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Perth Haematology :: Dr Steven Ward

Iron Deficiency Anaemia

 

Iron deficiency is one of the most common causes for anaemia in the world.

 

Humans only absorb around 10% of the available iron in the diet. Women particularly often struggle to maintain adequate iron stores.

 

There are a number of reasons for iron deficiency:

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Inadequate diet

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Highly unlikely in Western world

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Iron present in many foods; best sources are red meat and dark green veg

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Inability to absorb iron from the gut (malabsorption)

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Disorders like Coeliac disease, or surgical removal of part of the small intestine can lead to inability to absorb iron

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Blood loss - the commonest reason

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In women heavy periods (menorrhagia) is common

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GI bleeding: from oesophagus to colon. Chronic small volume bleeding can easily be silent, without obvious blood in the stools or any symptoms. Things like ulcers, acid reflux, friable blood vessels (angiodysplasia) and tumours can bleed leading to iron deficiency.

 

Sequence of events:

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The iron stores in the body are depleted

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The blood tests to measure iron stores become abnormal - low ferritin, high transferrin

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Note:Serum iron levels are not helpful in assessing iron stores

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Tiredness develops slowly at this stage; poor concentration and muscle weakness can also become an issue

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Next the red blood cells become progressively smaller (MCV drops)

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Then the Haemoglobin starts to fall, and anaemia develops [Anaemia is a late finding of chronic iron deficiency]

 

 

The finding of iron deficiency or iron deficiency anaemia should prompt further investigation to determine the cause, and treat that, as well as replacing iron.

 

Iron therapy

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Oral iron - tablets or liquid iron
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A decent dose of iron should be taken; this may cause GI upset initially; but usually settles on continued treatment after a week or two. At least 100mg of elemental iron daily should be provided by an iron supplement.

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Often "natural" or gentle iron preparations are simply very low-dose iron, with insufficient iron to do any good. Don't waste money on these.

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 IM iron injections
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These are no better than oral iron

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They can be painful, large injections; many are required to make any impact

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Often lead to skin staining from iron deposits - "rust marks"

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I do not recommend intramuscular iron in any circumstance

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IV iron infusion
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The iron preparations available now are much better than 10-15 years ago; with less potential for allergic or anaphylactic reactions

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See Iron Infusion page [Iron Infusion]

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Blood Transfusion

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Transfusion of blood is rarely needed for iron deficiency

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Treat with iron the required element; not blood with the potential for problems

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Even if transfusion is deemed necessary; iron replacement is also needed.

 

 

ASSESSMENT OF IRON STORES