1 Department of Pediatrics, Hematology/ Oncology Unit, University General Hospital of Alexandroupolis, Thrace, Greece.
2 Democritus University of Thrace Faculty of Medicine, Alexandroupolis, Thrace, Greece.
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deficiency and iron-deficiency anemia (IDA) affects approximately two
billion people worldwide, and most of them reside in low- and
middle-income countries. In these nations, additional causes of anemia
include parasitic infections like malaria, other nutritional
deficiencies, chronic diseases, hemoglobinopathies, and lead poisoning.
Maternal anemia in resource-poor nations is associated with low birth
weight, increased perinatal mortality, and decreased work productivity.
Maintaining a normal iron balance in these settings is challenging, as
iron-rich foods with good bioavailability are of animal origin and
either expensive and/or available in short supply. Apart from
infrequent consumption of meat, inadequate vitamin C intake, and diets
rich in inhibitors of iron absorption are additional important risk
factors for IDA in low-income countries. In-home iron fortification of
complementary foods with micronutrient powders has been shown to
effectively reduce the risk of iron deficiency and IDA in infants and
young children in developing countries but is associated with
unfavorable changes in gut flora and induction of intestinal
inflammation that may lead to diarrhea and hospitalization. In
developed countries, iron deficiency is the only frequent micronutrient
deficiency. In the industrialized world, IDA is more common in infants
beyond the sixth month of life, in adolescent females with heavy
menstrual bleeding, in women of childbearing age and older people.
Other special at-risk populations for IDA in developed countries are
regular blood donors, endurance athletes, and vegetarians. Several
medicinal ferrous or ferric oral iron products exist, and their use is
not associated with harmful effects on the overall incidence of
infectious illnesses in sideropenic and/or anemic subjects. However,
further research is needed to clarify the risks and benefits of
supplemental iron for children exposed to parasitic infections in
low-income countries, and for children genetically predisposed to iron
Dietary Absorption of Iron
|Table 1. Plant foods that reduce iron absorption.|
|Table 2. Recommended dietary allowance (RDA) for iron by age (modified from reference 23).|
Risk Factors and Prevention of IDA
|Table 3a. Risk factors for IDA by cause.|
|Table 3b. Main risk factors for IDA in low-income and developed countries.|
Diagnosis of IDA
|Table 4. Hematologic and biochemical features of IDA.|
IDA Screening Recommendations
Treatment of IDA with Oral Iron Products
|Table 5. Available oral iron medicinal products for prevention and treatment of iron deficiency and IDA.|
Parenteral Iron Therapy
|Table 6. Indications for intravenous iron therapy in children.|