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The Nonhematologic Manifestations of Iron Deficiency

The Nonhematologic Manifestations of Iron Deficiency Abstract Question: What disorder can produce apathy, irritability, anorexia, decreased exercise tolerance, and a craving for ice? Answer: Iron deficiency. Question: What disorder can produce angular stomatitis, glossitis, "spoon nails," and the excretion of a pink urine after the ingestion of beets? Answer: Iron deficiency. Question: What disorder can produce gastric achlorhydria, evidence of small bowel dysfunction, occult gastrointestinal bleeding, and failure to thrive? Answer: Iron deficiency. In the days of the Roman empire, medicinal iron was purported to produce "great effectes and marvelous works," as reported by Nicholas Monarde,1 a 16th century physician of Seville, Spain. Evidence exists that, even prior to that time, iron was employed for a variety of purposes in the major civilizations of the Mediterranean area and Asia. Today we tend to equate iron deficiency with anemia. Because iron deficiency anemia is easy to recognize and easy to treat, we have tended to overlook the References 1. Monarde N: Joyful Newes Out of the Newe Founde Worlde , Tudor N (trans). New York, Alfred A. Knopf Inc, 1925, vol 2, p 135. 2. Dallman PR: Tissue effects of iron deficiency , in Jacobs A, Wormwood M (eds): Iron in Biochemistry and Medicine . London, Academic Press, 1974, pp 437-475. 3. Iron Metabolism . Ciba Foundation symposium 51, Amsterdam, Elsevier Publishing Co, 1977. 4. Beutler E: Tissue Effects of Iron Deficiency in Iron Metabolism: An International Symposium . Berlin, Springer-Verlag, 1964, pp 256-272. 5. Chisholm M: Tissue changes associated with iron deficiency . Clin Haematol 2:303-322, 1973. 6. Judisch JM, Naiman JL, Oski FA: The fallacy of the fat iron-deficient child . Pediatrics 37:987-993, 1966. 7. Schubert WK, Lahey ME: Copper and protein depletion complicating hypoferremic anemia of infancy . J Pediatr 24:710-716, 1959. 8. Robbins E, Pedersen T: The role of iron in DNA and RNA synthesis . Proc Natl Acad Sci USA 66:1244-1251, 1970.Crossref 9. Canale V, Lanzkowsky P: Cellular growth in specific nutritional deficiency states in rats: I. Iron deficiency anemia in post-weanling period . Br J Haematol 19:579-586, 1970.Crossref 10. Lanzkowsky P, Karayalcin G, Kazi A: Cellular changes in rats made iron deficient in utero and uuring weaning periods . Pediatr Res 12( (pt 2) ):467, 1978. 11. Davidson LSP, Fullerton HW: Chronic nutritional hypochromic anemia . Edinburgh Med J 45:1-9, 1938. 12. Hogan GR, Jones B: The relationship of koilonychia and iron deficiency in infants . J Pediatr 77:1054, 1970.Crossref 13. Beveridge BR, Bannerman RM, Evanson JM, et al: Hypochromic anaemia . Q J Med 134:145-173, 1965. 14. Paterson DR: A clinical type of dysphagia . J Laryngol Rhinol Otol 34:289-293, 1919.Crossref 15. Kelly AB: Spasm at the entrance to the esophagus . J Laryngol Rhinol Otol 34:285-288, 1919.Crossref 16. Vinson PP: Hysterical dysphagia . Minn Med 5:107-111, 1922. 17. Chisholm M, Ardran GM, Callender ST, et al: A follow-up study of patients with post-cricoid webs . Q J Med 40:409-422, 1971. 18. Crawfurd MD, Jacobs A, Murphy B, et al: Paterson-Kelly syndrome in adolescence: A report of five cases . Br Med J 1:693-695, 1965.Crossref 19. Conrad ME, Weintraub LR, Crosby WH: The role of the intestine in iron kinetics . J Clin Invest 43:963-969, 1964.Crossref 20. Faber K: Anamische Zustande bei der chronischen Achylia gastrica . Berl Klin Wochenschr 50:958-961, 1913. 