritis (serum gastrin, parietal cell, or intrinsic factor antibodies), and H pylori infection (antibody screening or fecal antigen and urease breath test), and the recent recognition of rare inherited forms of iron deficiency greatly facilitated the diagnosis of these entities, resulting in an increased awareness of these conditions and their possible role in the causation of IDA. Recognition of the respective roles of H pylori, autoimmune gastritis, celiac disease, and inherited disease in the pathogenesis of iron deficiency should have a strong impact on the current diagnostic workup and management of refractory IDA and a sharp decrease in the proportion of IDA patients still labeled ―unexplained. |