Lesson 10 : Iron Deficiency Anaemia (IDA)


  • Plasma Ferritin levels give an idea of iron stores.
  • Transferrin saturation gauges iron supply to tissues.
  • Hemoglobin and Hematocrit measurements can indicate anemia.
  • Ratio of zinc protoporphyrin to heme indicates iron supply to developing RBCs.

Diagnosis of iron deficiency


Interpretary guidelines

Peripheral smear

Microcytic hypochromic



Serum iron µg/dl


Total iron Binding capacity µg/dl


Transferrin saturation (%)


Erythrocyteprotoporphyrin µg/dl


Protoporphyrin haemeratio


Serum ferritin µg/dl


Bone marrow iron (by perlstain)

0 or +

Source: Raman Leela and K. V Rameshwara Sarma. Nutrition and Anaemia. Text book of Human Nutritiona. Editied by Bamji M S et al. Oxford and IBH Publishing Co, Pvt ltd., new Delhi.

Clinical symptoms

The end result of iron deficiency is nutritional anemia which is not a disease entity. It is rather a syndrome caused by malnutrition in its widest sense. Besides anaemia there may be other functional disturbances such as impaired cell- medicated immunity, reduced resistance to infection, increased morbidity and mortality and diminished work performance.

When iron deficiency become more severe, then defect arise in the structure and function of the epithelial tissues , especially of the tongue, nails mouth and stomach.
The skin may appear pale and the inside of the lower eyelid may be light pink instead of red. Finger nails become thin and flat and eventually koiloniychia (spoon shaped nails) develops. Mouth changes include atrophy burning redness, smooth waxy and glistening appearance to the tongue (glossitis).

Gastritis occurs frequently and may result in achlorohydria. Progressive untreated anemia results in cardiovascular and respiratory changes that can eventually lead to cardiac failure.

Chromic long term deficiency symptoms reflect a malfunction of a variety of body systems. The general symptoms are lassitude, fatigue, breathiness on exertion, palpitations, dizziness, headache, dimness of vision, insomnia, paraesthesia in finger toes and angina; finally it results in reduced activity leading to poor performance.

Treatment: Treatment should focus primarily on the underlying diseases or situation leading to anemia.

  1. Oral administration of inorganic iron in the ferrous form–ferrous sulphate 50-200mg (60mg elemental iron) 3 times daily for adults and 6mg/kg for children.
  2. Iron is best absorbed when the stomach is empty.
  3. Iron therapy, should be continued for several months even after restoration of normal hemoglobin level to allow for repetition of body iron stores.
  4. An improvement in riboflavin status may stimulate iron absorption.
  5. Deworming done periodically would help in reducing anemia and improve the efficiency of iron supplement.
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