Decrease in iron reserves will be associated with behavioral changes, such as withdrawal, attention, concentration, reasoning, perception.
Iron deficiency is also associated with nervous and behavioral disorders especially in children. Patients have reduced concentration, interest, are irritable. With iron intake, these symptoms improve.
The ability to maintain body temperature when exposed to cold (cold intolerance), is affected in patients with chronic iron deficiency anemia. Sometimes they have neuralgic pain, vasomotor disorders, reduction of sensation and itching or the feeling of stinging (hyperesthesia). These symptoms are encountered in 15-30% (1/5) of patients with chronic iron deficiency anemia.
D. Impairment of immune function in subjects who are iron deficient, resulting in more frequent infections. It should be emphasized that it is not fully determined and other factors may influence. Bacterial and phagocytic activity of polymorphonuclear leukocytes depends on sideremia levels and is significantly reduced in iron deficiency. Iron deficiency is associated with a reduction in Leukocyte Alkaline Phosphatase (LAP), which is necessary for normal granulocytic metabolism.
2. Hematological clinic of iron deficiency;
Iron deficiency is first and foremost expressed by the development of Iron Deficiency Anemia with the clinic of anemic syndrome:
A. Symptoms; weakness, fatigue, breaking, more pronounced during physical exertion, palpitations, difficulty breathing, headache (in the back of it), floaters before the eyes, noise in the ear. In older ages and when it sets in quickly, symptoms of angina pectoris etc. may also appear.
B. General signs; paleness of the skin and mucous membranes (which appear when Hb is less than 9-10 gr/dl). Anemia is best seen in mucous membranes (lips, mouth, pharynx, conjunctivas), ear lobes, nail beds, palms of the hands and soles of the feet (when Hb < 7 gr/dl). When assessing the color of the hands they should first be warmed and held at heart level. In cases where anemia sets in quickly and is severe, we may have tachycardia, rapid and striking pulse, loud heart tones, systolic murmur, cardiomegaly}.
C. Splenomegaly may occur in severe, persistent untreated forms of AF.
Plummer Vinson-Syndrome
D. Blue sclera – Juvenile Chlorosis or Juvenile Iron Deficiency Anemia. Iron Deficiency Anemia can develop during puberty in young girls, most often born to mothers with iron deficiency. At this age, blood losses from the Menstrual Cycle begin, there is an increased demand for iron, due to rapid growth.
These also have other signs, hair loss, breaking of the fingernails and toenails, palpitations, pica (perversion of the taste), urinary disorders (difficulty holding urine at night and frequent urination). The skin color is green (which is not a primary color, but a combination of blue and yellow), greensickness.
E. Another pathology that accompanies iron deficiency (has other causes as well and in some cases idiopathic) is Restless Leg Syndrome. It is a neurological pathology characterized by unpleasant, painful sensations, of the legs when sitting or lying down (usually in sleep, hence it is also classified among sleep pathologies) and you are forced to move your legs often to get relief. The unpleasant sensation in any portion of the legs, when sitting or watching TV is an indication of this syndrome.
F. Pica can be the etiology, but also the consequence of iron deficiency in people who are accustomed to eating nails, ice, sand, etc. These substances reduce the absorption of dietary iron resulting in its deficiency. Eating them is widespread in all races, but more pronounced in Lesser Asia (clay eating) and among African tribal women (it begins in pregnancy as a treatment for morning sickness). However, pica is also one of the characteristics of iron deficiency and is corrected with the correction of iron deficiency.
Definition of Pica
It should be kept in mind that Anemia from Iron Deficiency does not set in immediately. It takes about 4 months from the depletion of iron stores for the entire normal normochromic, normocytic population to be replaced with the hypochromic, microcytic population (erythrocytes live 120 days). Thus, we talk about a Chronic Anemia. The clinic of the Anemic Syndrome (symptoms and signs) is determined by:
The diagnosis of AF requires the discovery of the cause, usually hemorrhage. Patients with obvious blood loss (e.g., a woman with menorrhagia) may not require further examinations. Men and postmenopausal women without obvious blood loss should examine the G-I Tract, since anemia may be the only indicator of an occult G-I tract cancer. Rarely, chronic epistaxis or gingivorrhagia may be underestimated by the patient (to be sought in cases with normal results of G-I tract examinations).
When taking the history, one should ask for:
1. The diet used, but it should be emphasized that it is no longer the main cause of iron deficiency at least in developed and developing countries knowing that iron is found in plant foods, animal foods, and in the pots in which food is cooked, so the relatively small amount that we need per day is possible to be ensured.
The most likely affected population are vegetarians who develop iron deficiency, at least when they do not take iron supplements, because they do not get animal (heme-iron) which is better absorbed. Many national dietary programs (adding iron supplements) have started in those countries where meat is not consumed and AF is possible. It should be emphasized that in many countries iron supplements are added to food ingredients and vitamins regardless of the role that iron plays in the formation of free radicals and the prevalence of genetic diseases with iron overload.
Due to poor economic conditions many elderly seek to survive on a "tea and toast" diet. They may also hesitate in taking dietary advice.
As we emphasized above, Pica can be the etiology but also the consequence of iron deficiency in people who are accustomed to eating nails, ice, sand, etc.
2. Hemorrhage. 2/3 of the body's iron is present in the blood circulation in the composition of Hb of RBCs. Every gram of Hb contains 3.47 mg iron (thus 15 gr/dl, Hb contains 52.05 gr/dl iron) so every ml of blood lost results in a loss of 0.5 mg iron.