21. Hawksley JC, Lightwood R, Bailey UM: Iron-deficiency anemia in children: Its association with gastrointestinal disease, achlorhydria, and haemorrhage . Arch Dis Child 9:359-365, 1934.Crossref 22. Stewart A: Gastric acidity in infants and young children under normal and pathological conditions with special reference to nutritional anemia . Br J Child Dis 34:1-7, 1937. 23. Hoag M, Wallerstein R, Pollycove M: Occult blood loss in iron-deficiency anemia of infancy . Pediatrics 27:199-204, 1961. 24. Wilson JF, Lahey ME, Heiner DC: Studies on iron metabolism: V. Further observations on cow's milk-induced gastrointestinal bleeding in infants with iron deficiency anemia . J Pediatr 84:335-344, 1971. 25. Woodruff CW, Clark JL: The role of fresh cow's milk in iron deficiency: I. Albumin turnover in infants with iron deficiency anemia . Am J Dis Child 124:18-23, 1972. 26. Naiman JL, Oski FA, Diamond LK, et al: The gastrointestinal effects of iron-deficiency anemia . Pediatrics 33:83-99, 1964. 27. Ghosh S, Daga S, Kasthuri D, et al: Gastrointestinal function in iron deficiency states in children . Am J Dis Child 123:14-17, 1972. 28. Kimber C, Weintraub LR: Malabsorption of iron secondary to iron deficiency . N Engl J Med 279:453-459, 1968.Crossref 29. Gross SJ, Stuart MJ, Swender PT, et al: Malabsorption of iron in children with iron deficiency . J Pediatr 88:795-799, 1976.Crossref 30. Allison AC, McWhirter KG: Two unifactorial characteristics for which man is polymorphic . Nature 178:748-749, 1959.Crossref 31. Watson WC, Luke RG, Inall JA: Beeturia: Its incidence and a clue to its mechanisms . Br Med J 2:971-973, 1963.Crossref 32. Tunnessen WW Jr, Smith C, Oski FA: Beeturia: A sign of iron deficiency . Am J Dis Child 117:424-426, 1969. 33. Finch CA, Miller LR, Inamdar AR, et al: Iron deficiency in the rat: Physiological and biochemical studies of muscle dysfunction . J Clin Invest 58:447-453, 1976.Crossref 34. Mauer AM: Pediatric Hematology . New York, McGraw-Hill Book Co Inc, 1969. 35. Pollitt E, Leibel RL: Iron deficiency and behavior . J Pediatr 88:372-382, 1976.Crossref 36. Sulzer JL, Wesley HH, Leonig F: Nutrition and behavior in head start children: Results from the Tulane study , in Kallen DJ (ed): Nutrition, Development and Social Behavior , publication 73-242. Department of Health, Education, and Welfare, 1973. 37. Howell D: Significance of iron deficiencies: Consequences of mild deficiency in children: Extent and meaning of iron deficiency in the United States , in Summary Proceedings of Workshop of the Food and Nutrition Board . National Academy of Sciences, 1971. 38. Webb TE, Oski FA: Iron deficiency anemia and scholastic achievement in young adolescents . J Pediatr 82:827-831, 1973.Crossref 39. Webb TE, Oski FA: Behavioral status of young adolescents with iron deficiency anemia . J Special Educ 8:153-156, 1974.Crossref 40. Chodorkoff J, Whitten CF: Intellectual status of children with sickle cell anemia . J Pediatr 63:29-34, 1963.Crossref 41. Logothetis J, Lowenson RB, Augostaki O: Body growth in Cooley's anemia with a correlative study as to other aspects of the illness in 138 cases . Pediatrics 50:92-99, 1972. 42. Symes AL, Sourkes TL, Youdim MBH, et al: Decreased monoamine oxidase activity in liver of iron-deficient rats . Can J Biochem 47:999-1007, 1969.Crossref 43. Youdim MBH, Woods HF, Mitchell B, et al: Human platelet monoamine oxidase activity in iron-deficiency anemia . Clin Sci Mol Med 48:289-296, 1975. 