Iron deficiency can occur at any age and has a number of different causes

Pasricha SS, et al. MJA. 2010; 193: 525-532.

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

World Health Organisation. Micronutrient deficiencies. Accessed Online.
October 2015: http://www.who.int/nutrition/topics/ida/en/

Dietary iron is made up of haem from animal sources, and non-haem from cereal and vegetable sources

Pasricha SS, et al. MJA. 2010; 193: 525-532.

Iron is a key component of red blood cells

Pasricha SS, et al. MJA. 2010; 193: 525-532.

What is iron deficiency?

Iron is an essential nutrient for your body, which you get from your food. It is needed for your mental and physical health and to keep your energy levels up. Sometimes your body’s demand for iron can outstrip supply, and this can lead to iron deficiency.

Iron deficiency causes many symptoms including fatigue, dizziness, and shortness of breath. If you are experiencing symptoms it is important that you talk to your doctor so that they can investigate what is causing them. If tests show that your iron levels are low, your doctor may recommend iron therapy.

Common signs and symptoms

If the iron levels in your body are low, you can become iron deficient. The recommended levels for iron in the body are different for different people, depending on age and gender.1 Iron deficiency is the most common nutrient deficiency in the world.2

Over time, iron deficiency can mean that your body makes fewer healthy red blood cells, a condition known as Iron Deficiency Anaemia (IDA). In industrialised countries, between two and four percent of people have IDA.1,3  There are many symptoms of IDA, however one of the main signs is feeling fatigued or exhausted because your blood is less able to transport oxygen around your body.4

If iron deficiency is not treated there can be long-term consequences for your health. Fatigue and other symptoms of iron deficiency can also lower your quality of life and reduce your ability to concentrate and be productive at work.5 If you think you may be anaemic or iron deficient, it is important that you speak to your doctor so that they can investigate further.

REFERENCES
  1. McLean E, et al. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993-2005. Public Health Nutr. 2009; 12(4): 444-54.
  2. Radlowski EC, et al. Perinatal iron deficiency and neurocognitive development. Front Hum Neurosci. 2013; 7:1-11.
  3. Iron Deficiency: United States 1999-2000. CDC MMWR. Accessed Online. October 2015: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5140a1.htm
  4. Dean L. 1. Blood and the cells it contains. Blood Groups Red Cell Antigens. 2005:1-6.
  5. Haas JD, Brownlie IV T. Iron Deficiency and Reduced Work Capacity: A Critical Review of the Research to Determine a Causal Relationship. J Nutr. 2001; 131(2): 676S-690S.
REFERENCES
  1. Clark SF. Iron deficiency anemia. Nutr Clin Pract. 2008; 23(2): 128-41.
  2. Favrat B, et al. Evaluation of a Single Dose of Ferric Carboxymaltose in Fatigued, Iron-Deficient Women – PREFER a Randomized, Placebo-Controlled Study. PLoS ONE 2014 9(4): e94217.
  3. Patterson AJ, et al. Iron deficiency, general health and fatigue: Results from the Australian Longitudinal Study on Women’s Health. Quality of Life Research. 2000; 9: 491-497.
  4. Scully C. ABC of oral health: Mouth ulcers and other causes of orofacial soreness and pain. BMJ. 2000; 321(7254): 162-165.
  5. Dhur A, et al. Comparative Biochemistry and Physiology Part A: Physiology Volume 94, Issue 1, 1989, Pages 11–19.
  6. McDermid J, Lönnerdal B. Iron. Adv Nutr. 2012; (1): 532-533.
  7. Lacey EP. Broadening the perspective of pica: literature review. Public Health Rep. 1990; 105(1): 29-35.
  8. Sun ER, et al. Iron and The Restless Legs Syndrome. 1998; 21(4): 381-387.
  9. Trost LB, et al. The diagnosis and treatment of iron deficiency and its potential relationship to hair loss. J Am Acad Dermatol. 2006; 54(5): 824-44.
  10. Huch R, Schaefer R. Iron Deficiency and Iron Deficiency Anaemia. Pocket Atl. New York: Thieme Medical Publishers; 2006:1-70.
  11. Osaki T, et al. The pathophysiology of glossal pain in patients with iron deficiency and anemia. Am J Med Sci. 1999; 318(5): 324-9.
  12. Stoltzfus R, Edward-Raj A. Clinical pallor is useful to detect severe anemia in populations where anemia is prevalent and severe. J Nutr. 1999; 129: 1675-1681.
  13. Cashman MW Sloan SB. Nutrition and nail disease. Clinics in Dermatology. 2010; 28: 420–425.
  14. Miller JL. Iron deficiency anemia: a common and curable disease. Cold Spring Harb Perspect Med. 2013; 3(7).
  15. World Health Organization. Iron deficiency anaemia. Assessment, prevention and control: A guide for programme managers; 2001:1-114. Accessed Online. October 2015: http://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/WHO_NHD_01.3/en/

Am I at risk of becoming iron deficient?

