Anaemia affects roughly a third of the world's population; half the cases are due to
iron deficiency. It is a major and global public health problem that affects maternal and child mortality, physical performance, and referral to health-care professionals. Children aged 0-5 years, women of childbearing age, and pregnant women are particularly at risk. Several
chronic diseases are frequently associated with
iron deficiency anaemia--notably
chronic kidney disease, chronic
heart failure,
cancer, and
inflammatory bowel disease. Measurement of serum
ferritin,
transferrin saturation, serum soluble
transferrin receptors, and the serum soluble
transferrin receptors-
ferritin index are more accurate than classic red cell indices in the diagnosis of
iron deficiency anaemia. In addition to the search for and treatment of the cause of
iron deficiency, treatment strategies encompass prevention, including food fortification and
iron supplementation. Oral
iron is usually recommended as first-line
therapy, but the most recent intravenous
iron formulations, which have been available for nearly a decade, seem to replenish
iron stores safely and effectively.
Hepcidin has a key role in
iron homoeostasis and could be a future diagnostic and therapeutic target. In this Seminar, we discuss the clinical presentation, epidemiology, pathophysiology, diagnosis, and acute management of
iron deficiency anaemia, and outstanding research questions for treatment.