Iron deficiency

What is iron?

Iron is one of the minerals in the human body. It is one of the components of haemoglobin, the substance in red blood cells that helps blood carry oxygen throughout the body.
If you do not have enough iron, your body cannot make haemoglobin, and you may develop anaemia. This is known as iron-deficiency anaemia, the most common type of anaemia.

Factors that can lower your body’s supply of iron include:

• Blood loss (caused by ulcers, some cancers, and other conditions; and, in women, during monthly periods)
• A diet that doesn’t have enough iron in it
• Taking medications that interfere with the ability of the body to absorb iron
• An increase in the body’s need for iron (for instance, in women during pregnancy)

What are the symptoms of anaemia?

There are several symptoms that may occur in all types of anaemia. They are:

• Feeling tired
• Paleness
• Difficulty breathing
• Fast heartbeat
• Dizziness
• Headache
• Feeling cold (including the sensation that your hands and feet are colder than usual)
• Infections (caused by problems with the immune system)

Who is most likely to develop iron-deficiency anaemia?

Anyone can develop iron-deficiency anemia, although the following groups have a higher risk:

• Women: Blood loss during monthly periods and childbirth
• People over 65, who are more likely to have iron-poor diets
• People who are on blood thinners such as aspirin, clopidogrel, warfarin or a direct oral anticoagulant (edoxaban, rivaroxaban, apixaban, dabigatran)
• People who have kidney failure (especially if they are on dialysis), because they have trouble making red blood cells
• People who have trouble absorbing iron

Diagnosis

Anaemia can usually be confirmed with a Full Blood Count test. Additional tests:

• Blood film – ie how the blood cells look under the microscope
• your RBC size and colour (RBCs are pale if they’re deficient in iron)
• Ferritin
• Transferrin saturation

Ferritin is a protein that helps with iron storage in your body. Low levels of ferritin indicate low iron storage.
A TIBC test is used to determine the amount transferrin that’s carrying iron. Transferrin is a protein that transports iron.

Treatment options

Iron supplements

Iron tablets can help restore iron levels in your body. If possible, you should take iron tablets on an empty stomach, which helps the body absorb them better. If they upset your stomach, you can take them with meals. You may need to take the supplements for several months. Iron supplements may cause constipation or black stools.

Intravenous iron supplementation

Patients who receive IV iron usually do so because they cannot take oral iron. These include the following:

• Patients who are bleeding in the gastrointestinal (GI) tract (the gut) and need to replace iron quickly. (IV iron is absorbed by the body more rapidly than oral iron.)
• Patients who have inflammatory bowel disease (diseases of the intestines that cause pain, diarrhoea, and weight loss), and cannot take oral iron because it upsets their GI tract.
• Patients who are on kidney dialysis, who often lose blood during dialysis. In addition, these patients are usually taking an erythropoietin stimulating agent (ESA) and may need extra iron.
• Patients with iron-deficiency anaemia who are having high blood loss surgery (> 500 ml) within the next 2 months and need to replace iron quickly. (IV iron is absorbed by the body more rapidly than oral iron.)
• Patients with coeliac disease (gluten intolerance).
• Cancer patients who have anaemia and are taking Erythropoietin.