Iron deficiency anaemia due to poor nutritional intake not to be sidelined

Iron deficiency anaemia (IDA) due to inadequate dietary iron intake is caused by a diet low in iron-rich foods. The best sources of iron come from lean meat, seafood, beans, and foods fortified with additional iron.

With that in mind, it is easy to see how the following group of persons may be at risk of IDA due to poor nutritional intake—vegetarians or vegans, especially if they do not supplement with iron-rich foods; those with eating disorders, the homeless or underprivileged, the elderly with limited access to diverse diet, people on a weight loss diet, those who consume very little iron-rich foods; those who drink excessive amounts of coffee or caffeine-containing beverages; and those who regularly take antacids. [Available at: https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/ Accessed on 16 February 2021; Available at https://www.healthline.com/health/iron-deficiency-inadequate-dietary-iron#diagnosis Accessed on 16 February 2021, Am J Lifestyle Med 2018;12:486–498]

IDA can be avoided by consuming a diet rich in iron, supplementing with oral iron when necessary (e.g. during pregnancy or in a premature infant).  [Available at https://www.healthline.com/health/iron-deficiency-inadequate-dietary-iron#treatment-and-prevention Accessed on 15 February 2021] Iron is an important component of haemoglobin and the lack of it (iron deficiency) is the most common cause of anaemia. The common causes of iron deficiency are worm infestations in children and poor pregnancy spacing and menstrual blood loss in women.  To diagnose iron deficiency, iron studies are carried out.

Iron studies are a series of blood tests that calculate and estimate the quantity of elemental iron present in the blood and deposited in the tissues of the body. Typically, iron studies encompass ferritin, serum iron, and transferrin tests. Ferritin is the most accurate marker of total body iron stores and the first component to drop when a person has iron deficiency. Serum iron indicates an estimated amount of iron present in the blood. Lastly, transferrin is a protein which transports iron in the blood. However, transferrin levels may be affected by inflammation or infection and is not the best indicator of iron deficiency anaemia. [Available at: https://healthengine.com.au/info/iron-studies-test#:~:text=Iron%20studies%20(Fe)%20are%20a,anaemia%20(low%20blood%20count) Accessed on 15 February 2021]

In conjunction with International Women’s Day on 8 March, MIMS Doctor spoke to Dr Carol Lim, head and consultant obstetrician and gynaecologist, department of obstetrics and gynaecology, and Dr Jameela Sathar, head and consultant haematologist, department of haematology, both of Hospital Ampang, Selangor, about IDA in the local setting.

Symptoms of IDA are usually fatigue, exhaustion, poor concentration, mind-fog, irritability, pica (a compulsive eating disorder where a person eats non-food items), depression, and shortness of breath. Women who are more predisposed to IDA are those who experience heavy menstrual bleeding, poor spacing between childbirths and multiparity. [Available at https://www.nhlbi.nih.gov/health-topics/iron-deficiency-anemia Accessed on 16 February 2021] There is an increased risk of low birth weight and neurocognitive deficits among infants born to mothers who are iron deficient. (Front Hum Neurosci. 2013; 7: 585).

According to Lim and Jameela, the prevalence of IDA amongst women in Malaysia stands at 20-25 percent. [Available at: https://www.moh.gov.my/moh/images/gallery/rni/15_chat.pdf Accessed on 16 February 2021] This figure is alarming as about a quarter of our female population may experience lethargy, weakness, impaired immune system, and decreased mood or “feeling down.” They are thus living life below their full potential, they said.

In the GP setting, the experts encouraged GPs to take good patient history and should IDA be suspected, the patient should have iron studies done to confirm the diagnosis of anaemia.. If anaemia is confirmed, the patient should be started on iron therapy immediately. This is usually enough to help a patient get back on track. However, if a woman suffers from heavy menstrual bleeding or if the IDA is not responding to adequate trial of oral iron therapy, then a referral to a specialist is necessary. Iron can also be given intravenously and is the preferred route if urgent correction is needed or if there is intolerance to oral iron. With the newer iron formulations, intravenous iron is very safe and effective and can be given in an outpatient clinic.