Recognising iron deficiency

In Australia, iron deficiency affects about 10% of young women and also affects a significant proportion of preschool children

It is also estimated to be highly prevalent in indigenous communities, report Dr Jonathan Baird-Gunning and Dr Jonathan Bromley in the latest edition of Australian Prescriber.

Other at-risk groups for iron deficiency include the very young and the very old, and people with restrictive dietary patterns such as vegetarians and vegans.

Clinical signs and potential consequences of untreated iron deficiency include fatigue, shortness of breath, dizziness, exacerbations of certain diseases such as angina, neurobehavioural disorders such as restless leg syndrome, and cognitive impairment in children.

People with iron deficiency should be tested first, with treatment depending on the severity of the iron deficiency and the patient’s other health conditions.

“Ideally the first step towards correcting iron deficiency is for your doctor to do an iron study to assess your iron stores,” says Dr Baird-Gunning.

“There are lots of ways to correct iron deficiency, ranging from dietary advice—ensuring you’re eating enough iron-rich food—to taking oral iron supplements,” he says. “In more severe cases iron injections or blood transfusions may be needed.”

Strategies include:

  • Diet: It is imperative to ensure that the patient has an adequate iron intake, particularly if they have a restrictive diet such as veganism, say the authors. In general, plant iron is non-heme iron which is poorly absorbed, however co-ingestion of an antioxidant such as vitamin C (e.g. a glass of orange juice) may improve absorption.
  • Oral iron: Oral iron therapy should correct anaemia and replenish iron stores. Therapeutic Guidelines suggests ferrous sulfate at a dose of 325–650 mg daily (equivalent to 105–210 mg elemental iron).
    Patients should be advised to take oral iron supplementation on an empty stomach as phosphates, phytates and tannates in food bind iron and impair absorption. Adverse effects include constipation, dysgeusia and nausea.
  • Parenteral iron: This treatment is indicated when oral therapy has failed or when patients require rapid iron replacement. This therapy includes ferric carboxymaltose, Iron polymaltose, and iron sucrose.

“There are a number of oral iron preparations, however these are often poorly tolerated, limiting their effectiveness,” say Drs Baird-Gunning and Bromley.

“Liquid iron replacement allows divided daily doses and reduces adverse effects. New liposomal preparations are under evaluation.”

The authors also warn that iron tablets should be kept out of the reach of children, since too much iron can be toxic.

Read the full article here.

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1 Comment

  1. Jarrod McMaugh

    Pharmacies can create a very effective POCT-based clinical service for this particular presentation. Use of a Hemocue device can help differentiate iron deficiency from other sources of tiredness.

    Important to remember as well that iron supplementation isn’t necessarily a long-term requirement.

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