Written by Dr Karyn Huntley, GP at Milton Village Medical
Iron deficiency is a common condition and the most common nutritional deficiency worldwide.
Causes
There are many possible causes of iron deficiency. It results from a combination of increased demand, decreased intake or absorption, and/or increased loss. Chronic iron deficiency may subsequently result in iron deficiency anaemia. It is common in children during their rapid growth phases. Pregnancy and breastfeeding demand additional iron requirements.
The most important cause of iron deficiency in adults is however blood loss. Menstrual blood loss commonly causes iron deficiency in women before the menopause. The most important cause of iron deficiency in men and in women after the menopause is gastrointestinal blood loss. Iron malabsorption may be caused by coeliac disease, inflammatory bowel disease, gastro-oesophageal reflux and after bariatric surgery. Other pathological causes of iron deficiency include chronic kidney disease and chronic heart failure.
Symptoms and signs of iron deficiency
Iron deficiency has important consequences on people’s general health and wellbeing. Iron deficiency in pregnancy is associated with low birth weight and maternal anaemia. Children’s mental and physical development can be impaired. In adults, iron deficiency can result in physical fatigue, exhaustion, reduced productivity and impaired immune function. Other symptoms of iron deficiency and iron deficiency anaemia include mental fatigue, hair loss, headaches, mouth ulcers, sore tongue, paleness, shortness of breath, brittle nails, restless legs and cold intolerance.
Dietary iron sources
There are two types of dietary iron:
· Haem iron – is found in animal foods such as red meat and, to a lesser extent in chicken and fish
· Non-haem iron – is found in eggs and plant-based foods such as nuts, cereals, breads, beans and vegetables
Approximately 50% of Haem iron is absorbed in the body whereas only 10% of nonhaem iron is absorbed. Vitamin C increases the absorption of nonhaem iron. Calcium reduces the absorption of both haem and nonhaem iron.
Vegetarians and vegans may find it difficult to maintain healthy iron stores.
Management of iron deficiency
The management of patients with iron deficiency involves the identification and treatment of the underlying cause of the iron deficiency; in addition to iron replacement to replenish iron stores.
Increasing dietary iron alone is often insufficient to treat cases of established iron deficiency.
First line therapy involves oral iron replacement for 3-6 months to improve iron stores. Unfortunately, many patients do not tolerate oral iron due to gastrointestinal side-effects including constipation and nausea.
Intravenous iron infusions (Ferric carboxymaltose) is indicated when: -
· Patients are intolerant or noncompliant with oral iron
· Patients have been diagnosed with malabsorption
· Patient’s require rapid increases in haemoglobin or iron stores
· Patients have ongoing iron loses that exceed absorptive capacity.
The major advantage of intravenous iron is that a single total dose can be given within 30 – 45mins minutes.
Patients can expect to be at the clinic for approximately one hour and most patients return to school or work after the procedure.
Adverse reactions are rare.
At Milton Village Medical we offer intravenous iron infusions five days per week.
Dr Karyn Huntley and Dr Andrea Connelly are trained in intravenous iron infusions and enjoy being able to provide an effective treatment for a condition that can be debilitating and affect quality of life.