Iron deficiency

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Classification according to ICD-10
E61.1 Iron deficiency
D50.0 Iron deficiency anemia after blood loss (chronic)
Posthemorrhagic anemia (chronic)
D50.1 Sideropenic dysphagia
Kelly-Paterson syndrome
Plummer-Vinson syndrome
D50.8 Other iron deficiency anemia
ICD-10 online (WHO version 2019)

Iron deficiency or sideropenia ( Greek  σίδηρος síderos "iron" and πενία , penía "deficiency") means an iron deficiency in the organism . Iron deficiency is often symptom-free. If the symptoms of iron deficiency appear before the anemia , it is called sideropenia. The human body contains around 2 to 4 grams of iron. About 60 percent of this is bound to the red blood pigment hemoglobin , the remaining 40 percent to ferritin , hemosiderin , myoglobin and enzymes.

Most common causes

The most common causes of iron deficiency vary from region to region: in western industrialized countries, chronic blood loss, for example through consuming processes such as tumor disease , hypermenorrhea or chronic inflammatory processes such as osteomyelitis, is the leading factor, while in the third world bacterial (e.g. tuberculosis ), parasitic (e.g. B. malaria ) and malnutrition-related causes dominate.

Bleeding often occurs in men and women in the gastrointestinal tract , often as bleeding from tumors . In young women, excessive menstruation can also be the cause of iron deficiency anemia. On average, women lose around 15 mg of iron with each menstrual period. During pregnancy , the iron requirement is increased by almost 100%. Regular blood donors also have an increased need, as about 250 mg of iron are lost by withdrawing about half a liter of blood. Furthermore, iron deficiency occurs more frequently in connection with chronic heart failure .

The treatment of diseases with frequent, regular bloodletting , such as polycythemia vera , specifically causes iron deficiency in the patient. Too many blood cells are produced in the blood disease polycythemia vera . The iron deficiency deliberately caused by bloodletting leads to a desired long-term reduction in hematocrit , above all through a reduction in the size of erythrocytes and blood cell production.

Adequate reserves of iron are an essential prerequisite for the survival of people, but also of microorganisms such as bacteria and parasites. The body has several mechanisms in place to fight the risk of infection, and it makes cytokines to raise body temperature while reducing the availability of iron in the blood and tissue fluid, preventing the growth and reproduction of microorganisms. Therefore, iron deficiency or anemia due to infections are not necessarily reasons for iron supplements.

Microorganisms also adapt to the poor conditions that the immune system prepares for them by removing ferritin from the circulation, for example chlamydia can extract iron from the cells, hemolytic streptococci decompose the red blood cells, some microorganisms draw iron from hard-to-reach bound reserves .

Symptoms and secondary diseases

The following symptoms and secondary diseases are typical:

Investigation methods

Determining the ferritin level and transferrin saturation in the blood is decisive for the exclusion or proof of iron deficiency . Also zinc protoporphyrin in blood is a useful parameter, but is rarely used in most European countries. Determining the iron value only is not suitable for this because it fluctuates too much.

treatment

Food Iron (mg / 100 g)
Thyme , dried 123.6
Cardamom , spice 100
Spearmint , dried 87.5
Marjoram , dried 82.7
Sorrel , dried 81.7
cumin 69
Dill , dried 48.77
licorice 41.4
cinnamon 38.1
Nettles , dried 32.2
Blood sausage 29.4
Parsley , dried 23.961
Pork liver 22.1
Spirulina , dried 20.0
Brewer's yeast , dried 20.0
Soy flour 15.0
Edible hemp seeds , unpeeled 14.9 (or 12)
Cocoa powder , heavily de-oiled 14.5
Beet syrup 13.0
Cocoa powder , slightly de-oiled 12.5
Textured soy 12.5
Pumpkin seeds 11.2
Ginger , powder 11.5
sesame 10.0
Pig kidney 10.0
Poppy 9.5
Pine nuts 9.2
millet 9.0
Soybeans 8.6
Sorrel , fresh 8.5
linseed 8.2
Quinoa 8.0
Calf liver 7.9
amaranth 7.6
lenses 6.9
Chanterelles 6.5
Sunflower seeds 6.3
White beans 6.1
Persipan , raw mass 6.1
oats 5.8
Oysters 5.8
Parsley , fresh 5.5
Dill , fresh 5.5
Liver sausage 5.3
Apricots , dried 3.8
Peas 5.0
Whey cheese 5.0
rye 4.9
crispbread 4.7
oatmeal 4.6
barley 4.5
Green kernels 4.2
spinach 4.1
Nettle 4.1
almond 4.1
Corned beef 4.1
soy sauce 3.9
hazelnut 3.8
Jerusalem artichoke , fresh 3.7
Whole grain bread 3.3
beef 3.2
Dandelion , fresh 3.1
pork meat 3.0
poultry 2.6
fennel 2.5
veal 2.2
tuna 1.2
Beetroot 0.93
Beetroot juice 0.87
salmon 0.7