People of all ages can become iron deficient, but there are certain long-term conditions and lifestyle choices that make iron deficiency more likely. These include conditions that may cause blood loss, affect how well you absorb iron from your food, limit your intake of iron rich foods, or increase the amount of iron that your body needs.

Conditions that can make iron deficiency more likely include:

  • Chronic Heart Failure
  • Coeliac Disease
  • Chronic Kidney Disease
  • Bariatric Surgery
  • Cancer
  • Inflammatory bowel disease

How is iron deficiency diagnosed?

If your doctor suspects that you have iron deficiency then they will want to talk to you about your medical history, conduct a physical examination to look for any signs or iron deficiency and take a sample of your blood for testing.

With this information, your doctor should be able to tell you if you have iron deficiency and help you plan how to manage this.

Medical history¹

Your doctor may ask you about the following areas of your life:

  • Diet
  • Menstruation and history of pregnancy
  • Other conditions that may be relevant such as gastrointestinal disease, chronic kidney disease, chronic heart failure and cancer
  • Family history of conditions that can cause anaemia, e.g. sickle cell anaemia
  • Exercise and physical activity
  • Foreign travel (this is to assess the risk of exposure to parasitic diseases that can cause similar symptoms)

Physical examination¹

Your doctor may want to examine you physically for any signs of iron deficiency, such as:

  • Brittle nails
  • Paleness
  • Hair loss
  • Mouth ulcers
  • Restless legs
  • Shortness of breath

Please remember that while these symptoms may indicate iron deficiency, they are not enough to confirm a diagnosis by themselves and can also be caused by a number of other conditions.

Blood test²

Following a conversation about your medical history and physical examination, your doctor may want to conduct a blood test if he or she still suspects you have iron deficiency.

Your doctor will take a small sample of your blood using a needle. This blood will be sent to a laboratory for a ‘complete blood count’ (CBC). A CBC will give your doctor a measurement of the different types of iron in your body.

With this information, your doctor should be able to tell you if you have iron deficiency and help you plan how to manage this.

REFERENCES
  1. Pasricha SS, et al. Diagnosis and management of iron deficiency anaemia: a clinical update. MJA. 2010; 193: 525-532.
  2. National Heart, Lung, and Blood Institute. How is iron-deficiency diagnosed? Accessed Online. October 2015: http://www.nhlbi.nih.gov/health/health-topics/topics/ida/diagnosis

How is iron deficiency treated?

Once your doctor has understood your symptoms and looked at the results of your blood tests they will be able to confirm if you are iron deficient or have iron deficiency anaemia, and recommend the best treatment for you.

One treatment option may be to increase the amount of iron in your diet by eating more iron-rich foods like red meat, liver, enriched cereals and leafy greens.1

Your doctor may also decide that you need extra iron given through:

  • Oral iron supplements,1 available over-the-counter or on prescription, or
  • Intravenous iron,2,3 where iron is delivered directly into your blood stream.

Some treatments may be more suitable for you than others, depending on your level of iron deficiency and any other medical conditions that you may have. Your doctor will be able to discuss the treatment options available with you and advise you on the most suitable treatment option for your condition.3,4

It may take different lengths of time for you to feel better, depending on the treatment. It is best to find out from your doctor when you can expect to notice a positive effect.3,5,6 If you are having problems with your treatment and experiencing side effects, or finding that your symptoms are not improving, go to see your doctor again for advice.

REFERENCES
  1. Alleyne M, et al. Individualized treatment for iron-deficiency anemia in adults. Am J Med. 2008; 121(11): 943-8.
  2. Krayenbuehl PA, et al. Intravenous iron for the treatment of fatigue in non-anemic, premenopausal women with low serum ferritin concentration. 2011; 118(12): 3222-7.
  3. Goddard AF, et al. Guidelines for the management of iron deficiency anaemia. Gut. 2011; 60(10): 1309-16.
  4. Stein J, et al. Diagnosis and management of iron deficiency anemia in patients with IBD. Nat Rev Gastroenterol Hepatol. 2010; 7(11): 599-610.
  5. Auerbach M, Ballard H. Clinical use of intravenous iron: administration, efficacy, and safety. Am Soc Hematol Educ Program. 2010; 2010: 338-47.
  6. Seid MH, et al. Ferric carboxymaltose injection in the treatment of postpartum iron deficiency anemia: a randomized controlled clinical trial. Am J Obstet Gynecol. 2008; 199(4): 435.e1-7.

Where can I get support?

Dietitian’s Association of Australia: http://daa.asn.au/for-the-public/
Iron Deficiency in Women’s Health: https://idinwomenshealth.com.au/
Iron Deficiency in people with Irritable Bowel Syndrome (IBS): http://www.irondeficiencyibd.com.au/