The role of iron

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Iron is responsible for oxygen transportation around the body

(within haemoglobin)

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Physical performance and Iron Deficiency

Iron is responsible for oxygen utilisation by all cells in our body (giving us energy)

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.

 
about 1 in 3 women suffer from iron deficiency and that may occur many years before the onset of anaemia
Heavy periods result in blood loss and hence iron - every 1mL of blood contains 0.5mg of iron.
During pregnancy iron demands are significantly increased as the growing baby develops. Most women have about 3,000mg of iron in their body and the growing child will take about 1,000mg! In many cases oral iron sources aren’t sufficient and 40% of women are iron deficient when falling pregnant. Even if having healthy iron (ferritin) levels at conception it is worth checking again in your third trimester – remember iron is needed for both mother and child.
Unfortunately phyto (or plant) forms of iron are poorly absorbed by our body. If taking a vegetarian diet it is best to avoid black tea within an hour of your meal. Vitamin C also helps with the absorption of iron.
Each donation of blood can result in you generously giving 200 or more millilitres of blood. As 1mL of blood contains 0.5mg of iron, every unit of blood donated equates to more than 100mg of iron lost from your body (or the equivalent of ~50 to 100 days of iron intake).
In patients with chronic diseases (such as chronic kidney disease, heart failure, rheumatoid arthritis, inflammatory bowel disease, cancer etc) there is an upregulation of the iron regulatory hormone called hepcidin. In such cases the absorption from oral iron sources (including from food sources) is impaired and one may gradually become iron deficient. Additionally, some diseases (or medicines used to treat diseases) lead to bleeding which further increase the risk of iron deficiency.
GI disturbances may lead to reduced iron absorption from oral iron (including food) sources. Additionally, many GI diseases result in some blood loss which further exacerbates the risk of iron deficiency.
Endurance exercising can lead to iron deficiency via multiple pathways including increased loss of iron through sweat.

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.

 

Where do we have iron in our body?

50%

in red blood cells

15%

in other cells of the body

10%

in muscles

25%

in liver
(iron storage)

 

Reference: Camaschella (2015) Iron-Deficiency Anemia. England Journal of Medicine, 372: 1832-1843

Signs & Symptoms of iron deficiency

PICA_Hair Loss_Fatigue_Poor Concentratio
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
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
When iron deficient, it is difficult for the body to defend itself against infections which may result in more frequent common colds, flues and/or infections.⁶ ⁷
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
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
Iron is needed to help the muscles grow, develop and function properly. A deficiency of accessible iron in muscle creates an energy crisis by limiting an energy producing reaction. Low iron also causes muscles to fatigue faster due to a lack of sustained oxygenation of muscle, in turn causing muscle pain.¹¹
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
Restless leg syndrome refers to uncomfortable sensations in legs and feet, especially when resting. The feelings could be described as itching, burning, crawling or painful and these can affect sleep quality.²² ²³ ²⁴
Iron deficiency can be related to abnormalities such as the colour, shape, or texture of nails. Nails that are dipped in the middle and raised at the edges to give a rounded appearance like a spoon are associated with iron deficiency anaemia. To grow strong, healthy nails require a mix of nutrients, including iron.²¹
A bruise appears when blood vessels are damaged beneath the skin enough for a little bit of blood to leak out. If you have Iron Deficiency, this may happen more easily. Easy bruising is a sign of Iron Deficiency.²⁰
Lack of iron in in your blood may result in decreased speed and insufficient amount of oxygen delivery to the brain which can result in dizziness and irritability.¹³ ¹⁴
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
Iron is essential for the formation of RBC and the production of energy in muscles. With iron deficiency the capacity to exercise or work may decreased significantly due to the impairment of energy production. Correction of iron deficiency will replenish iron stores and may significantly improve the exercise capacity after 1-2 weeks.¹⁹
Fatigue is a permanent sense of feeling worn out and can be mental as well as physical exhaustion. Iron is essential for the formation of Red Blood Cells. Iron Deficiency may reduce our body’s oxygen delivery capacity which resulted in a state of fatigue. Our muscles also required iron for all aerobic activities, depletion of iron may impair the body’s function to utilise oxygen to create energy.¹³ ¹⁴ ¹⁵ ¹⁶ ¹⁷ ¹⁸

References:

1) Rabel et al.  J Am Assoc Nurse Pract. 2016;28(2):116-120.   2) Bryant et al. Transfusion. 2013;53(8):1673-1644.   3) Lacey. Public Health Rep. 1990;105(1):29-35.  4) Trost et al. J Am Acad Dermatol. 2006;54(5):824-44.   5) Malkud. J Clin Diagnostic Res. 2015;9(8):1-4.   6) Beard.  JL. J Nutr. 2001:568-580.   7) Hung et al. PLOS ONE | DOI:10.1371/journal.pone.0119647   8) Fallah et al. Iran J Pediatr Hematol Oncol. 2016;6(1):32-7.   19) Lopez et al. Lancet. 2016;387(10021):907-16.   10) Brigham et al. Crit RevFood SciNutr. 1996;36(1040-8398):747-763.   11) Gerwin. Acupunct Med. 2005 Sep; 23(3):121-34.   12) Dama et al. J Obstet Gynaecol Can. 2018.   13) Lozoff et al. 2006.

14) Beard.  J. Nutr. 2008;138: 2534–2536.   15) Patterson et al. Qual Life Res. 2000;9:491-497.   16) Radlowski et al. Front Hum Neurosci. 2013;7:585.   17) Pinero et al. Neurosci. 2000;6(6):435-453.   18) Patterson et al. J Am Coll Nutr. 2001;20(4):337-342.   19) Jankowska et al. Eur Heart J. 2010;31(15):1872-80.   20) https://www.livestrong.com/article/489269-can-iron-deficiency-cause-psychological-problems/    21) http://www.progressivehealth.com/signs-of-anemia.htm    22) Barton et al. BMC Blood Disord. 2010;10:9.   23) Sloan et al. Clin Dermatol. 2010; 28(4):420-5.   24) Daubian-Nosé et al. Sleep Sci. 2014 Dec;7(4):234-7  

 

The iron deficiency journey

Hair Loss_Fatigue_Anaemia_Concentration

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.
     

Diagnosing Iron Deficiency

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

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

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

IV 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).  

Benefits of an Intravenous Iron Infusion
  • 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.

 

For more information on iron deficiency