Causes of absolute iron deficiency

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Article written by Doctor Bui Thi Hang - Unit of Regenerative Medicine Clinic and Educational Psychology

1. Inadequate absorption of iron

Amount of iron in nutrient deficiency Deficiency in dietary iron + Low amount of Haem iron (eg vegans or vegetarians)
+ Unsafe food or Poorly varied diets (eg due to poverty, especially in low-income countries)
+ Low iron fortified diets (eg, breastfeeding or prolonged milk)

2. Iron absorption deficiency from nutrients

Due to simultaneous ingestion with an iron absorption inhibitor (such as calcium or tea) Decreased gastric acid: + Atrophic gastritis
+ Use of proton pump inhibitors or gastric antacids
+ Helicobacter infection pylori
+ Retrogastric bypass surgery
Intestinal mucosal dysfunction (eg, Celiac disease or inflammatory bowel disease)

3. Obesity

Increased levels of hepcidin inappropriately anti-iron absorption (eg in chronic inflammation or iron-resistant iron-deficiency anemia caused by TMPRSS6 mutations)
Increased iron requirements:
Development (eg in the period child or adolescent) Pregnancy Physiological rate of blood loss in excess of iron supply erythropoiesis-stimulating agent therapy

4. Blood loss

Intestinal blood loss
Esophageal: esophageal varices, carcinoma, ulcer, reflux esophagitis other non-steroidal, vascular dysplasia, varicose and antral varices of stomach (watermelon stomach) Small intestine: Hookworm, Inflammatory bowel disease, duodenal ulcer, lymphoma, cancer, polyps, Vascular dysplasia, varicose veins, Meckel's diverticulitis, gastrointestinal bleeding due to excessive exercise, milk protein allergy (in infants less than 12 months of age) Colon: colon cancer, polyps, bleeding diverticulitis, vascular dysplasia, enteritis, Heyde syndrome (severe aortic stenosis, acquired von Willebrand syndrome type 2, vascular dysplasia, and iron deficiency anemia), hamartomatous polyposis in Peutz-Jeghers syndrome Rectal: Hemorrhoids Entire gastrointestinal tract: hereditary bleeding superficial varicose veins Gynecological bleeding
Menstrual (in premenopausal women and girls) Worsened by bleeding disorders (von Willebrand disease, hemophilia A or B carrier, platelet dysfunction) IUD use Fibroids Cancer of the uterus or other parts of the reproductive system Urinary tract bleeding
Cancer Kidney or bladder Urinary schistosomiasis Hemolysis (eg, paroxysmal nocturnal hemoglobinuria)

Intravascular hemolysis (eg, valve hemolysis, March hemoglobinuria, and malaria) Respiratory bleeding : severe hemoptysis (eg, cancer or lung infection)
Donating blood (especially whole blood donation)
Excessive medical blood loss (eg, excessive blood draw for diagnostic tests and iron loss during dialysis)
Blood loss due to self-harm (Munchausen syndrome)

5. Exercise

Multifactorial: decreased dietary iron supply, decreased iron absorption due to inflammatory response, increased loss through sweat, gastrointestinal bleeding, and hemolysis with hemoglobinuria
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References:
Seminar Journal
Iron deficiency
Sant-Ryan Pasricha, Jason Tye-Din, Martina U Muckenthaler, Dorine Swinkels