Iron Deficiency Anemia

Overview

Iron deficiency anemia (and iron deficiency without anemia) is very common in refugees, especially in women and young children. Although an iron deficient diet is a common cause of anemia in refugee patients, potential blood loss (mainly abnormal uterine and gastrointestinal bleeding) should always be considered in these patients as for the rest of the population.

Underlying Etiology

Always wait for the complete hemoglobinopathy screen results before interpreting the mean corpuscular volume (MCV) since patients with some traits such as alpha-thalassemia can have lower MCV even in the absence of iron deficiency.

Consider the following causes:

• H. pylori infection
• Parasitic infections
• Celiac disease
• Hematuria

Workup for Potential GI Bleeding

For refugee patients who require assessment of potential occult GI bleeding but who are at low risk of GI malignancy (<50 years old, no family history), it is reasonable to begin with the following investigations before referring them for GI endoscopy:

• H. pylori stool antigen test
• Stool Ova & Parasites examination (preferably 3 samples)*
• Celiac Screen

* Based on our experience with our refugee patients, it is often difficult to obtain a proper stool sample to perform this test. In these cases, it is reasonable and safe to simply treat empirically for helminth infections with mebendazole (500 mg once or 100 mg twice daily for 3 days - for patients ≥ 2 years of age).

Treatment

Ferrous sulfate is the recommended treatment for iron deficiency. The standard dose is 300mg (60mg elemental iron) 1-3 times daily, though every-other-day dosing may improve absorption and reduce side effects.