INTRODUCTION
Iron deficiency anaemia (IDA) is a common finding in general practice. The prevalence of IDA in the general population is around 2% and rises to >5% in premenopausal females.1 The presenting symptoms of IDA vary, but mostly include fatigue, exercise intolerance, weakness, headache, and irritability. These symptoms may also be present in iron deficiency without anaemia. The main causes of IDA are age-dependent. Iron loss by menstrual or gastrointestinal bleeding and malabsorption of iron in the small intestine are the most reported causes of IDA.2 Less known and therefore an often forgotten cause of IDA, is physical exercise. Here we present three cases of young white female adults in whom IDA was induced by intensive physical training.
CASE PRESENTATIONS
Case 1
A 24-year-old female with a medical history of exercise-induced asthma, was referred to the internal medicine outpatient clinic with IDA (haemoglobin [Hb] 4.3 mmol/l, MCV [mean corpuscular haemoglobin] 57.4 fl, ferritin 1 ug/l). A year before presentation, the patient began intensive gymnastic training and subsequently noticed palpitations, fatigue, and dyspnoea on exertion. Aside from occasional constipation, she had no gastrointestinal complaints. She used oral contraceptives continuously, did not experience any intercurrent menstrual bleedings, and was not on any dietary restrictions. She underwent an extensive work-up with gastroscopy, colonoscopy, …
