Unexplained Iron‑Deficiency Anemia Attributable To Hookworm Infection: A Decade of Case Reports In Asia

Abstract

Iron-deficiency anemia (IDA) remains a major public health concern, with hookworm infection a significant yet often overlooked contributor, particularly in Asia. Hookworms (Ancylostoma duodenale, Necator americanus, and Ancylostoma ceylanicum) cause chronic intestinal blood loss, leading to progressive microcytic anemia, fatigue, and pallor. Susceptible populations include children, the elderly, and individuals with comorbidities or nutritional deficiencies. Diagnosis is challenging due to nonspecific symptoms and low sensitivity of routine stool microscopy, often resulting in misdiagnosis as nutritional anemia or other chronic conditions. Case reports highlight the utility of endoscopy and molecular assays in detecting low-burden or occult infections. Treatment with anthelmintics, iron supplementation, transfusion, and nutritional support results in favorable hematological recovery. This scoping review maps published case reports in Asia (2015–2025), summarizing patient characteristics, diagnostic approaches, species identified, and treatment outcomes. Findings emphasize the need for heightened clinical awareness, comprehensive diagnostic strategies, and preventive measures to reduce the burden of hookworm-associated anemia.