What is Anemia?

After oxygen, silicon and aluminium, iron is the most commonly occurring element on Earth. In spite of this, it is very peculiar that such a large portion of the earth's population suffer from iron deficiency. Iron deficiency is the most common deficiency in Sweden.

The body normally holds large iron reserves in the spleen, liver and bone marrow. The body uses these reserves as needed in order to maintain an iron balance, the Hb value. If the supply of iron becomes unbalanced, the body will prioritize the formation of new red blood cells over increasing the iron deposits. When the deposits are reduced or becoming empty, the condition that we call iron deficiency develops.

Symptoms of iron deficiency include feeling tired, out of sorts, becoming easily irritated and having difficulties focusing and concentrating. Paleness, headaches, increased need for sleep and reduced performance can be signs of a lack of iron. Various studies have shown that even a minor iron deficiency can affect our physical and mental performance. Iron deficiency is a condition that should be treated before it develops into anaemia.

One explanation for this is that our need for energy has changed dramatically. This is due primarily to the technical developments that have occurred in society. Automation has replaced much of the physical work that we used to perform, and we spend more and more time sitting at our workplaces. Our energy needs have decreased because our physical activities are also decreasing. The reduced need for energy also reduces our energy intake. We eat less and therefore we take in less iron. Among women of childbearing age, this decrease has been significant, such that the amount of iron in many people's diets is below the recommended level that is necessary to balance the loss of iron.

Approx. 15 percent of the world's population suffer from iron deficiency. According to the WHO, it is the second most common deficiency after a protein deficiency. In our part of the world, iron deficiency is more common than we think. Studies have shown that 30 percent of all Scandinavian women of childbearing age have low iron levels. Teenage girls have an even higher level of iron deficiency. According to one study, 50 percent of teenage girls in the year 2000 had iron levels that were too low.

Iron deficiency caused by a low amount of iron in the diet, severe menstruation or donating blood can be easily restored through an iron supplement. Iron supplements are often required for a longer period of time, and therefore an iron supplement with a low dose of iron, approximately 20-30 mg per day, is recommended. Higher doses of iron often generate side effects in the form of stomach upset, constipation, diarrhoea or nausea. 60-100 mg per day is considered a high dose of iron. Taking more than 50 mg of iron per day can make it difficult to absorb other minerals, for example zinc. Zinc is important for many functions in the body especially during pregnancy. A lack of zinc can result in premature birth or children with a low birth weight. Iron deficiency during pregnancy should be treated in conjunction with a physician.

The Hb value, the haemoglobin value, is an expression of the amount of haemoglobin in the blood and the capacity of red blood cells to bind with oxygen. This value varies by age and sex. The normal blood value for men is 130-160 g per litre blood, and for women the corresponding number is 120-140 g per litre. Low values are often due to a lack of iron, however a normal value can still mask a deficiency. Namely, the Hb value does not indicate the status of the iron reserves. When the body is facing a low intake of iron, major iron losses or an increased need for iron, the body will try as long as possible to maintain the iron levels in the blood and body tissues. Therefore, the body's iron reserves can empty before the Hb value decreases. This means that you cannot always rely on the Hb value.

Iron deposits in the liver, spleen and bone marrow contain a protein called ferritin. There is a clear connection between the amount of ferritin in the blood and the amount of iron in the body’s reserves. A low serum concentration of ferritin is the first signs that the iron reserves are starting be emptied. This is a clearer sign of iron deficiency or a negative iron balance than the Hb value, since the Hb value only becomes low when the iron reserves are already empty. A serum ferritin value below 10-15 micrograms per litre always indicates an iron deficiency. The serum ferritin concentration is a small, dynamic parameter, which means that the daily variation is small and the effect of the diet is minimal. Using serum ferritin levels as a way to detect iron deficiency has become increasingly important in recent years.

Serum iron and the total iron binding capacity (TIBC) are the other methods for measuring the iron status in the body. Serum iron shows the status of the iron that is circulating in the body. The concentration is easily affected by physical activity and the intake of iron in the diet. This means that the daily variation can be large, and this method is increasingly used when determining the serum ferritin level by performing iron tests on an individual. TIBC, Total Iron Binding Capacity indicates whether the total iron binding capacity is reduced or elevated.