Iron deficiency & anaemia

 

The average person has 3,000-4,000mg of iron in the body. 1-2mg is lost and 1-2mg is absorbed and utilised daily. Every 1ml of blood contains 0.5mg of iron and excess blood loss is the key cause of iron deficiency. If iron deficiency is not treated it may lead to impaired quality of life, a reduced immune system and ultimately result in anaemia.

 

Iron deficiency ≠ anaemia

 

The most common cause of anaemia is iron deficiency – but it is NOT the only cause.

Anaemia is defined as the reduced concentration of haemoglobin in red blood cells. It is important to check the cause of anaemia before commencing treatment as it could be caused by other issues such as Vitamin B12, Folate or other deficiencies. 

Iron deficiency usually occurs many years before anaemia.

Signs & symptoms of iron deficiency

 
 

Fatigue

Fatigue is a permanent sense of feeling worn out - it may be mental or physical exhaustion. Iron is essential for carrying oxygen (via haemoglobin) and convert to energy in muscles. As such, even before anaemia, low iron levels may cause fatigue.¹³ ¹⁴ ¹⁵ ¹⁶ ¹⁷ ¹⁸

Hairloss

Iron is present in every cell of the body and is an essential element of hair and nail growth. Usually hair loss is one of the first symptoms of iron deficiency and is associated with Serum Ferritin levels falling below <70ng/ml.⁴ ⁵

 

Cold Intolerance

Iron is important for a range of systems that are involved in keeping our bodies at the right temperature. Having iron deficiency may result in you feeling cold easily.¹⁰

 

Headaches

Headaches and migraines can be caused by iron deficiency. When deprived of oxygenated blood (secondary to iron deficiency) the muscles in the face, neck, and/or shoulders may become sore or tense which can result in more frequent and otherwise unexplainable headaches.⁸ ⁹

 

Frequent Infection

When iron deficient, it is difficult for the body to defend itself against infections which may result in more frequent common colds, flu's and/or infections.⁶ ⁷

 

Lack of Concentration / Brain Fog

The role of iron in the Central Nervous System (CNS) of our body, particularly in neuronal and neurotransmitter function, is significant. Iron deficiency may lead to decreased ability of our CNS to properly function, this can lead to difficulty concentrating.¹³

 

Craving for Ice, Dirt or Paper

Craving ice is one of the most common cravings caused by iron deficiency. Unusual cravings to eat things such as clay, dirt, ash and paper may also be caused by iron deficiency.¹ ² ³

 

Depression

While iron deficiency may not be the sole cause of depression, it can cause symptoms similar to depression such as a lack of appetite, irritability, extreme fatigue, headaches and mood swings. Having a broad range of symptoms can be troubling and lead to feelings of sadness, helplessness and depression. Recent publications have shown that iron deficiency is also strongly associated with post-natal depression.¹² ¹³ ¹⁴ 

 

The iron deficiency journey

 

References:1) Bryant et al. Transfusion 2013; 53(8): 1673-1644.  2) Camaschella. N Engl J Med 2015; 372: 1832-43.   3) Kantor et al. JID VOL.121, NO. 5 NOVEMBER 2003.   4) Lacey EP. Public Health Rep. 1990; 105(1): 29-35.   5) Malkud. J Clin Diagnostic Res. 2015; 9 (8): 1-4.   6) Muñoz et al. J Blood Transf 2017; 15:422–37.   7) Patterson et al. Qual Life Res. 2000; 9: 491-497.   8) Patterson et al. 2001; 20(4): 337-342.   9) Park et al. J Korean Med Sci 2013; 28: 934-938.   10) Pinero et al. Neurosci. 2000; 6(6): 435-453.   11) Rabel et al. J Am Assoc nurse Pract 2016; 28(2): 116-120.   12) Radlowski et al. Front Hum Neurosci 2013; 7: 585.   13) Shashikant. JCDR/2015/14089.6170.   14) Trost et al. Am Acad Dermatol 2006; 54 (5): 824-44.
 

Diagnosing iron deficiency

 - with a simple blood test -

 
  • Iron Deficiency occurs when serum ferritin is lower than <30ng/mL.
     

  • Serum ferritin between 30 -100ng/mL indicates low iron stores.
     

  • The ideal level of serum ferritin should be >100ng/mL.
     

30ng/ml

  • In case of inflammation or infection, iron saturation (% Fe saturation), is a more reliable indicator as serum ferritin levels might be artificially increased.
     

  • Our medical experts do not diagnose iron deficiency based on lab results alone but rather take the individual symptoms of patients into consideration.

