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 finished.

If the individual cannot tolerate oral iron and needs intravenous iron replacement or transfusions of red blood cells, 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 in circulation) world wide. 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 red blood cells.

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. 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 iron deficiency anemia.

Iron deficiency anemia is more common in women than 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: According to the Centers for Disease Control and Prevention (CDC), more than 11% of women of childbearing age in the US are deficient in iron (Pallarito). The prevalence of postpartum iron deficiency anemia is 27% in the US and among women who have normal blood hemoglobin in the third trimester of pregnancy, 21% will develop postpartum anemia (Bodnar). The overall world wide prevalence of iron deficiency anemia is 30% (Lucca). Prevalence of iron deficiency anemia is 6 to 8 times higher in countries where there is little dietary intake of meat as compared to North America and Europe (Conrad). Prevalence is 79% in Southeast Asia, and 44% in Sub-Saharan Africa ("Iron World Update"). In developing countries, prevalence of iron deficiency anemia is 46% to 51% in children and 42% in women (Picciano). More than 2 billion people are affected world wide (Pallarito).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals with increased risk of iron deficiency anemia are vegetarians, children undergoing growth spurts, the elderly, and those with gastrointestinal bleeding disorders. Individuals living in developing countries without access to iron-fortified rice are also at increased risk.

Twenty percent of women, half of all pregnant women, and 3% of children will have iron deficiency anemia ("Iron Deficiency Anemia"). The prevalence of iron deficiency anemia in Mexican American women is 6.2%, nearly 3 times higher than in white women at 2.3% (Frith-Terhune).

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), dirt (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 nails), have chapped lips, brittle nails, or the whites of the eyes (sclerae) may look bluish. Heart and respiratory rates may be elevated, even at rest.

Tests: A complete blood count (CBC) shows anemia with small red blood cells and a low hemoglobin concentration. A low serum ferritin level with a high total iron binding capacity 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 and 15 g/dL). Although it is rarely needed, a bone marrow biopsy can also establish the diagnosis.

Once a diagnosis of iron deficiency anemia 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. 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. Sometimes if the anemia is causing severe symptoms, such as shortness of breath, severe dizziness, or chest pain, red blood cell transfusions may be necessary. 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 menstrual flow. 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 iron deficiency anemia is easily treated with oral iron supplements. Normalization of the red blood cell count is seen in around 6 weeks. Correction of iron deficiency anemia 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 iron deficiency anemia 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.

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 red blood cell 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.

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?
  • 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 nails), 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?
  • 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 red blood cell transfusion?
  • Was CBC repeated in 6 weeks from the start of treatment?
  • 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

"Iron Deficiency Anemia." HealthCentral.com. HealthCentral.com. 22 Dec. 2004 <http://www.healthcentral.com/mhc/top/000584.cfm>.

"Iron World Update." Friedman School of Nutrition Science and Policy. Mar. 2002. Tufts University. 22 Dec. 2004 <http://nutrition.tufts.edu/academic/idpas/2002-03.html>.

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. MD Consult. Elsevier, Inc. 14 Oct. 2004 <http://home.mdconsult.com/das/journal/view/41608297-4/N/12357496?sid=280093079&source=MI>.

Conrad, Marcel E. "Iron Deficiency Anemia." eMedicine. Ed. Kaushik A. Shastri. 8 Dec. 2004. Medscape. 14 Oct. 2004 <http://emedicine.com/med/topic1188.htm>.

Frith-Terhune, Amy L., et al. "Iron Deficiency Anemia: Higher Prevalence in Mexican American than in Non-Hispanic White Females in the Third National Health and Nutrition Examination Survey, 1988-1994." American Journal of Clinical Nutrition 72 4 (2000): 963-968. American Journal of Clinical Nutrition. American Society for Clinical Nutrition, Inc.. 22 Dec. 2004 <http://www.ajcn.org/cgi/content/abstract/72/4/963>.

Lucca, Paola, Richard Hurrell, and Ingo Potrykus. "Fighting Iron Deficiency Anemia with Iron-Rich Rice." Journal of the American College of Nutrition 21 90003 (2002): 184S-190S. Journal of the American College of Nutrition. American College of Nutrition. 22 Dec. 2004 <http://www.jacn.org/cgi/content/abstract/21/suppl_3/184S>.

Pallarito, Karen. "Iron Pills May Boost Brain Function in Women." Yahoo! Health. 19 Apr. 2004. Yahoo! Inc. 22 Dec. 2004 <http://health.yahoo.com/search/healthnews?lb=s&p=id%3A56767>.

Picciano, Frances Mary. "Iron and Folate Supplementation: An Effective Intervention in Adolescent Females." American Journal of Clinical Nutrition 69 6 (1999): 1069-1070. American Journal of Clinical Nutrition. American Society for Clinical Nutrition, Inc.. 22 Dec. 2004 <http://www.ajcn.org/cgi/content/full/69/6/1069>.

Source: Medical Disability Advisor






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