الفهرس 
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Abstract
Iron is essential to virtually all living organisms and
is integral to multiple metabolic functions. The most
important function is oxygen transport in hemoglobin. Iron
deficiency anemia is usually caused by chronic blood loss
Severe iron deficiency is characterized by a microcytic,
hypochromic, potentially severe anemia with a variable
regenerative response. Iron metabolism and homeostasis
was reviewed, followed by a discussion of diagnostic
testing and therapeutic recommendations for patients with
iron deficiency anemia.
Iron deficiency is one of the most common
nutritional problems of the human race. It is associated with
serious health risks including abnormal mental and motor
development in infancy, impaired work capacity, increased
risk of premature delivery, and, in severe anemia, increased
maternal and infant mortality. The development of iron
deficiency is the consequence of an interaction of 3 distinct
risk factors: increased host requirements, limited supply,
and increased blood loss.
Studies in the late 90s have established celiac disease
as a possible cause of IDA refractory to oral iron treatment,
without other apparent manifestations of malabsorption
syndrome. In addition, Helicobacter pylori has been
implicated in several earlier studies as a cause of IDA
refractory to oral iron treatment, with a favorable response
to H pylori eradication. Likewise, autoimmune atrophic gastritis, a condition associated with chronic idiopathic iron
deficiency, has been shown to be responsible for refractory
IDA in over 20% of patients with no evidence of
gastrointestinal blood loss.
The availability of convenient, noninvasive screening
methods for identifying celiac disease (anti-tissue
transglutaminase [TTG] antibodies), autoimmune atrophic
gastritis (serum gastrin, parietal cell, or intrinsic factor
antibodies), and H pylori infection (antibody screening or
fecal antigen and urease breath test), and the recent
recognition of rare inherited forms of iron deficiency
greatly facilitated the diagnosis of these entities, resulting
in an increased awareness of these conditions and their
possible role in the causation of IDA.
Recognition of the respective roles of H pylori,
autoimmune gastritis, celiac disease, and inherited disease
in the pathogenesis of iron deficiency should have a strong
impact on the current diagnostic workup and management
of refractory IDA and a sharp decrease in the proportion of
IDA patients still labeled ―unexplained.