This review will be confined to a discussion of iron deficiency anemia as it affects
Pregnancy is probably the greatest physiological challenge to the human body.
Considering the ingenuity of Nature, one would expect that mechanisms with sufficient
safety margins had been developed to ensure the needs of mother and fetus
The need for dietary iron is greater during infancy and childhood than at any other
period of life (1-3).
Most cases of nutritional macrocytic anemia are caused by megaloblastic change
in the bone marrow, producing macrocytic erythrocytes.
Iron has a central role in redox reactions and oxygen transport, and living organisms
have developed efficient mechanisms for its acquisition, transport, and storage.
Anemia is one of the most common manifestations of malaria. The causative mechanisms
are multifactorial, and the severity of the anemia varies in relation to the
level of malaria transmission in a population.
Iron deficiency anemia, the most common single nutrient deficiency disorder in
the world, has a peak prevalence among infants, affecting an estimated 25% of all
In recent years, the relationship between vitamin A deficiency, iron, and anemia
has been the subject of several investigations.
In 1928 Hart et al. (1) demonstrated that copper was essential for erythropoiesis
in the rat.
The approach to the study of anemia that I shall discuss has developed over the
past 20 years; during this period I have been directly involved in the study and
management of newborn infants with anemia.
The biological functions attributed to vitamin E are performed by a group of related chemical compounds, namely the tocopherols and the tocotrienols.
Erythroid burst-forming units are present in large numbers in infants with the
anemia of prematurity. The erythroid progenitors respond normally in vitro to recombinant
human erythropoietin (rHuEpo) (1).
The usual approach to combating nutritional iron deficiency is to provide additional
iron to the population at risk.
Iron status in the body is determined by the balance between iron losses and iron
requirements for growth on the one hand and the absorption of iron from the diet
on the other.
The practical problems associated with iron fortification have previously been
defined, and guidelines for the implementation of fortification programs have been
laid down (1).
Five major factors govern the amount of iron absorbed from an iron-fortified food.
These are the iron fortification compound used, the amount of iron added, the presence
of enhancers or inhibitors of iron absorption in the meal, and the iron status
of the consumer.
Nutritional anemias may result from deficiency of any number of nutrients. In this
workshop, we have considered anemias associated with deficiencies of iron, folic
acid, vitamin B)2, vitamin E, vitamin A, and copper.