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IRON DEFICIENCY AND IRON DEFICIENCY ANAEMIA - a patient's
guide
Editorial Team
Overview
Iron deficiency is the most common dietary deficiency
in the world
It may also indicate a serious underlying disease causing
blood loss (e.g. bowel cancer)
Iron deficiency anaemia causes developmental and learning
problems in children
Symptoms include tiredness, lack of concentration and
problems fighting infections
Iron deficiency is more common among children, women,
and pregnant women
Blood tests are used to diagnose the condition
Further tests may be needed to determine the exact cause
Iron tablets or syrup is used to treat iron deficiency
It can be prevented by having enough iron in the diet
Red meat is a good source of iron. Vegetables with iron
are not well absorbed
What is it?
Iron deficiency anaemia is a condition which causes a
decrease of red blood cells in the blood. However, iron
deficiency can be present before actual anaemia develops.
Actual anaemia only develops once iron deficiency becomes
more severe.
It is caused by a lack of iron in the diet, poor iron
absorption in the body, or from blood loss, for example,
by heavy menstrual bleeding or from bleeding from the bowel
e.g. ulcer or bowel cancer.
It is also caused by lead poisoning in children.
In young patients it is more likely to be caused by poor
intake in the diet. In older patients there is more likely
to be an underlying cause of blood loss and this should
be investigated by further tests.
It is the most common diet deficiency around the world.
Research shows many women and children do not have enough
iron in their diet.
Up to 25 percent of three year olds have iron-deficiency
anaemia. In addition, 20 percent of women, 50 percent of
pregnant women and three percent of men are iron deficient.
A total of 15 percent of the population worldwide have iron
deficiency anaemia.
Iron in the body is used to carry oxygen to cells and
to help fight infections. It is essential for a child's
growth and learning ability.
Anaemia develops slowly over time after iron stores have
been depleted in the body.
You need larger amounts of iron at certain times in you
life. Infants, children and teenagers need more because
they are growing. Pregnant women, women who have periods,
athletes, and vegetarians also need an adequate iron intake.
Babies are born with high iron stores in the liver which
is enough to last for about four to six months of breast
feeding or formula feeding. Additional iron is needed at
about six months when iron-fortified baby cereal is introduced,
followed by other solids. Premature babies may deplete their
iron stores sooner than other infants.
Women need more iron because their iron stores are depleted
during menstruation.
Babies up to 12 months need 9 mg of iron a day, children
up to 11 years need 6 to 8 mg of iron, teenagers need 10
to 13 mg, women need 12 to 16 mg, and pregnant women need
22 to 36 mg. Adult men need the least at 7 mg a day.
Diagnosis
This is made on the basis of a blood test which will show
iron deficiency or depleted body iron stores. If this is
severe, it will have led to anaemia with a lower than normal
haemoglobin (red blood cell) level.
Iron deficiency anaemia is not a complete diagnosis in
itself and an underlying cause should be sought. Recent
studies have shown that is may be particularly dangerous
to attribute iron deficiency solely to menstruation in women
over 40, as there could also be a source of blood loss from
the bowel.
Your doctor will usually base the decision on whether
further investigation is needed, on the patients age and
other symptoms.
For example, an otherwise healthy vegetarian woman of
20 with heavy periods, can probably assume that iron deficiency
is a combination of limited intake and heavy iron loss and
further tests may not be needed if the deficiency corrects
itself with treatment.
In contrast, an older patient (usually over 40), with
symptoms of bowel problems would need a full investigation
to determine the cause of the blood loss (with gastroscopy
and colonoscopy).
What are the symptoms?
Note: early and mild iron deficiency and anaemia may cause
no noticeable symptoms in many people.
If there is not enough iron in the blood you may feel
tired and cold, have problems concentrating, are more prone
to infection, and find it difficult to learn. Naturally
many other things could cause similar symptoms.
Children may experience long-term learning difficulties
if they are iron deficient. They may have problems with
stunted growth, a lack of appetite, and lack of fitness.
Iron deficiency anaemia for more than three months is
associated with more learning problems than anaemia for
less than three months.
Iron deficiency can lead to anaemia and shortness or breath
and dizziness. Usually a significant degree of anaemia is
needed to cause symptoms like these.
Blood tests to assess a person's serum ferritin level,
red cell blood count and iron saturation, are used to diagnose
the condition.
Sometimes there will be symptoms of the underlying problem
which has caused the iron deficiency e.g. heavy periods
or bleeding from the bowels.
What is the treatment?
It is important to have a full understanding of the condition
which has caused the problem as that will determine what
other treatments may be needed apart from simply replacing
iron.
For example, specific treatment for heavy periods, a stomach
ulcer or bowel cancer may be needed.
Iron supplements are necessary to rebuild a person's iron
count. Adults can take iron tablets and children can be
given an iron syrup such as ferrous gluconate.
The syrup can be given with a drink containing vitamin
C, and should be taken for three months.
Side effects from iron supplements include constipation
and other intestinal upsets. A large overdose can be fatal.
Studies have shown that developmental delays in children
from lack of iron are not repaired from a higher iron intake.
Eating iron-rich foods that are well absorbed can also
help.
How can dietary iron deficiency be prevented?
Having enough iron in the diet is the best way to prevent
this form of anaemia.
Many foods contain iron but many are not well absorbed
such as spinach.
Haem iron is the easiest iron for the body to absorb.
This is found in red meat such as beef and lamb. Smaller
amounts are found in pork, chicken and fish. As a general
rule the redder the meat, the higher the iron content.
Non-haem iron is about 10 times harder for the body to
absorb. This form of iron is found in foods such as bread,
breakfast cereals, beans and nuts. Absorption can be improved
by eating it with foods rich in vitamin C like citrus fruit,
broccoli, tomatoes and capsicum.
Adding meat to a meal will also increase the absorption
of non-haem iron.
Coffee, tea and milk can prevent absorption of iron. Do
not have these drinks with meals. Do not give cow's milk
to a baby under 12 months or tea to a preschooler.
Getting help
Your doctor, practice nurse or dietitian will be able
to help.
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