References:1) Camaschella (2015) Iron-Deficiency Anemia. England Journal of Medicine, 372: 1832-1843.   
2) Munoz, et al. (2017) Current misconceptions in diagnosis and management of iron deficiency. Journal of Blood Transfusions, 15: 422-437.

Available treatments

 

Iron Rich Diet

Click here for iron content in food

 

~5% of plant based iron and

~25% from meat based iron can be absorbed by the body

 

1kg of spinach = 200g of fish

= 1mg of iron

Oral Iron

Iron tablets / liquid formulation should contain at least 100mg iron per serving

only 10% of the iron is absorbed & require 6-12 months of continuous treatment

30-50% may suffer from gastrointestinal side effects (constipation / diarrhea)

Intravenous Iron

up to 1,000mg iron administered via a single infusion

rapid correction with functional improvements reported within 48hours

~10% will experience headache

and / or feeling warm the next day

 

References:1) Camaschella (2015) Iron-Deficiency Anemia. England Journal of Medicine, 372: 1832-1843.   
2) Munoz, et al. (2017) Current misconceptions in diagnosis and management of iron deficiency. Journal of Blood Transfusions, 15: 422-437.

Benefits of an intravenous iron infusion

 
  • In the last decade new preparations of iron have been developed that permit 'total dose' infusions safely in 15 to 30 minutes. This means we can safely and effectively give you enough iron to replenish your iron stores in a singly treatment. 
     

  • An iron infusion is considerably faster (1hour) and more effective than iron tablets (6-12 months).  

  • Iron is delivered straight to the muscles and bone marrow, where it is needed most and patients treated in our clinic routinely advise symptomatic improvements within ~ 48 hours to 1 week.
     

  • Following the infusion, provided you maintain a healthy diet which includes iron, you will not need any further treatment with iron tablets.

References:1) Camaschella (2015) Iron-Deficiency Anemia. England Journal of Medicine, 372: 1832-1843.   
2) Munoz, et al. (2017) Current misconceptions in diagnosis and management of iron deficiency. Journal of Blood Transfusions, 15: 422-437.

Women & iron deficiency

 

1 in 3 women suffer from iron deficiency

 

Heavy Menstrual Bleeding (HMB) is the leading cause of iron deficiency putting women at increased risk. You may suffer from HMB if 2 or more of the following apply:

- Passing of large blood clots
 

- Need for double sanitary protection
(both towels and tampons)

 

- Need for frequent changes of tampons & towels
(every 2 hours or less, or 12 items per cycle)

 

- Flooding through to clothes or bedding

 

Iron deficiency & pregnancy

During pregnancy, approximately 1,000mg of iron is needed. Iron is essential for the neurological, cognitive and physical development of the foetus.

During pregnancy the iron requirements increase significantly - especially in the 3rd trimester. Unfortunately diet alone cannot always support the increased iron demands and oral iron supplements are often poorly tolerated or not effective.

 

Iron deficiency & endurance athletes

Iron deficiency is more common among physically active individuals compared with their sedentary counterparts.

Iron is essential for performance because of its role in energy metabolism, oxygen transport & acid-base balance. The oxidative capacity of the muscle is reduced when an athlete is iron deficient.

Increased iron turnover in the body during endurance exercise:
 

  • Increased iron losses via the gastrointestinal tract, hematuria & hemoglobinuria
     

  • Athletes have up to 70% higher iron requirements

Why athletes are at higher risk of iron deficiency?

Sweat

As sweat contains iron, the more you sweat, the more iron you loose.

Foot Strike

Wrong foot landing can lead to rupture of red blood cells, resulting in loss of iron. This is common among long distance runners.

Upregulation of Hepcidin

Iron transport and absorption are negatively impacted by upregulation of hepcidin.

Iron deficiency & chronic illness

 

Iron deficiency & chronic illness

Diseases (such as chronic kidney disease,
heart failure, inflammatory bowel disease, etc.) upregulate a peptide called hepcidin which reduces the body's ability to absorb iron from the diet. In addition to this process, the disease and/or drugs used to treat the disease can limit iron absorption and/or increase iron loss (due to small bleeding).

 

Iron deficiency & cancer

Iron deficiency & cancer

Severe iron deficiency may impair the immune system and increase the risk for developing cancers.

Conversely, cancers can lead to iron deficiency due to cancer directly (i.e., cancer may be bleeding), through treatment of the cancer, poorer food consumption and/or up-regulation of hepcidin which inhibits iron absorption from gut and oral sources.

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