Iron Deficiency Anemia : A profile of a tertiary care hospital

Background and aim: Iron deficiency refers to the reduction of iron stores that precedes overt iron deficiency anemia. Iron deficiency anemia (IDA) is the commonest nutritional deficiency around the globe. Though etiology of IDA is multifaceted, and results from the iron demands which is not met by iron absorption in the body, regardless of the reason. This study was aimed to observe the several hematologic parameters among IDA cases presented to a tertiary level referral hospital of Nepal army. Methods: This prospective hospital based study was conducted among cases of iron deficiency anemia presented to a hematology clinic for six-month duration. With the help of semi-structured questionnaire demographic variables, presenting complaints, baseline laboratory parameters, iron profile and etiology of iron deficiency anemia were recorded. The collected data were entered in SPSS version 22 and analyzed. Results: In the six-month study period, there were 175 IDA cases who presented to hematology clinic. IDA was more common in females accounting 78% of 175 cases while rest were male. Mean value of parameters of iron profile were all significantly lower than normal range except TIBC which was significantly raised clinching the diagnosis of IDA. Weakness was the commonest mode of presentation (83, 47.4%). Poor intake was the main culprit of IDA (88, 50.3%). Most of the cases (82, 46.9%) belonged to moderate anemia group. Severity of anemia was associated with platelet count and total leucocyte count (p<0.05) while it was not associated with iron profile values (p>0.05). Conclusion: In adult group, IDA is more common in women and non-specific symptoms like weakness is the commonest mode of presentation. Poor dietary intake is the main cause of IDA in our context. Among IDA cases, most of them belonged to moderate anemia. DOI Name http://dx.doi.org/10.3126/jaim.v7i1.19575


IntroductIon
2][3][4] Though etiology of IDA is multifaceted, and results from the iron demands which is not met by iron absorption in the *Corresponding author Dr. Dhan Bahadur Shrestha Birendra Hospital, Chhauni, Kathmandu e-mail: medhan75@gmail.combody, regardless of the reason.Notable causes are inadequate intake, impaired absorption or transport, physiologic losses associated with chronological or reproductive age, or chronic blood loss secondary to disease. 3,5,6It has a great public health significance affecting children, adolescents and women of reproductive age worldwide. 7,8Worldwide, prevalence of IDA is estimated to be 20-80 % among reproductive age female population and has impact on the both fetal and maternal health. 9ron supplement in antenatal period has pivotal role. 10Anemia reduces physical work capacity and cognitive function and adversely affects learning and school performance in schoolgirls entering adolescence so it needs the proper address on time. 11e study from Nepal showed, the prevalence of anemia, 12%; depleted iron stores, 20%; IDA, 6% and iron deficient erythropoiesis in 7% of non-pregnant women of reproductive age group respectively. 12is study was aimed to observe several hematologic parameters among IDA cases presented to the tertiary level referral hospital of Nepal army as such study have not been conducted so far.

Selection and Description of Participants
This single centered, prospective cross-sectional study was conducted among anemic patients presented to hematology clinic and kept under regular follow up of a tertiary level hospital in Kathmandu over a period of six months from June to December 2017.With the help of semi-structured questionnaire demographic variables, presenting complaints, baseline laboratory parameters, iron profile and etiology of iron deficiency anemia were recorded.All the diagnosed cases of IDA were evaluated for the etiology and treated with iron therapy based on severity and standard protocol and kept under regular follow-up.Again, iron profile was repeated among all cases at third month of follow up.
The study proposal was approved by ethical review committee (IRC) of Nepalese army institute of health sciences (NAIHS).Informed verbal consent was taken while enrolling the individual in the study.

Statistics
The collected data were entered in SPSS version 22 and analyzed.Chi-square test was used to see association between severity of iron deficiency anemia with other variables with the help of p value based on 95% confidence interval and 5% standard error.

RESULT
In the six-month study period, there were 175 iron deficiency anemia cases who presented to hematology clinic.Proper evaluation was done with physical examination and laboratory parameters to see overall health status and severity of anemia.The mean age of patients was 52.61±15.44 years and hemoglobin 8.46±1.5 gm/dl.Mean value of parameters of iron profile were all significantly lower than normal range except TIBC which was significantly raised clinching the diagnosis of IDA (Table 1.).

Min.
Max

DISCUSSION
Iron deficiency anemia is a common hematological problem in medical practice with more burden in developing and underdeveloped world. 1,13 n this study, the mean age of patients was 52.61±15.44 years and hemoglobin 8.46±1.5 gm/dl.Similarly, other studies also support high prevalence of anemia in extreme of age due to several factors. 14,15One study concluded high prevalence of anemia after 50 years, and older counting greater than 20% by 85 years.In older age group there is tendency of having anemia either due to nutritional or chronic diseases. 15A presents with nonspecific symptoms due to poor oxygen carrying capacity of blood.IDA can be result of various factors like dietary factor, blood loss and parasitic infestations. 1,6In this study, commonest mode of presentation was generalized weakness and blood loss from gastrointestinal tract.Among the cases of IDA, most common cause was nutritional, due to poor intake (50.3%), followed by UGI bleeding.Most of the cases (46.9%) belonged to moderate anemia group in present study while some study has reported mild anemia as the commonest entity in elderly group. 15Iron profile study is the commonly performed laboratory study to diagnose IDA.In most cases, MCV, serum ferritin will be low while iron binding capacity will be high.And there will be typical picture of IDA in peripheral blood film. 1,6ripheral blood film showed microcytic hypochromic anemia in 132 cases while in rest there was associated polychromasia and anisopoikilocytosis in current study.Severity of anemia were associated with platelet count and total leucocyte count (p<0.05) while severity was not associated with iron study (p>0.05) in this study while such things has not been mentioned in previous studies.

CONCLUSION
In adult group, women are most commonly affected and nonspecific symptoms like generalized weakness is the commonest mode of presentation of IDA.Poor dietary intake is the main cause of IDA in our context.Among IDA cases, most of them belonged to moderate anemia group.Severity of anemia was associated with total leucocyte count and platelets while iron profile and severity of anemia did not show any association.This small study was conducted among army personnel and their family in a tertiary level hospital but to make it generalizable, further study may be needed with a large sample size.
Descriptive parameters of IDA cases IDA was more common in females accounting 78% of 175 cases and rest were male (Figure 1.) 1. Gender distribution of IDA Among the cases of IDA, commonest mode of presentation | Original Article was

Table 2 .
Mode of presentation of IDA casesAmong the cases of IDA, most common cause was nutritional, due to poor intake (88, 50.3%), followed by UGI bleeding and other mode of blood loss (Table3.).

Table 4
In most (>75%) of the cases studied; MCH, MCHC, serum ferritin was lower than normal.Only in 2 cases, serum ferritin was not corrected after 3 months of the treatment while in rest, it was normalized.Severity of anemia was associated with platelet count and total leucocyte count (p<0.05) while severity was not associated with iron profile study (p>0.05)(Table5.).
. Severity of IDA In all patients, MCV was lower than normal while RDA was high.In most of the cases (132), peripheral blood film showed microcytic hypochromic anemia while in rest (43) there was associated polychromasia and anisopoikilocytosis.

Table 5 .
Severity of anemia and its relation with other parameters