44. Voorhess ML, Stuart MJ, Stockman JA, et al: Iron deficiency anemia and increased urinary norepinephrine excretion . J Pediatr 86:542-548, 1975.Crossref 45. Mackler B, Person R, Miller LR, et al: Iron deficiency in the rat: Biochemical studies of brain metabolism . Pediatr Res 12:217-220, 1978.Crossref 46. Oski FA, Honig A: The effects of therapy on the developmental scores of iron deficient infants . J Pediatr 92:21-25, 1978.Crossref 47. Pollitt E, Greenfield D, Leibel R: Behavioral effects of iron deficiency among preschool children in Cambridge, Mass , abstracted. Fed Proc 37:487, 1978. 48. Coltman CA: Pagophagia and iron lack . JAMA 207:513-515, 1969.Crossref 49. Reynolds RD, Binder HJ, Miller MB, et al: Pagophagia and iron deficiency anemia . Ann Intern Med 69:435-440, 1968.Crossref 50. Dyment PG: Pagophagia and iron deficiency anemia in adolescent girls . Pediatrics 49:766-767, 1972. 51. MacDougall LG, Anderson R, McNab GM, et al: The immune response in iron-deficient children: Impaired cellular defense mechanisms with altered humoral components . J Pediatr 86:833-843, 1975.Crossref 52. Srikantia SG, Prasad JS, Bhaskram C, et al: Anaemia and the immune response . Lancet 1:1307-1309, 1976.Crossref 53. Chandra RK: Reduced bactericidal capacity of polymorphs in iron deficiency . Arch Dis Child 48:864-866, 1973.Crossref 54. Pearson HA, Robinson JE: The role of iron in host resistance . Adv Pediatr 23:1-33, 1976. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

The Nonhematologic Manifestations of Iron Deficiency

American Journal of Diseases of Children , Volume 133 (3) – Mar 1, 1979

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American Medical Association
Copyright
Copyright © 1979 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1979.02130030091017
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Abstract

Abstract Question: What disorder can produce apathy, irritability, anorexia, decreased exercise tolerance, and a craving for ice? Answer: Iron deficiency. Question: What disorder can produce angular stomatitis, glossitis, "spoon nails," and the excretion of a pink urine after the ingestion of beets? Answer: Iron deficiency. Question: What disorder can produce gastric achlorhydria, evidence of small bowel dysfunction, occult gastrointestinal bleeding, and failure to thrive? Answer: Iron deficiency. In the days of the Roman empire, medicinal iron was purported to produce "great effectes and marvelous works," as reported by Nicholas Monarde,1 a 16th century physician of Seville, Spain. Evidence exists that, even prior to that time, iron was employed for a variety of purposes in the major civilizations of the Mediterranean area and Asia. Today we tend to equate iron deficiency with anemia. Because iron deficiency anemia is easy to recognize and easy to treat, we have tended to overlook the References 1. Monarde N: Joyful Newes Out of the Newe Founde Worlde , Tudor N (trans). New York, Alfred A. Knopf Inc, 1925, vol 2, p 135. 2. Dallman PR: Tissue effects of iron deficiency , in Jacobs A, Wormwood M (eds): Iron in Biochemistry and Medicine . London, Academic Press, 1974, pp 437-475. 3. Iron Metabolism . Ciba Foundation symposium 51, Amsterdam, Elsevier Publishing Co, 1977. 4. Beutler E: Tissue Effects of Iron Deficiency in Iron Metabolism: An International Symposium . Berlin, Springer-Verlag, 1964, pp 256-272. 