Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Iron Deficiency Anemia


Related Terms

  • Anemia

Differential Diagnosis

  • Autoimmune hemolytic anemia
  • Lead poisoning
  • Non-iron deficiency anemia secondary to chronic (kidney, inflammatory, infectious) disease
  • Non-iron deficiency anemia secondary to neoplasm
  • Pernicious anemia
  • Thalassemia (alpha and beta)

Specialists

  • Gastroenterologist
  • Hematologist
  • Internal Medicine Physician

Comorbid Conditions

  • Cancer
  • Malabsorption of iron
  • Uncontrolled bleeding

Factors Influencing Duration

Duration depends on severity and underlying cause. Unless the underlying cause of iron deficiency is complicated, recovery is usually complete once treatment is completed.

If the individual cannot tolerate oral iron and needs intravenous iron replacement or transfusions of packed RBCs, there may be brief absences from work for these treatments.

Medical Codes

ICD-9-CM:
280.0 - Iron Deficiency Anemia Secondary to Blood Loss (Chronic); Normocytic Anemia Due to Blood Loss
280.1 - Iron Deficiency Anemia Secondary to Inadequate Dietary Iron Intake
280.8 - Iron Deficiency Anemias, Other Specified; Paterson-Kelly Syndrome; Plummer-Vinson Syndrome; Sideropenic Dysphagia
280.9 - Iron Deficiency Anemia, Unspecified; Anemia, Achlorhydric, Chlorotic, Idiopathic hypochromic, Iron Deficiency NOS

Overview

Iron deficiency anemia (IDA) is the most common form of anemia (a low number of red blood cells [RBCs] or a low level of hemoglobin in circulation) worldwide. In this condition, the amount of iron in the body is low and results in a decreased amount of hemoglobin, the oxygen-carrying component of RBCs.

This depletion of iron in adults is almost always caused by chronic blood loss and only rarely by a deficiency of iron in the diet; this may not be the case in individuals who have immigrated from developing countries, where nutritional IDA is common. Individuals who eat a diet including meat, seafood, eggs, whole-grains, dark leafy vegetables, beans and peas, nuts and seeds, and iron-fortified foods are less likely to have IDA.

Iron deficiency anemia is more common in women than in men because of menstrual blood loss and iron loss associated with pregnancy. It also occurs in both men and women who experience chronic bleeding such as gastrointestinal bleeding caused by peptic ulcers; bleeding from a colon polyp or hemorrhoids; tumors of the kidney, bladder, uterus, or ovary; hiatal hernia; or from intake of medications such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs).

Incidence and Prevalence: It is generally assumed that about half of all cases of anemia are due to iron deficiency (WHO, "Iron Deficiency"). According to the Centers for Disease Control and Prevention (CDC), about 9% of women of childbearing age in the US have IDA (CDC). The prevalence of postpartum IDA is 10% in the US (James). Among low-income American women, 27% have postpartum anemia (Bodnar). The overall worldwide prevalence of IDA is 24.8% of the population (WHO, "Worldwide Prevalence") with at least 30% to 40% affected in non-industrialized countries (WHO, "Iron Deficiency"). Prevalence in Southeast Asia ranges from 45.7% for non-pregnant women to 65.5% for preschool-aged children, and in Sub-Saharan Africa prevalence rates range from 47.5% among non-pregnant women to 67.6% among preschool-aged children (WHO, "Worldwide Prevalence"). More than 1.62 billion people are affected worldwide (WHO, "Worldwide Prevalence").

Source: Medical Disability Advisor



Causation and Known Risk Factors

Anemia occurs in all age, racial, and ethnic groups. Both men and women can have anemia. However, women of childbearing age are at increased risk because of blood loss from menstruation. Anemia can also develop during pregnancy. Infants and young children are at increased risk especially if they do not get enough iron in their diets. Older adults also are at increased risk for anemia especially if they have other medical conditions as well. A diet that is low in iron, vitamins, or minerals; premature birth; blood loss from surgery or an injury; long-term or serious illnesses, such as kidney disease, cancer, diabetes, rheumatoid arthritis, HIV/AIDS, inflammatory bowel disease (including Crohn's disease), liver disease, heart failure, and thyroid disease; and long-term infections can increase the risk of IDA (CDC; NIH; Janus).

Source: Medical Disability Advisor



Diagnosis

History: Mild anemia usually has no symptoms and may be recognized only because of abnormal laboratory test results. Individuals with moderate to severe anemia may have symptoms such as fatigue, pallor, headache, weakness, dizziness, shortness of breath, and decreased exercise capacity. Children may have poor appetite. If the anemia is from gastrointestinal bleeding, individuals may report black stools or bloody bowel movements. A desire to eat large amounts of non-food substances (pica)—including ice (pagophagia), pure starch (amylophagia), soil (geophagia), or paint—is uncommon but considered to be a very specific symptom of iron deficiency.

Physical exam: Individuals with anemia may look pale (particularly the conjunctiva, tongue, palms, and nail beds), have chapped lips, brittle nails, or the whites of the eyes (sclerae) may look bluish. Heart and respiratory rates may be elevated (tachycardia and tachypnea), even at rest.

Tests: A complete blood count (CBC) shows anemia with small RBCs and a low hemoglobin concentration. A low serum ferritin level with a high total iron binding capacity (TIBC) confirms the diagnosis. A hematocrit of less than 10 g/dL in women, and less than 12 g/dL in men is considered abnormal (normal values range from 11.1 g/dL to 15 g/dL). Although it is rarely needed, a bone marrow biopsy can also establish the diagnosis.

