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Sideropenia – Iron Deficiency: Causes and Treatment

Sideropenia refers to an iron deficiency in the body. It can cause fatigue, pallor, and difficulty concentrating, and is one of the most common nutritional deficiencies worldwide.

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Things worth knowing about "Sideropenia"

Sideropenia refers to an iron deficiency in the body. It can cause fatigue, pallor, and difficulty concentrating, and is one of the most common nutritional deficiencies worldwide.

What is Sideropenia?

Sideropenia (from Greek sideros = iron and penia = deficiency) describes a condition in which the body iron level falls below the normal reference range. Iron is an essential trace element required for the production of haemoglobin – the red blood pigment – and for numerous metabolic processes. Sideropenia can, but does not necessarily, lead to anaemia (iron deficiency anaemia). In early stages, iron stores may be depleted without visible impairment of red blood cell production.

Causes

Sideropenia can result from a variety of causes:

Insufficient dietary iron intake: A diet low in iron-rich foods, or a vegan or vegetarian diet without adequate compensation.
Increased iron requirements: Pregnancy, breastfeeding, and growth phases in children and adolescents.
Increased iron losses: Heavy menstrual bleeding, chronic gastrointestinal bleeding (e.g. from stomach ulcers, bowel polyps, or tumours), and surgical procedures.
Impaired iron absorption: Small intestine conditions such as coeliac disease or Crohn's disease, low stomach acid, or the use of certain medications (e.g. proton pump inhibitors).
Chronic diseases: Inflammatory or chronic conditions can interfere with iron utilisation, leading to the so-called anaemia of chronic disease.

Symptoms

In early stages, sideropenia is often asymptomatic. As the deficiency worsens, the following symptoms may occur:

Persistent fatigue and exhaustion
Pallor of the skin and mucous membranes
Difficulty concentrating and memory problems
Headaches and dizziness
Brittle nails and hair, as well as hair loss
Angular cheilitis (cracks at the corners of the mouth)
Restless legs syndrome
In children: developmental delays and impaired cognitive development

Diagnosis

Sideropenia is primarily diagnosed through blood tests. The following laboratory parameters are relevant:

Serum ferritin: The most important marker for assessing iron stores; a low value indicates depleted reserves.
Serum iron: Reflects the amount of iron currently circulating in the blood.
Transferrin saturation: Indicates the percentage of the transport protein transferrin that is bound to iron.
Full blood count (haemoglobin, MCV, MCH): Used to assess whether iron deficiency anaemia has already developed.

If a bleeding source is suspected, further investigations such as gastroscopy or colonoscopy may be necessary.

Treatment

Dietary Adjustment

Mild forms of sideropenia can be managed through dietary changes. Iron-rich foods include red meat, legumes, whole grains, dark leafy vegetables, and nuts. Consuming vitamin C alongside iron-rich plant foods significantly enhances the absorption of non-haem iron. In contrast, coffee, tea, and calcium can inhibit iron absorption.

Iron Supplementation

In more pronounced cases of sideropenia, or when dietary changes alone are insufficient, iron supplements are used. These are available in various forms:

Oral iron: Tablets or liquid preparations containing iron sulfate, iron gluconate, or iron fumarate; generally the first-line treatment.
Intravenous iron infusion: Recommended in cases of severe anaemia, intolerance to oral preparations, or malabsorption.

Treatment typically continues for several months in order to not only correct the immediate deficiency but also to replenish iron stores.

Treating the Underlying Cause

If sideropenia is caused by an underlying condition (e.g. a bleeding source or absorption disorder), this must be treated simultaneously to prevent recurrent iron deficiency.

Risk Groups

Certain groups of people are at higher risk of developing sideropenia:

Women of childbearing age (heavy menstruation)
Pregnant and breastfeeding women
Infants, children, and adolescents during growth phases
Vegans and vegetarians
Competitive athletes
Older adults with limited dietary variety
Individuals with chronic inflammatory bowel disease

References

World Health Organization (WHO): Iron Deficiency Anaemia – Assessment, Prevention, and Control. Geneva, 2001. Available at: https://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/en/
Camaschella C. Iron-deficiency anemia. New England Journal of Medicine. 2015;372(19):1832–1843. doi:10.1056/NEJMra1401038
Goddard AF, James MW, McIntyre AS, Scott BB; British Society of Gastroenterology: Guidelines for the management of iron deficiency anaemia. Gut. 2011;60(10):1309–1316. doi:10.1136/gut.2010.228874

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