5. Chisholm M: Tissue changes associated with iron deficiency . Clin Haematol 2:303-322, 1973. 6. Judisch JM, Naiman JL, Oski FA: The fallacy of the fat iron-deficient child . Pediatrics 37:987-993, 1966. 7. Schubert WK, Lahey ME: Copper and protein depletion complicating hypoferremic anemia of infancy . J Pediatr 24:710-716, 1959. 8. Robbins E, Pedersen T: The role of iron in DNA and RNA synthesis . Proc Natl Acad Sci USA 66:1244-1251, 1970.Crossref 9. Canale V, Lanzkowsky P: Cellular growth in specific nutritional deficiency states in rats: I. Iron deficiency anemia in post-weanling period . Br J Haematol 19:579-586, 1970.Crossref 10. Lanzkowsky P, Karayalcin G, Kazi A: Cellular changes in rats made iron deficient in utero and uuring weaning periods . Pediatr Res 12( (pt 2) ):467, 1978. 11. Davidson LSP, Fullerton HW: Chronic nutritional hypochromic anemia . Edinburgh Med J 45:1-9, 1938. 12. Hogan GR, Jones B: The relationship of koilonychia and iron deficiency in infants . J Pediatr 77:1054, 1970.Crossref 13. Beveridge BR, Bannerman RM, Evanson JM, et al: Hypochromic anaemia . Q J Med 134:145-173, 1965. 14. Paterson DR: A clinical type of dysphagia . J Laryngol Rhinol Otol 34:289-293, 1919.Crossref 15. Kelly AB: Spasm at the entrance to the esophagus . J Laryngol Rhinol Otol 34:285-288, 1919.Crossref 16. Vinson PP: Hysterical dysphagia . Minn Med 5:107-111, 1922. 17. Chisholm M, Ardran GM, Callender ST, et al: A follow-up study of patients with post-cricoid webs . Q J Med 40:409-422, 1971. 18. Crawfurd MD, Jacobs A, Murphy B, et al: Paterson-Kelly syndrome in adolescence: A report of five cases . Br Med J 1:693-695, 1965.Crossref 19. Conrad ME, Weintraub LR, Crosby WH: The role of the intestine in iron kinetics . J Clin Invest 43:963-969, 1964.Crossref 20. Faber K: Anamische Zustande bei der chronischen Achylia gastrica . Berl Klin Wochenschr 50:958-961, 1913. 21. Hawksley JC, Lightwood R, Bailey UM: Iron-deficiency anemia in children: Its association with gastrointestinal disease, achlorhydria, and haemorrhage . Arch Dis Child 9:359-365, 1934.Crossref 22. Stewart A: Gastric acidity in infants and young children under normal and pathological conditions with special reference to nutritional anemia . Br J Child Dis 34:1-7, 1937. 23. Hoag M, Wallerstein R, Pollycove M: Occult blood loss in iron-deficiency anemia of infancy . Pediatrics 27:199-204, 1961. 24. Wilson JF, Lahey ME, Heiner DC: Studies on iron metabolism: V. Further observations on cow's milk-induced gastrointestinal bleeding in infants with iron deficiency anemia . J Pediatr 84:335-344, 1971. 25. Woodruff CW, Clark JL: The role of fresh cow's milk in iron deficiency: I. Albumin turnover in infants with iron deficiency anemia . Am J Dis Child 124:18-23, 1972. 26. Naiman JL, Oski FA, Diamond LK, et al: The gastrointestinal effects of iron-deficiency anemia . Pediatrics 33:83-99, 1964. 27. Ghosh S, Daga S, Kasthuri D, et al: Gastrointestinal function in iron deficiency states in children . Am J Dis Child 123:14-17, 1972. 28. Kimber C, Weintraub LR: Malabsorption of iron secondary to iron deficiency . N Engl J Med 279:453-459, 1968.Crossref 29. Gross SJ, Stuart MJ, Swender PT, et al: Malabsorption of iron in children with iron deficiency . J Pediatr 88:795-799, 1976.Crossref 30. Allison AC, McWhirter KG: Two unifactorial characteristics for which man is polymorphic . Nature 178:748-749, 1959.Crossref 31. Watson WC, Luke RG, Inall JA: Beeturia: Its incidence and a clue to its mechanisms . Br Med J 2:971-973, 1963.Crossref 32. Tunnessen WW Jr, Smith C, Oski FA: Beeturia: A sign of iron deficiency . Am J Dis Child 117:424-426, 1969. 