Change of diet

If the cause of an iron deficiency is due to malnutrition or malnutrition, appropriate changes should be made and more attention should be paid to the consumption of iron-containing foods or care should be taken. The German Nutrition Society recommends an iron intake of 10 to 12 mg / day, depending on age and gender. 20 mg / day is recommended for breastfeeding and 30 mg / day for pregnancy.

The realization that the use of cast iron cookware can improve the iron values ​​in case of iron deficiency led to the development of the “ lucky iron fish ” in Cambodia , which is cooked with meals and thereby releases iron into the often low-iron food.

For the consequences of the increased intake of iron-containing compounds in the plant organism, see iron toxicity .

Improved absorption of iron

An Indian study of 54 iron-deficient vegetarian children showed that iron deficiency can be treated by improving vitamin C intake. After 100 mg of vitamin C ( ascorbic acid ) were added to lunch and dinner for 60 days without any other change in eating habits, all subjects in the group supplied with vitamin C experienced a significant improvement in their hemoglobin status . In fact, the majority of these children became completely healthy.

The amount of 100 mg vitamin C is contained, for example, in approx. 200 ml freshly squeezed orange juice , 100 g broccoli or a few strips of red bell pepper , but half is enough to cause a large increase in absorption . However, only if there are no more than a few hours between the consumption of foods containing ascorbic acid and foods rich in iron, i.e. the vitamin C is still in the digestive tract. It is best to take it with the same meal.

Promoters of iron absorption:

  • Vitamin C is the most effective known promoter of iron absorption. It can completely cancel out the iron-inhibiting effect of many inhibitors.
  • other organic acids such as malic acid , tartaric acid and citric acid ; possibly acetic acid and lactic acid as well
  • sulfur-containing amino acids such as cysteine
  • Phytase , which can be activated by fermentation or long soaking of grain
  • animal protein from muscle tissue
  • Fructose (fruit sugar), to a lesser extent other sugars

In general, these are mainly the ingredients of fruits and fruit vegetables as well as cabbage vegetables .

Iron absorption inhibitors:

The inhibiting effect of naturally occurring dietary fiber on iron absorption is probably due to phytic or oxalic acid that is also present in them. In its pure form, however, there is hardly any negative effect of dietary fiber.

Medical therapy

If the iron deficiency is pronounced or cannot be compensated for by changing one's diet alone, iron supplements can be administered. In principle, this can be done in two ways: in tablet form (“perorally”) or as an infusion (“intravenously”). In general, oral administration is preferable as this corresponds to the natural way in which iron is absorbed by the body. Iron tablets mostly contain bivalent iron (Fe 2+ ) because of the better absorption . The tablets should be taken daily on an empty stomach with an interval between meals. In sensitive people, iron-containing tablets can cause local stomach irritation with abdominal pain and possibly diarrhea. If this occurs, an attempt can be made to switch to another oral iron supplement. Only a small percentage of the iron contained in the tablets is absorbed, the greater part is excreted with the stool, which turns it from deep dark brown to black. It is important that the iron therapy is continued for a while after, for example, the anemia caused by iron deficiency has already disappeared, since the body's iron stores need to be replenished, which takes a long time because there is only a small amount in the intestine can be included. Typical tablet-based iron therapy usually lasts for months.

