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Iron Deficiency Anaemia, An Epidemic

Dr Krupali Rathod Tappoo is an Australian qualified general practitioner, a Fellow of the Royal Australian College of General Practitioners and the Medical co-ordinator for Fiji based NGO – Sai
02 Feb 2018 11:00
Iron  Deficiency Anaemia,  An Epidemic

Dr Krupali Rathod Tappoo is an Australian qualified general practitioner, a Fellow of the Royal Australian College of General Practitioners and the Medical co-ordinator for Fiji based NGO – Sai Prema Foundation. Dr Krupali is based at TappooCity Medical Centre in TappooCity Suva and has a special interest in Women and Children’s Health.

Iron deficiency is the most common and widespread nutritional disorder in the world.

As well as affecting a large number of children and women in developing countries, it is the only nutrient deficiency which is also significantly prevalent in industrialized Countries.

The numbers are staggering: 2 billion people – over 30 per cent of the world’s population – are anaemic, many due to iron deficiency, and in resource-poor areas, this is frequently exacerbated by infectious diseases. Malaria, HIV/AIDS, hookworm infestation, and other infections such as tuberculosis are particularly important factors contributing to the high prevalence of  anaemia in some areas (WHO).

Iron is very important in maintaining many body functions, including the production of haemoglobin, the molecule in your blood that carries oxygen. Iron is also necessary to maintain healthy cells, skin, hair, and nails.

Iron from the food we eat is absorbed into the body by the cells that line the gastrointestinal tract; the body only absorbs a small fraction of the iron we ingest.

The iron is then released into the blood stream, where a protein called transferrin attaches to it and delivers the iron to the liver. Iron is stored in the liver as ferritin and released as needed to make new red blood cells in the bone marrow. When red blood cells are no longer able to function (after about 120 days in circulation), they are re-absorbed by the spleen. Iron from these old cells can also be recycled by the body (American Society of Hematology).

 

 

Who is at Risk?

The following group- of -people are at highest risk of iron deficiency anaemia:

  • Women who menstruate(have periods), especially if the periods are heavy
  • Women who are pregnant, breastfeeding or have given birth recently
  • After major surgery
  • People with gastrointestinal disease such as celiac disease, inflammatory bowel disease such as Crohn’s disease or ulcerative colitis
  • People with peptic ulcer disease
  • Vegetarians, vegans and others whose diet does not include iron rich foods
  • Children over the age of 2 who drink more than 500mls of cow’s milk- cow’s milk does not contain much iron and it can also decrease absorption of iron and irritate the intestinal lining)

 

Less common cause of iron deficiency:

  • Blood loss from the gastrointestinal tract due to gastritis, stomach ulcers, small bowel ulcers, tumors in the stomach, small bowel or colon
  • Blood loss from the kidneys or bladder
  • Very frequent blood donations

 

Signs and Symptoms of Iron Deficiency Anemia

  • Being pale
  • Lack of energy
  • Shortness of breath or chest pain especially with exertion
  • Rapid heartbeat/palpitations
  • Brittles nails
  • Hair loss
  • Sore or smooth tongue
  • Headache
  • Dizziness

 

How is iron deficiency anemia diagnosed?

A simple blood test which includes a full blood count. This shows whether the hemoglobin level is low. In addition, iron studies need to be conducted to look at the level of iron that is circulating in the body and the amount of iron that is stored in the body.

Other tests that may be required include a stool test checking for the presence of blood.

In addition gastroscopy and colonoscopy may also be required if there is a concern regarding stomach ulcers/tumors.

Urine may need to be tested to ensure there are no signs of blood in the urine. In women with heavy menstrual bleeding, a thorough gynecological examination is required and may include a pelvic ultrasound scan and biopsy of the uterus/lining of the uterus.

Most of the body’s iron stores are within the hemoglobin of red cells and carry oxygen to the body. Additional iron is stored in the liver and is used when dietary intake is inadequate.

The body’s iron stores will deplete over time if the dietary need for iron isn’t met. This can lead to:

  1. Iron depletion- this is when the hemoglobin level is normal but the body has a small amount of stored iron. There are usually no obvious symptoms at this stage.
  2. Iron Deficiency- When the stored and circulating iron levels are low and then hemoglobin levels are below normal. Symptoms may include tiredness.
  3. Iron deficiency Anaemia- when the hemoglobin levels are so low that the blood is not able to deliver enough oxygen to the cells. Symptoms include pallor, breathlessness, fatigue, dizziness and impaired concentration.

 

Treatment

  1. Increasing dietary iron through iron rich foods
  • Meat- beef, lamb, pork and organ meat such as liver
  • Poultry- chicken and duck
  • Fish especially shellfish and sardines
  • Green leafy vegetables such as spinach, bele, chauraya bhaji
  • Legumes and beans
  • Dried fruit
  • Fortified breakfast cereals
  1. Iron tablets- used very commonly in iron deficiency anaemia.

Vitamin c helps in the absorption of iron. Iron tablets need to be taken till the iron stores have normalised which take from up to three to six months. Some common side effects of iron tablets include diarrhea, constipation, nausea and abdominal discomfort.

  1. Iron infusions- may be used in people with severe iron deficiency or in those who cannot tolerate iron tablets
  2. Blood transfusion – used only in very severe anemia and active bleeding

As you can see, iron deficiency anaemia is a common condition and can be easily treated if it is diagnosed early.

So if you are at risk or have any symptoms, please visit your doctor who will advise you on the appropriate tests required based on your history and examination findings.

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