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Investigating the underlying cause of iron deficiency

Iron Deficiency is NOT a Normal Physiologic State

The high prevalence of iron deficiency and iron deficiency anemia does not rationalize them as a normal conditions. Identifying and treating iron deficiency and the underlying cause for the deficiency is crucial to ensure optimal patient care, equity, and safety [1,3].

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Appropriate follow up investigations can lead to timely diagnoses of abdominal pathology, malignancy, chronic heavy menstrual bleeding, and bleeding disorders [9,11,12,31,32].

Identifying the Etiology of Iron Deficiency

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High Iron Demand States

Breastfeeding

Childhood and adolescence

Recent major surgery

Use of erythropoietin stimulating agents

[8, 10, 12, 18-20,23]

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Blood loss

Heavy menstrual bleeding

Gastrointestinal bleeding

Hematuria

[9, 11, 12, 23, 25]

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Malabsorption

Celiac disease

Inflammatory bowel disease

Atrophic gastritis

H. pylori infection

Post-bariatric surgery

Chronic use of antacids

Decreased intake

Vegetarian/vegan diets

Excess intake of dietary bran,

tannins, phytates, starch

Increased cow's milk consumption

in children

Decreased intake of iron rich foods

An Issue of Health Equity, Public Health, and Social Justice

Risk factors for iron deficiency emphasize the mismatch between those who need iron supplementation and those who have access to it.

Key risk factors for iron deficiency include:

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Female sex

Food insecurity

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Minority ethnicity and race

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Lower socioeconomic status

Obesity

Pregnancy and multiple pregnancies in rapid succession

Gastrointestinal bleeding

Heavy menstrual bleeding

[10–12, 18, 20, 22–24]

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