2017 HCHB_digital

Iron Deficiency
Iron is an essential mineral found in every cell of the body. Iron boosts the immune
system, helps fight infections and is vital for normal child growth and intellectual
development. It is also used to make haemoglobin, which is the substance in red
blood cells responsible for transporting oxygen around the body.
Iron is stored in the liver, spleen and bone marrow. Iron requirements are higher
during periods of rapid growth and development – such as during early childhood,
adolescence and pregnancy. Low body iron levels can also be caused by:
• surgery, medical conditions that cause blood loss (eg, heavy menstruation,
haemorrhoids, gastrointestinal bleeding), or clotting disorders
• frequent blood donation, especially in women of child-bearing age
• chronic malabsorption syndromes (ie, people with coeliac disease)
• kidney failure
• poor dietary intake (eg, vegetarians).
People who engage in regular, intense exercise – especially if they are female
or vegetarian – are also at a higher risk of iron deficiency. It is uncommon for
adult men or postmenopausal women to become iron deficient.
Symptoms of iron deficiency include tiredness, pallor (pale complexion)
and weakness. A person’s ability to exercise may be reduced and shortness
of breath, fast heart rate, fainting and unusual food cravings may also be
present. The condition usually comes on slowly, so may go unrecognised for
some time. Iron-deficiency anaemia (IDA) occurs when the iron deficiency is
severe enough to affect the production of red blood cells. Blood tests are
required to confirm IDA, so it is important to refer people who suspect they
are iron deficient to the doctor.
The amount of haemoglobin in the blood will be measured, along with the
amount of iron present within the blood or stored. The doctor will also carry out a
physical examination and conduct a history to try to determine the cause of IDA.
Many other types of anaemia and even haemochromatosis (a medical
condition where too much iron is absorbed) can cause similar symptoms, so do
not assume the diagnosis is iron-deficiency anaemia without blood test results.
Too much iron can be toxic, especially to children, and iron supplements should
not be taken routinely without a doctor's advice.
Haem iron and non-haem iron
Two types of iron exist. Haem iron and non–haem iron. Haem iron is the
iron contained within myoglobin and the blood pigment haemoglobin, and
approximately 30% of haem iron ingested is absorbed. It is found in animal
foods, such as beef, lamb, chicken, egg yolks and fish. Offal foods (eg, liver,
kidneys) are particularly good sources of haem iron; however, these offal meats
also contain large amounts of vitamin A which is known to cause birth defects,
so should not be eaten in large quantities by pregnant women. Red meat also
contains non-haem iron.
Non-haem iron is found in plant foods such as dried beans, dark green leafy
vegetables, tofu, fortified breakfast cereals, flours and whole grains. In the past,
non-haem iron was considered inferior to haem-iron because less is absorbed.
However, our bodies have more control over plant-based sources of iron and
absorption can be improved if non-haem iron is consumed with products high
in vitamin C such as kiwifruit, citrus fruit, orange juice, and capsicums. Research
has also found that vegans are no more susceptible to iron deficiency than the
general population.
TREATMENT OPTIONS
Category Examples Comments
Iron supplements
Iron supplements in
combination with other
minerals or vitamins
[GENERAL SALE]
eg, Douglas Carbonyl Iron (=elemental iron
18mg), Natures Own Liquid iron (=elemental
iron 7.5mg), Sanderson Superior Organic
Iron (=elemental iron 24mg), Spatone 100%
Natural* (=elemental iron 5mg),
[PHARMACY ONLY MEDICINE]
eg, Ferrograd (=105mg elemental iron)
[GENERAL SALE]
eg, Blackmores Bio Iron, Clinicians Iron Boost,
Fab Iron, Floradix Floravital Liquid Iron and
Vitamin Formula, Incremin Iron Mixture, Iron
Melts, Solgar Gentle Iron, Spirulina
[PHARMACY ONLY MEDICINE]
eg, Elevit with Iodine, FabFol Plus with Iodine
(=elemental iron 60mg)
eg, Ferrograd C (=105mg elemental iron +
vitamin C 500mg)
eg, Ferrograd F (=105mg elemental iron + folic
acid 0.35g)
Iron supplements contain either the ferrous or ferric form of iron. Of the two, the ferrous
form is better absorbed and is available as either ferrous sulphate, ferrous fumurate or
ferrous gluconate. Each one of these ferrous salts contains a different amount of available
iron, called elemental iron. Iron dosages should be based on the amount of elemental iron
contained within the product, not the amount of ferrous salt present.
Recommended daily intakes (RDIs) of iron vary according to age and gender. Pregnant
women also require higher daily intakes of iron. RDIs can be found on the NZ Nutrition
Foundation’s website (www.nutritionfoundation.org.nz).
Higher dosages of iron are best taken as divided doses as the amount of iron absorbed
decreases as dosages get larger. Iron supplements prescribed for anaemia may need to be
taken for up to six months, or for three months after haemoglobin concentration is normal, to
build up iron stores.
Iron supplements may cause nausea, constipation and/or diarrhoea, and make the stools a
dark colour. Taking iron tablets with food may help settle gastrointestinal problems.
Be aware iron is dangerous in overdose and tablets must be taken as directed for the
recommended course. Keep all iron products out of reach of children.
Sip iron liquid through a straw to avoid tooth discolouration.
Combination formulations may contain vitamin C, folic acid, B vitamins (ie, B1, B6, or B12)
and other vitamins. Many act as co-factors to facilitate absorption.
If iron levels are very low, follow a doctor’s advice with regards to dosage.
Products with an asterisk have a detailed listing in the Iron Deficiency section of OTC Products, starting on page 249.
READY, SET, LEARN!
Page 100 HEALTHCARE HANDBOOK 2017-2018 Common Disorders