Once a diagnosis of IDA is established, a variety of other tests may need to be done to find the cause, such as testing of stool samples to rule out gastrointestinal bleeding (fecal occult blood test [FOBT]). An endoscopy may be necessary to explore the upper GI tract for peptic ulcers or hiatal hernia, or a colonoscopy may be needed to examine the lower GI tract for colon polyps or internal hemorrhoids that may be sources of internal bleeding.

Source: Medical Disability Advisor



Treatment

Iron deficiency anemia is usually successfully treated with oral iron supplements. In rare cases when an individual cannot tolerate or absorb iron, the iron may be given intramuscularly or intravenously with precautions concerning an anaphylactic allergic reaction. Sometimes if the anemia is causing severe symptoms, such as shortness of breath, severe dizziness, or chest pain, blood transfusions may be necessary, preferably using packed RBCs instead of whole blood. In addition to treating the anemia itself, any underlying causes must always be addressed. A CBC is usually done around 6 weeks after treatment begins in order to reassess the condition.

Treatment addressing specific causes of internal bleeding may include antibiotics to treat gastric ulcers; surgery to remove a tumor, polyp, or hemorrhoid; or oral contraceptives to lighten heavy and prolonged menstrual flow (menorrhagia). Individuals may be encouraged to consume more iron-rich foods, and to supplement the diet with vitamin C which can help with iron absorption.

Source: Medical Disability Advisor



Prognosis

Uncomplicated IDA is easily treated with oral iron supplements. Normalization of the RBC count is seen in around 6 weeks. Correction of IDA due to a serious underlying problem, such as gastrointestinal bleeding or tumor, is more difficult and depends on successful treatment of the underlying problem.

Source: Medical Disability Advisor



Complications

If IDA is severe, it can result in shortness of breath and fainting spells, or in individuals with heart disease it can cause chest pain (angina pectoris) or congestive heart failure (CHF).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work may be temporarily interrupted by the occasional side effects of oral iron therapy (constipation, nausea, or heartburn) or by the need for intramuscular or intravenous iron therapy or packed RBC transfusions. If the individual has symptoms such as chest pain, shortness of breath, or dizziness, physical exertion at work may need to be reduced until the anemia is corrected.

Risk: No job that follows OSHA standards would be expected to place an individual at risk for anemia nor to place an individual with anemia at increased risk. If the anemia persists despite treatment, then avoiding work at unprotected heights or working at high altitude would be prudent. Ensuring adequate hydration is also needed.

Capacity: Capacity can often be gauged by the level of hemoglobin. A more functional assessment may include the use of metabolic stress testing.

Tolerance: Encouragement, counseling, and flexible work hours may be used to assist individuals with being in a work environment if their anemia is persistent.

Source: Medical Disability Advisor



Maximum Medical Improvement

120 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have chronic bleeding such as gastrointestinal bleeding from ulcers, the presence of tumors, and use of medications such as aspirin and other NSAIDs?
  • Does individual have a deficiency of iron in their diet?
  • Was individual's anemia discovered on a routine blood test? Was diagnosis of IDA confirmed?
  • Does individual have heavy and prolonged menstrual periods? Is individual pregnant?
  • Does individual report fatigue, weakness, dizziness, shortness of breath, and decreased exercise capacity? Black or bloody stools?
  • Does individual report a desire to eat large amounts of ice?
  • On physical exam did individual appear pale (particularly the conjunctiva, tongue, palms, and nail beds), have chapped lips, brittle nails, or a bluish tinge to the sclerae?
  • Are individual's heart and respiratory rates elevated, even at rest?
  • Has individual had a CBC and serum ferritin level? TIBC?
  • Was it necessary to do a bone marrow biopsy?
  • Did individual have other specific testing to determine the underlying cause?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Is individual being treated with oral iron supplements? Intravenously?
  • Was it necessary for individual to have a packed RBC transfusion?
  • Was CBC repeated in 6 weeks from the start of treatment? Did IDA resolve?
  • Is the underlying condition being treated?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Does individual have any complications such as shortness of breath, fainting spells, angina pectoris or congestive heart failure?

Source: Medical Disability Advisor



References

Cited

Bodnar, Lisa M., et al. "High Prevalence of Postpartum Anemia Among Low-Income Women in the United States." American Journal of Obstetrics and Gynecology 185 2 (2001): 438-443.

CDC. "Anemia or Iron Deficiency." CDC. 30 May. 2013. Centers for Disease Control and Prevention. 22 Jun. 2014 <http://www.cdc.gov/nchs/fastats/anemia.htm>.

Harper, James L. "Iron Deficiency Anemia." eMedicine. Ed. Emmanuel C. Besa. 16 Dec. 2013. Medscape. 22 Jun. 2014 <http://emedicine.com/med/topic1188.htm>.

James, A. H. , et al. "An Assessment of Medical Resource Utilization and Hospitalization Cost Associated with a Diagnosis of Anemia in Women with Obstetrical Bleeding in the United States." Journal of Women's Health 17 (2008): 1279-1284.

Janus, J. , and S. K. Moerschel. "Evaluation of Anemia in Children." American Family Physician 81 (2010): 1462-1471.

NIH. "Who is at Risk for Anemia?" National Heart Lung and Blood Institute. 18 May. 2012. U.S. National Institutes of Health. 22 Jun. 2014 <http://www.nhlbi.nih.gov/health/health-topics/topics/anemia/atrisk.html>.

WHO. "Iron Deficiency Anaemia: Assessment, Prevention, and Control. A Guide for Programme Managers." WHO. 2001. World Health Organization. 22 Jun. 2014 <http://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/WHO_NHD_01.3/en/>.

WHO. "Worldwide Prevalence of Anemia 1993 - 2005." WHO. 2008. World Health Organization. 22 Jun. 2014 <http://www.who.int/vmnis/publications/anaemia_prevalence/en/>.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.