If iron tablets are not tolerated or the iron deficiency is very pronounced and needs to be remedied quickly, iron-containing infusions can be administered. These infusion preparations contain iron bound to a carrier. Preparations should be selected that contain high-dose iron (500–1000 mg iron per infusion) and only release iron slowly ( iron carboxymaltose , iron polymaltose ). The previously common intravenous iron preparations, which contained low-dose iron (typically 40-62.5 mg iron), which is easily released (e.g. in the form of iron gluconate ), should no longer be used because they have to be given repeatedly. to achieve the same effect. In addition, due to the free iron content, they lead to hypersensitivity and circulatory reactions much more frequently.

Vegetarian diet and iron

In view of the significantly higher bioavailability of heme iron from animal food compared to trivalent iron from plant foods (approx. 20% vs. 2-5%), a vegetarian diet requires a significantly higher iron intake than a mixed diet.

Basically, the iron requirement can also be met with a balanced meat-free diet. It is important to ensure that such a diet cannot only lead to an iron deficiency. Concentrating purely on an iron-rich diet therefore does not make sense.

Children and adolescent girls with increased needs should be avoided on a vegetarian diet, or this should be done under medical supervision, for example as part of a balanced lacto-ovo-vegetarian diet.

literature

  • Eberhard J. Wormer : Iron. The life element. Kopp, Rottenburg 2016.
  • A. Draper, E. Wheeler: The diet and food choice of vegetarians in Greater London. Center of Human Nutrition, London 1989.
  • B. Anderson et al. a .: The iron and zinc status of long-term vegetarian women. In: American Journal of Clinical Nutrition. 6/34/1981, pp. 1042-1048. PMID 7234735 .
  • S. Seshadri, A. Shah, S. Bhade: Haematologic response of anaemic preschool children to ascorbic acid supplementation. In: Hum Nutr Appl Nutr. 1985 Apr; 39 (2), pp. 151-154. PMID 4019257 .
  • Gerd Herold : Internal Medicine. Cologne 2007.
  • Markus Keller: Iron - well supplied from plants . In: UGB forum. 3/2012, pp. 141-144.
  • Hermann Heimpel, Martin Neuss, Ellen Wollmer: Iron Deficiency and Iron Deficiency Anemia . Onkopedia guidelines of the German Society for Hematology and Medical Oncology eV.

