Iron defi ciency anaemiaWhat is it, why is it common and how can it be managed?

What is Iron Defi ciency Anaemia?At its simplest level, iron defi ciency anaemia (IDA) is a condition where a lack of iron in the body (iron defi ciency) reduces the number of oxygen-carrying red blood cells circulating around the body (anaemia).1

Why does iron defi ciency 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 defi ciency 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 identifi ed appropriately.4

SymptomsA 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.

Those with IDA may also have some physical signs such as paleness in the eyes, lips, skin and nails or hair loss.5

Normal level Anaemia

Fast heartbeat Shortness of breath

Headache Tiredness

What causes IDA?

There are three main causes of IDA:

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

People with certain long term inflammatory conditions frequently have IDA as the inflammation can cause iron uptake in the gut to be blocked.6

1

Blood loss

Inflammation

2

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

Inflammatory bowel disease

Chronic heart failure

Gluten allergy

Gut infection

Certain medications

Partial or total

removal of the gut

Surgical patients

Kidney dialysis

Blood loss from the gut

Menstrual blood loss

Gastritis

Bowel cancer

Rheumatoid arthritis

Chronic kidney disease Chronic

obstructive pulmonary

disease

MALABSORPTIONBLOOD LOSS

INFLAMMATION

These three main causes of IDA can be related to underlying chronic conditions, as shown in the graph below.

How is IDA diagnosed?

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

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?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:

• Tablets containing iron

• Iron injected directly into the blood

• Blood transfusion (only used in severe cases wherehaemoglobin levels are extremely low)

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

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

Good sources of iron1

• White and red meat

• Dark green leafy vegetables, such ascurly kale and watercress

• Brown rice

• Pulses and beans

• Nuts and seeds

• Fish

• Eggs

• Dried fruit

Negative impact on iron levels1

• Tea

• Coffee

• Calcium (dairy products such as milk)

• Indigestion medication

• Wholegrain cereal

If your GP suspects IDA they will ask for a sample of blood.

Contact your GP if you experience symptoms of IDA.1

The blood sample will be tested for low haemoglobin levels to confirm a diagnosis of anaemia.

More informationThere 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 Choiceshttp://www.nhs.uk/Conditions/Anaemia-iron-deficiency-/Pages/Introduction.aspx

Crohn’s & Colitis UKhttps://www.crohnsandcolitis.org.uk

Kidney Research UKhttp://www.kidneyresearchuk.org

British Kidney Patient Associationhttp://www.britishkidney-pa.co.uk

CIRCAhttp://www.cicra.org

COREhttp://corecharity.org.uk/conditions/crohns-disease

References1 NHS Choices. Iron deficiency anaemia. Available

at: http://www.nhs.uk/Conditions/ Anaemia-iron-deficiency-/Pages/Introduction.aspx. Accessed May 2016.

2 ASH. Iron Deficiency-Anemia. Available at: http://www.hematology.org/Patients/ Anemia/Iron-Deficiency.aspx. Accessed May 2016.

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).

4 Goddard AF, et al. Guidelines for the management of iron deficiency anaemia. Gut 2011;60:1309–1316.

5 Gasche C. Anemia in Inflammatory Bowel Diseases. Bremen: UNI-MED Verlag, 2008.

6 Stein J & Dignass AU. Ann Gastroenterol 2013; 26: 104-113.

7 WHO. Worldwide prevelance of anaemia 1993-2005. WHO Global Database of Anaemia 2008. Iron Deficiency Anaemia. 2001.

8 Kulnigg S, et al. Am J Gastroenterol 2009; 104: 1460-1467.

This leaflet was produced by Vifor Pharma UK LtdUK/OTH/15/0243b | Date of preparation: May 2016