The World Health Organisation (WHO) estimates that in Australia, just under 1 in 10 preschool children and more than 1 in 10 women of reproductive age have anaemia. However, up to three times as many people may have iron deficiency.
Writing in the December edition of Australian Prescriber, Dr Shalini Balendran and Dr Cecily Forsyth from Westmead Hospital and Central Coast Haematology explain that iron deficiency can cause more problems than just anaemia, and explain what can be done about it.
“Although iron deficiency can often cause anaemia, iron deficiency without anaemia can also cause a range of symptoms. You may feel tired, weak and irritable. Iron deficiency has also been associated with restless legs syndrome and fibromyalgia.
“It is important to diagnose and treat iron deficiency. This includes finding the cause of the iron deficiency and correcting it,” says Dr Cecily Forsyth.
While iron from meat is the most easily absorbed and a wide range of iron-rich vegetables like wholegrains, nuts and leafy greens are beneficial, this is not usually enough to correct iron deficiency, added Dr Forsyth.
“If you are iron deficient, avoid tea, coffee, cocoa and red wine as these prevent the uptake of iron from the gut.
“Iron supplements are a safe way to treat iron deficiency. They should be taken one hour before or two hours after food,” she says, adding that it is convenient and cost effective.
“A number of different iron supplements are available in Australia, however, ferrous salts (fumarate, sulphate, gluconate) are preferred as they are the best absorbed. Guidelines recommend that patients should be counselled to take their iron supplements one hour before or two hours after food,” the paper notes.
They also suggest that tolerability, adherence and absorption can be improved by alternate-day dosing, varying from 60–200 mg.
However, they point out that adverse effects such as nausea, epigastric pain and diarrhoea reduce often adherence.
“Controlled-release preparations and iron polymaltose complex are reported to have a lower incidence of gastrointestinal adverse effects, however, the iron polymaltose complex is expensive which limits its use,” they add.
Vitamin C co-administration has long been recommended to improve oral iron absorption, but a recent study reported no significant between-group difference for the mean change in serum ferritin at eight weeks.
They concluded: “The correction of iron deficiency before the development of anaemia may improve symptoms and the patient’s quality of life, but the supporting evidence is variable. Management of iron deficiency requires identification and investigation. For uncomplicated iron deficiency, oral iron is readily available, effective, safe, convenient and cost effective. For those patients intolerant of oral iron or with conditions where oral iron is likely to be ineffective or harmful, the intravenous route is preferred.”
Source: Australian Prescriber
"Non-Aneamic Iron Deficiency"
VOLUME 44: NUMBER 6: DECEMBER 2021
Authors: Shalini Balendran and Cecily Forsyth