Individual evidence

  1. ^ German Nutrition Society: Reference values ​​for nutrient intake. 1st edition. Umschau / Braus Verlag, 2001.
  2. ^ Haehling S et al .: Prevalence and clinical impact of iron deficiency and anemia among outpatients with chronic heart failure: The PrEP Registry. In: Clin Res Cardiol . No. 106 (6): 436-443. , June 2017, doi : 10.1007 / s00392-016-1073-y , PMID 28229219 , PMC 5442200 (free full text) - (English).
  3. ↑ M. Wessling-Resnick: Iron homeostasis and the inflammatory response. In: Annual review of nutrition. Volume 30, August 2010, pp. 105-122, doi: 10.1146 / annurev.nutr.012809.104804 , PMID 20420524 , PMC 3108097 (free full text) (review).
  4. ^ FM Pieracci, PS Barie: Iron and the risk of infection. In: Surg Infect (Larchmt). (6), 2005, pp. 1-41.
  5. ^ J. Kletzmayr, WH Horl: Iron overload and cardiovascular complications in dialysis patients. In: Nephrol Dial Transplant. (2), 2002, pp. 25-29.
  6. ↑ M. Wessling-Resnick: Iron homeostasis and the inflammatory response. In: Annual review of nutrition. Volume 30, August 2010, pp. 105-122, doi: 10.1146 / annurev.nutr.012809.104804 . PMID 20420524 , PMC 3108097 (free full text) (review).
  7. ↑ S. Moalem, ED Vineyard, ME Percy: Hemochromatosis and the enigma of misplaced iron: implications for infectious disease and survival. In: Biometals. 17, 2004, pp. 135-139.
  8. ^ ES Ford, ME Cogswell: Diabetes and serum ferritin concentration among US adults. In: Diabetes Care. 22, 1999, pp. 1978-1983.
  9. ^ S. Denic, MM Agarwal: Nutritional iron deficiency: an evolutionary perspective. In: Nutrition. 23, 2007, pp. 603-614.
  10. ↑ F. Fumeron, F. Pean, F. Driss, B. Balkau, J. Tichet et al .: Ferritin and transferrin are both predictive of the onset of hyperglycemia in men and women over 3 years: the data from an epidemiological study on the insulin Resistance Syndrome (DESIR) study. In: Diabetes Care. 29, 2006, pp. 2090-2094.
  11. ^ DR Richardson, DS Kalinowski, S. Lau, PJ Jansson, DB Lovejoy: Cancer cell iron metabolism and the development of potent iron chelators as anti-tumor agents. In: Biochim Biophys Acta. 1790 (7), Jul 2009, pp. 702-717.
  12. ↑ EM Walker, SM Walker: Effects of iron overload on the immune system. In: Ann Clin Lab Sci. 30 (4), Oct 2000, pp. 354-365.
  13. ↑ M. Pieracci, PS Barie: Diagnosis and management of iron-related anemias in critical illness. In: Critical care medicine. Volume 34, Number 7, July 2006, pp. 1898-1905, doi: 10.1097 / 01.CCM.0000220495.10510.C1 . PMID 16691135 (Review).
  14. ↑ Prasad N. Paradkar, Ivana De Domenico, Nina Durchfort, Irene Zohn, Jerry Kaplan: Iron depletion limits intracellular bacterial growth in macrophages . In: Blood . tape 112 , no. 3 , August 1, 2008, ISSN  0006-4971 , p. 866-874 , doi : 10.1182 / blood-2007-12-126854 , PMID 18369153 , PMC 2481528 (free full text).
  15. ↑ Bobby J. Cherayil: The role of iron in the immune response to bacterial infection . In: Immunologic research . tape 50 , no. 1 , May 1, 2011, ISSN  0257-277X , p. 1–9 , doi : 10.1007 / s12026-010-8199-1 , PMID 21161695 , PMC 3085559 (free full text).
  16. ↑ Eric P. Skaar: The Battle for Iron between Bacterial Pathogens and Their Vertebrate Hosts . In: PLoS Pathogens . tape 6 , no. 8 , August 1, 2010, ISSN  1553-7366 , doi : 10.1371 / journal.ppat.1000949 , PMID 20711357 , PMC 2920840 (free full text).
  17. ↑ Herold: Internal Medicine . Cologne 2007, p. 24.
  18. ↑ SD Anker, J. Comin Colet, G. Filippatos, R. Willenheimer, K. Dickstein, H. Drexler, TF Lüscher, B. Bart, W. Banasiak, J. Niegowska, BA Kirwan, C. Mori, B. von Eisenhart Rothe, SJ Pocock, PA Poole-Wilson, P. Ponikowski: FAIR-HF Trial Investigators: Ferric carboxymaltose in patients with heart failure and iron deficiency. In: N Engl J Med. 361 (25), 2009, pp. 2436-2448. doi: 10.1056 / NEJMoa0908355 PMID 19920054
  19. ↑ Lothar Thomas u. a .: New parameters for the diagnosis of iron deficiency states: Conclusion . In: Bundesärztekammer (Ed.): Dtsch Arztebl . tape 102 , no. 42 , 2005, p. A-2878 . : Ferritin must always be determined if iron deficiency is suspected; the iron value (is) obsolete for the diagnosis of iron deficiency anemia
  20. ↑ Iron content of various foods according to the Swiss nutritional value table 2004, GU nutritional value table 2002/2003.
  21. ↑ Product data sheet organic hemp seeds, 150g ecoinform.de
  22. ↑ Product data sheet edible hemp seeds unpeeled ( memento from November 21, 2015 in the Internet Archive ) by Davert
  23. ^ S. Seshadri, A. Shah, S. Bhade: Haematologic response of anaemic preschool children to ascorbic acid supplementation. In: Hum Nutr Appl Nutr. 39 (2), Apr 1985, pp. 151-154. PMID 4019257 .
  24. ↑ a b I. Elmadfa, C. Leitzmann: Nutrition of the people . 4th edition. Eugen Ulmer, 2004, ISBN 3-8252-8036-5 .
  25. ↑ a b Vegetarian diets in children and adolescents Statement of the nutrition commission of the German Society for Child and Adolescent Medicine e. V. (DGKJ), accessed on July 11, 2020
  26. ↑ a b Deutsches Ärzteblatt : Vegetarian and Vegan, What Parents and Doctors Must Pay Attention to , accessed on July 11, 2020