An Awareness Initiative by

Understanding Iron Deciency

& Hemoglobin

Dr. R.B. Pandit

MD(BOM), FICP, FICN
FICA(USA), FCCP(USA)
Understanding Iron Deciency
Iron deciency is a condition resulting from too little iron in the body. Iron deciency is
the most common nutritional deciency and the leading cause of anemia in the world.
The denition of iron deciency means - abnormal value for at least two of the following
three indicators: serum ferritin, transferrin saturation, and free erythrocyte
protoporphyrin.
Iron deciency at critical times of growth and development can result in –

premature births, low birth weight babies, delayed growth and development, delayed
normal infant activity and movement.
Iron deciency can result in -

Poor memory or poor cognitive skills (mental function) and can result in poor
performance in school, work, and in military or recreational activities.
Lower IQs have been linked to iron deciency occurring during critical periods of growth.

Understanding Hemoglobin & Iron

Hemoglobin is a pigment present in the blood which gives red colour to the blood and is
important for carrying oxygen to the different body tissues .
Hemoglobin is a substance containing iron and protein. Hemoglobin = Haem + Globin
Here, Haem = Ferrous Iron (Fe2+) chelated between porphyrin rings and globin chain .
** When iron is inadequate small erythrocytes with insufcient hemoglobin are formed
giving rise to microcytic hypochromic anemia

Iron deciency and Anemia

Anaemia is the most common indicator used to screen for iron deciency, the terms
anaemia, iron deciency and iron deciency anaemia are sometimes used
interchangeably. There are, however, mild-to-moderate forms of iron deciency in which,
although anaemia is absent, tissues are still functionally impaired

Understanding Iron Deciency 1

& Hemoglobin
 Sign and Symptoms of iron deciency

A person who is iron decient may also be anemic and as a result may have one or more
symptoms of anemia. The symptoms include –
chronic fatigue, weakness, dizziness, headaches, depression, sore tongue, sensitivity to
cold (low body temp), shortness of breath doing simple tasks (climbing stairs, walking
short distances, doing housework), restless legs syndrome, pica (the desire to chew ice
or non-food items,) and loss of interest in work, recreation, relationships, and intimacy.

IRON DEFICIENCY SYMPTOMS

Fatigue Poor Cognitive Function

Tachycardia Reduced Exercise Tolerance

Palpitations Inability to maintain body temperature

Rapid Breathing on exertion Brittle & Spoon Shaped Nails

Restless Leg Sores at corner of mouth

Infection Pica

Iron deciency at critical times of growth and development can result in –

premature births, low birth weight babies, delayed growth and development, delayed
normal infant activity and movement.
Iron deciency can result in -

Poor memory or poor cognitive skills (mental function) and can result in poor
performance in school, work, and in military or recreational activities.
Lower IQs have been linked to iron deciency occurring during critical periods of
growth.

Understanding Hemoglobin & Iron

Hemoglobin is a pigment present in the blood which gives red colour to the blood and
is important for carrying oxygen to the different body tissues .
Hemoglobin is a substance containing iron and protein. Hemoglobin = Haem + Globin
Here, Haem = Ferrous Iron (Fe2+) chelated between porphyrin rings and globin chain
.
** When iron is inadequate small erythrocytes with insufcient hemoglobin are formed
giving rise to microcytic hypochromic anemia

Understanding Iron Deciency

2
& Hemoglobin
Iron deciency and Anemia

Anaemia is the most common indicator used to screen for iron deciency, the terms
anaemia, iron deciency and iron deciency anaemia are sometimes used
interchangeably. There are, however, mild-to-moderate forms of iron deciency in which,
although anaemia is absent, tissues are still functionally impaired

Sign and Symptoms of iron deciency

A person who is iron decient may also be anemic and as a result may have one or more
symptoms of anemia. The symptoms include –
chronic fatigue, weakness, dizziness, headaches, depression, sore tongue, sensitivity to
cold (low body temp), shortness of breath doing simple tasks (climbing stairs, walking
short distances, doing housework), restless legs syndrome, pica (the desire to chew ice
or non-food items,) and loss of interest in work, recreation, relationships, and intimacy.

Hair Loss
Reduced
Chronic Red Blood
Cells
Recurrent
Infection

Fatigue
Inability
to carry
Inability oxygen
to heal

According to Nutrient Requirements & NIN Dietry guidelines of India the

recommended consumption per day is as follows :

Adult male : 17 mg/day

Women : 21 mg/day
5- 10 % of the dietary iron is absorbed
Pregnant Women : 35 mg/day 1 molecule of hemoglobin = 33% iron
1ml blood loss= 0.5 mg iron loss

Understanding Iron Deciency 3

& Hemoglobin
 Causes iron deciency
Iron deciency can be the result of numerous and multiple causes. These fall into two
broad categories: an increased need for iron and/or decreased intake or absorption of
iron.

Increased Demand
Iron deciency can occur during rapid periods of growth. Nature makes certain that
developing fetuses, newborns and infants up until the age of about 6 months have an
ample supply of iron.
Conditions that result in iron deciency include blood loss from heavy menstruation,
pregnancy, frequent or excessive blood donation, broids, digestive tract disease
(including infections), as well as surgeries and accidents. Iron deciency can also be
caused by certain medications, some dietary supplements or substances that cause
bleeding such as pain relievers with aspirin, and also as a result of poisoning from lead,
toxic chemicals or alcohol abuse.

