Tired and forgetful, are you anemic?

Author: Yu Yibing, Chief Physician, Qinhuangdao First Hospital, Hebei Province

Wang Jing, deputy chief physician of the First Hospital of Qinhuangdao City, Hebei Province

Zhang Lin, deputy chief physician of the First Hospital of Qinhuangdao City, Hebei Province

Reviewer: Li Fengmin Chief Physician, Director of Hematology Department, Qinhuangdao First Hospital, Hebei Province, Standing Committee Member of Hematology Branch of Hebei Provincial Medical Association

Xiao Li is an office worker. She is usually busy at work and occasionally has to work overtime. Two to three cups of coffee a day are her life-saving magic weapon. She has irregular meals and, as a girl who loves beauty, she often chooses to be a "vegetarian" to maintain her figure. In the past six months, she has gradually felt that her physical strength is not as good as before, and she is frequently exhausted. Even a few brisk steps will cause palpitations and shortness of breath. Her memory has also declined significantly, and she often forgets things in a blink of an eye.

Figure 1 Copyright image, no permission to reprint

It was not until she took part in the physical examination organized by her company that Xiao Li learned that her blood routine showed that her hemoglobin was only 87g/L, far below the normal range. At the same time, the average red blood cell volume and average hemoglobin content on the test report were both lower than normal. After the doctor's detailed explanation, Xiao Li suddenly realized that the culprit for her long-term fatigue and forgetfulness was iron deficiency anemia. Next, we will explore this health issue in depth.

1. Common symptoms of iron deficiency anemia

1. Pale complexion and mucous membranes, fatigue, easy fatigue, accompanied by dizziness, tinnitus, palpitations and shortness of breath after activities;

2. Irritability, poor concentration, and even pica (e.g., eating dirt, coal slag, raw rice, etc.);

3. Children may experience growth retardation and their intellectual development may be affected;

4. Iron deficiency dysphagia;

5. Dry hair and severe hair loss;

6. The nails lack luster and are easily brittle and cracked. In severe cases, the nails may become flat or inverted (spoon-shaped).

2. Interpretation of blood test report

Routine blood analysis has a suggestive effect, but a comprehensive diagnosis is required. Key indicators include: hemoglobin (Hb): male <120g/L, female <110g/L, pregnant women <100g/L. Mean corpuscular volume (MCV) <80fl, mean corpuscular hemoglobin content (MCH) <27pg, mean corpuscular hemoglobin concentration (MCHC) <320g/L.

In addition, it is necessary to combine the results of serum ferritin, decreased serum iron levels, and increased transferrin. However, at different stages of iron deficiency or when combined with other diseases, some indicators may not be typical, and a doctor should be consulted for professional diagnosis.

3. Common causes of iron deficiency anemia

1. Increased iron requirements and insufficient intake

Infants, adolescents, pregnant women and lactating women all have an increased need for iron. If their diet lacks foods high in iron, such as eggs and meat, they are more likely to suffer from iron deficiency. Adolescents or adults who are picky eaters are also more likely to suffer from iron deficiency.

2. Iron Absorption Impairment

Iron absorption mainly occurs in the duodenum. After gastrectomy, iron absorption is affected and reduced due to insufficient gastric acid secretion and rapid entry of food into the jejunum. In addition, long-term drinking of strong tea and strong coffee may also have an adverse effect on iron absorption. At the same time, gastrointestinal dysfunction caused by various reasons, such as Helicobacter pylori infection, long-term unexplained diarrhea, chronic enteritis, and Crohn's disease, may cause iron deficiency due to iron absorption disorders.

3. Excessive iron loss

Chronic gastrointestinal blood loss (such as hemorrhoids, gastroduodenal ulcers, esophageal hiatal hernia, digestive tract polyps, gastrointestinal tumors, parasitic infections, esophageal/gastric varicose vein rupture, etc.), excessive menstrual flow (intrauterine contraceptive ring placement, uterine fibroids and menstrual disorders and other gynecological diseases) and other long-term iron loss have not been corrected. For the elderly, if black stools are accompanied by iron deficiency anemia, the possibility of intestinal tumors should be alerted.

4. Treatment of iron deficiency anemia

First, actively eliminate the cause of the disease, such as adjusting the diet structure to ensure balanced nutrition; treat gynecological diseases that cause menorrhagia, etc. Secondly, actively and effectively use sufficient long-term iron supplementation, including oral iron and intravenous iron. Oral iron is the first choice for the treatment of iron deficiency anemia, and divalent iron (ferrous sulfate, iron dextran, ferrous succinate and polysaccharide iron complex) is appropriate. In addition, regular follow-up visits are required during iron supplementation to monitor blood routine, ferritin and reticulocyte levels to adjust the dosage of oral iron. For those with gastrointestinal absorption disorders or those who need rapid iron supplementation, intravenous iron supplementation can be considered, but it needs to be done under the guidance of a doctor, and attention should be paid to prevent risks such as allergies, vascular irritation and iron overload.

5. Dietary Recommendations

In daily life, patients with iron deficiency anemia can improve their symptoms by consuming more foods high in iron. Animal foods, such as animal liver, blood, and red meat (such as beef, pork, and lamb), as well as fish, shrimp, and shellfish, are all good sources of easily absorbed heme iron. In addition, soybeans, black fungus, sesame paste, and dried fruits are also rich in iron, but the iron in these foods is mainly non-heme iron with a low absorption rate.

In contrast, vegetables, milk and dairy products do not contain high levels of iron, and their bioavailability is relatively low. For example, although cereals, spinach, lentils, peas, etc. contain a certain amount of iron, they are not the first choice for iron supplementation.

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Therefore, it is recommended that patients with iron deficiency anemia focus on choosing animal foods rich in heme iron in their diet, while consuming a moderate amount of plant foods containing non-heme iron to achieve better iron supplementation effects.