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Iron deficiency anaemia What is it, why is it common and how can it be managed? What is Iron Deficiency Anaemia? Symptoms At its simplest level, iron deficiency anaemia (IDA) is a condition where a lack of iron in the body (iron deficiency) reduces the number of oxygencarrying red blood cells circulating around the body (anaemia).1 A common indicator of IDA is a feeling of exhaustion - those with IDA often report feeling drained of energy, lethargic and weak. Other common symptoms include shortness of breath, irregular heartbeats, headaches and dizziness. Normal level Anaemia Those with IDA may also have some physical signs such as paleness in the eyes, lips, skin and nails or hair loss.5 Why does iron deficiency cause anaemia? Iron is an essential mineral, important for maintaining healthy skin, hair and nails. However, its critical role is transporting oxygen around the body.1,2 Iron is present in haemoglobin, a protein found in all healthy red blood cells. The iron here is able to bind with oxygen molecules to move them around the body.1,2 Anaemia occurs where there is a low level of haemoglobin in the red blood cells. There are a number of reasons for this, though the most common is a deficiency in iron.1 But despite being a common condition (over 71,000 patients treated in hospital in 2014/15)3 the management of IDA is often poor with most sufferers not being identified appropriately.4 Fast heartbeat Shortness of breath Headache Tiredness What causes IDA? There are three main causes of IDA: 1 In pre-menopausal women, menstrual blood loss is the most common cause of IDA; in men and post-menopausal women blood loss from the gut is the most common cause.4 These three main causes of IDA can be related to underlying chronic conditions, as shown in the graph below. INFLAMMATION Blood loss 2 People with certain long term inflammatory conditions frequently have IDA as the inflammation can cause iron uptake in the gut to be blocked.6 Inflammation 3 Reduced absorption of iron Reduced absorption of iron (malabsorption) - those with damage to their gut have a reduced ability to uptake iron and are at high risk of IDA.4 Chronic kidney disease Chronic obstructive pulmonary disease Rheumatoid arthritis Gluten allergy Gastritis Menstrual blood loss Bowel cancer Gut infection Chronic heart failure Inflammatory bowel disease Blood loss from the gut BLOOD LOSS Surgical patients Kidney dialysis Certain medications MALABSORPTION Partial or total removal of the gut How is IDA diagnosed? Contact your GP if you experience symptoms of IDA.1 Low levels of haemoglobin are defined by the World Health Organization and are different for men and women (<120g/L in adult women; <130g/L in adult men).7 It is critical to understand the cause of the anaemia. Iron deficiency is the most common cause and can easily be identified by testing the amount of a substance called If your GP suspects IDA they will ask for a sample of blood. The blood sample will be tested for low haemoglobin levels to confirm a diagnosis of anaemia. ferritin in the blood.1 After a diagnosis of IDA your GP may ask you a series of questions or do physical examinations to understand why you have IDA or iron deficiency. Following this it may be necessary to visit a specialist doctor. How can IDA be managed? Good sources of iron1 Anybody diagnosed with IDA should be provided with treatment to restore the levels of iron in the body and cure the anaemia.4 This can be done in a number of ways: • Dark green leafy vegetables, such as curly kale and watercress • Tablets containing iron • Pulses and beans • Iron injected directly into the blood • Nuts and seeds • Blood transfusion (only used in severe cases where haemoglobin levels are extremely low) • Fish A GP or a dietician can also provide advice on how to include more iron into your diet, as well as what to avoid as some types of food and drink may decrease how much iron is absorbed.1 • Dried fruit Unfortunately, IDA may recur after successful treatment, particularly if the underlying cause remains.8 As such, someone with IDA should monitor for recurrence of symptoms to allow for early treatment.4 • Coffee • White and red meat •Brown rice •Eggs Negative impact on iron levels1 • Tea • Calcium (dairy products such as milk) • Indigestion medication • Wholegrain cereal More information There is no patient support group with a direct focus on IDA, however more information on IDA and conditions associated with it can be found at the following: NHS Choices http://www.nhs.uk/Conditions/Anaemia-iron-deficiency-/Pages/Introduction.aspx Crohn’s & Colitis UK https://www.crohnsandcolitis.org.uk Kidney Research UK http://www.kidneyresearchuk.org British Kidney Patient Association http://www.britishkidney-pa.co.uk CIRCA http://www.cicra.org CORE http://corecharity.org.uk/conditions/crohns-disease References 1 NHS Choices. Iron deficiency anaemia. Available at: http://www.nhs.uk/Conditions/ Anaemia-irondeficiency-/Pages/Introduction.aspx. Accessed May 2016. 5 Gasche C. Anemia in Inflammatory Bowel Diseases. Bremen: UNI-MED Verlag, 2008. 2 ASH. Iron Deficiency-Anemia. Available at: http://www. hematology.org/Patients/ Anemia/Iron-Deficiency. aspx. Accessed May 2016. 7 WHO. Worldwide prevelance of anaemia 19932005. WHO Global Database of Anaemia 2008. Iron Deficiency Anaemia. 2001. 3 Hospital Episode Statistic Data 2014/15, NHS Information Centre for Health and Social Care (under a commercial re-use license via Harvey Walsh Ltd). 8 Kulnigg S, et al. Am J Gastroenterol 2009; 104: 14601467. 6 Stein J & Dignass AU. Ann Gastroenterol 2013; 26: 104113. 4 Goddard AF, et al. Guidelines for the management of iron deficiency anaemia. Gut 2011;60:1309–1316. UK/OTH/15/0243b | Date of preparation: May 2016 This leaflet was produced by Vifor Pharma UK Ltd