Decreased intake or absorption

Decreased intake or absorption can occur in diets that do not include heme iron, the
iron in meat and shellsh. Heme iron is absorbed more efciently than non-heme iron
found in plants and dietary supplements. Other nutrients, however, such as vitamins C
and B12, folate or zinc can facilitate sufcient non-heme iron absorption.

Decreased intake or absorption

Consuming certain foods and medications can interfere with the absorption of iron.
These include dairy products, coffee, tea, chocolate, eggs, and ber.
Medication that inhibit iron absorption include antacids, proton pump inhibitors (to
treat acid reux) or calcium supplements. Diseases conditions like - insufcient
stomach acid, lack of intrinsic factor (hormone needed to absorb vitamin B12), celiac
disease, inammatory conditions such as Crohn's disease, and in autoimmune diseases
and hormone imbalances.

Most at risk for iron deciency:

Women, children and the elderly are most at risk. Men are rarely iron decient; but
when they are, it is generally due to blood loss from the digestive tract (sometimes
indicating disease), diseases that affect iron absorption, and in some cases, alcohol
abuse. Except for those who are strict vegetarians, men rarely have dietary iron
deciency.

Understanding Iron Deciency

4
& Hemoglobin
How iron deciency can be diagnosed

The tests used most often to detect iron deciency include hemoglobin, hematocrit
which provides the percentage measures of red blood cells in the blood, serum
ferritin, which indicates the amount of iron stored in the body, and serum iron and
iron-binding capacity (IBC, UIBC or TIBC).

The latter measures are used to calculate transferrin-iron saturation percentage

(TS%), a measure of iron in transit in the serum.

Serum ferritin test : It is a very important test because it helps distinguish between
iron deciency anemia and anemia of chronic disease. Other tests might include: a
complete blood count, zinc protoporphyrin, free erythrocyte protoporphyrin or
reticulocyte hemoglobin content (CHr).

Iron deciency anemia

Anemia is a severe form of iron deciency. It is a disease that results from decreased red blood
cells that are needed in the body with hemoglobin 12 g/dL When an iron deciency isn't treated
promptly, it can lead to anemia. Iron deciency is
the most common cause of anemia.

Iron deciency anemia occurs when your body

doesn’t have enough of the mineral iron. As iron is
needed to make hemoglobin when there isn’t
enough iron in your blood stream, the rest of your
body can’t get the amount of oxygen it needs.

While the condition may be common, many

people don’t know they have iron deciency
anemia. It’s possible to experience the symptoms
for years without ever knowing the cause.

In women of childbearing age, the most common cause of iron deciency anemia is a loss of
iron in the blood due to heavy menstruation or pregnancy. A poor diet or certain intestinal
diseases that affect how the body absorbs iron can also cause iron deciency anemia.

Symptoms of Iron deciency anemia:

¯ Fatigue
¯ Weakness
¯ Pale skin
¯ Shortness of breath
¯ Dizziness
¯ Strange cravings to eat items
like dirt, ice, or clay
¯ A tingling or crawling feeling in
the legs
¯ Tongue swelling or soreness
¯ Cold hands and feet
¯ Fast or irregular heartbeat
¯ Brittle nails
¯ headaches
I

Understanding Iron Deciency

5
& Hemoglobin
 Food Sources of Iron
Vegeterian sources of Iron does not contain
sufcient absorbable iron due to the
presence of inhibitors. Animal foods from
which iron is better absorbed due to the
presence of enhancers are less popular in
India due to religious & socio-economic
reasons.
Red Meat & Liver - Red meat, liver, spleen
are one of the best sources of iron. These
contain substantial amounts of absorbable
iron.
Among the plant foods the list of iron
sources include green leafy vegetables like - amarnath leaves, mustard leaves,
colocasia leaves, mint leaves, spinach etc.
Cereals like whole wheat our, rice akes, bajra, ragi, jowar and pulses especially the
whole one are good souces of iron.
Soyabean is an example of a pulse containing good amounts of iron. Jaggery is another
food that contains fair amounts of iron.

Nuts, Chia Seeds,Pumpkin Seeds, dried Apricots, Raisins and Dates also contain iron
Iron absorption issue:
The extent of iron absorption from different food stuffs varies. In general, its
absorption is high from animal foods and absorbed from plant sources is very low.
Certain substances present in plant foods bind iron and hinder absorption (inhibitor).
These inhibitors prevent much iron to be absorbed in the body. Protein and vitamin C
present in foods aid in the absorption of iron. These substances can be called
enhancers. It is suggested that protein-rich foods like milk and vitamin C rich foods like
oranges, lime, amla and guava should be included in the diet so as to promote
absorption of iron.

Have you checked your Iron level ?

Get yourself checked before complications strike.

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Understanding Iron Deciency
& Hemoglobin
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Disclaimer : The content given here is purely informative & educational in nature and should not be
construed as medical advice. Kindly use the content only in consultation with a certied medical or
healthcare professional.