33. Finch CA, Miller LR, Inamdar AR, et al: Iron deficiency in the rat: Physiological and biochemical studies of muscle dysfunction . J Clin Invest 58:447-453, 1976.Crossref 34. Mauer AM: Pediatric Hematology . New York, McGraw-Hill Book Co Inc, 1969. 35. Pollitt E, Leibel RL: Iron deficiency and behavior . J Pediatr 88:372-382, 1976.Crossref 36. Sulzer JL, Wesley HH, Leonig F: Nutrition and behavior in head start children: Results from the Tulane study , in Kallen DJ (ed): Nutrition, Development and Social Behavior , publication 73-242. Department of Health, Education, and Welfare, 1973. 37. Howell D: Significance of iron deficiencies: Consequences of mild deficiency in children: Extent and meaning of iron deficiency in the United States , in Summary Proceedings of Workshop of the Food and Nutrition Board . National Academy of Sciences, 1971. 38. Webb TE, Oski FA: Iron deficiency anemia and scholastic achievement in young adolescents . J Pediatr 82:827-831, 1973.Crossref 39. Webb TE, Oski FA: Behavioral status of young adolescents with iron deficiency anemia . J Special Educ 8:153-156, 1974.Crossref 40. Chodorkoff J, Whitten CF: Intellectual status of children with sickle cell anemia . J Pediatr 63:29-34, 1963.Crossref 41. Logothetis J, Lowenson RB, Augostaki O: Body growth in Cooley's anemia with a correlative study as to other aspects of the illness in 138 cases . Pediatrics 50:92-99, 1972. 42. Symes AL, Sourkes TL, Youdim MBH, et al: Decreased monoamine oxidase activity in liver of iron-deficient rats . Can J Biochem 47:999-1007, 1969.Crossref 43. Youdim MBH, Woods HF, Mitchell B, et al: Human platelet monoamine oxidase activity in iron-deficiency anemia . Clin Sci Mol Med 48:289-296, 1975. 44. Voorhess ML, Stuart MJ, Stockman JA, et al: Iron deficiency anemia and increased urinary norepinephrine excretion . J Pediatr 86:542-548, 1975.Crossref 45. Mackler B, Person R, Miller LR, et al: Iron deficiency in the rat: Biochemical studies of brain metabolism . Pediatr Res 12:217-220, 1978.Crossref 46. Oski FA, Honig A: The effects of therapy on the developmental scores of iron deficient infants . J Pediatr 92:21-25, 1978.Crossref 47. Pollitt E, Greenfield D, Leibel R: Behavioral effects of iron deficiency among preschool children in Cambridge, Mass , abstracted. Fed Proc 37:487, 1978. 48. Coltman CA: Pagophagia and iron lack . JAMA 207:513-515, 1969.Crossref 49. Reynolds RD, Binder HJ, Miller MB, et al: Pagophagia and iron deficiency anemia . Ann Intern Med 69:435-440, 1968.Crossref 50. Dyment PG: Pagophagia and iron deficiency anemia in adolescent girls . Pediatrics 49:766-767, 1972. 51. MacDougall LG, Anderson R, McNab GM, et al: The immune response in iron-deficient children: Impaired cellular defense mechanisms with altered humoral components . J Pediatr 86:833-843, 1975.Crossref 52. Srikantia SG, Prasad JS, Bhaskram C, et al: Anaemia and the immune response . Lancet 1:1307-1309, 1976.Crossref 53. Chandra RK: Reduced bactericidal capacity of polymorphs in iron deficiency . Arch Dis Child 48:864-866, 1973.Crossref 54. Pearson HA, Robinson JE: The role of iron in host resistance . Adv Pediatr 23:1-33, 1976.

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Mar 1, 1979

References