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Iron Deficiency Anaemia

Iron Deficiency anaemia is the commonest nutritional deficiency worldwide. It is a particular problem during pregnancy - both for the developing baby and mother - and after delivery - again for both the mother and baby, particularly if breastfeeding. It cannot be overstated that iron deficiency is common and the patient may not be anaemic despite suffering from lethargy, breathlessness, palpitations and maybe even itch. Once over the hurdle of making the diagnosis one has got to receive appropriate treatment. The mainstay of treatment is oral iron (for instance ferrous sulphate, ferrous fumarate from the doctor, or many over the counter preparations, from the pharmacy, supermarket or health food shop) but many patients have symptoms from oral iron. The commonest are gastrointestinal upset, and constipation is the commonest, though pain, cramps, diarrhoea and nausea can all occur. These symptoms can be particularly difficult to deal with during pregnancy and after delivery.

There is a recent report from Denmark on the benefits of intravenous iron on various measures of health and well being in women with severe fatigue after post-partum haemorrhage (loss of more than 500 ml of blood). They feel better more quickly after an iron infusion, compared to iron tablets. There is a word of caution in interpreting the study - it was funded by the company (Pharmacosmos) making the drug in question (Monofer), several of the authors are employed by the company and the unit enrolling the patients received a fee per patient enrolled.

There are other options for intravenous iron, should it be necessary. Historically intravenous iron was little used, it was complicated to give, patients would occasionally react to it, and thus it was only used as a last resort, in hospital if resuscitation facilities were available. Now there are safer preparations, that can be given quickly in out-patient settings.

Some patients with chronic iron deficiency, who become anaemic, are at risk of receiving a transfusion. Many of these patients do not need a transfusion and do not have the alternatives to transfusion explained to them, including oral and intravenous iron. I work with my colleagues across England with NHS Blood and Transplant, to improve the recognition and management of iron deficiency, to ensure patients are treated quickly and appropriately, they have the reasons for iron deficiency appropriately considered and managed as necessary, they receive the correct follow up, either to prevent its recurrence or retreat developing iron deficiency before the patient becomes unnecessarily symptomatic.

If you would like a consultation for iron deficiency anaemia at King's College Hospital on the Guthrie Wing, to consider whether intravenous iron might be right for you, please visit LondonSwissMedical and make an enquiry.

Dr Philip Kelly is a Consultant Physician and Endocrinologist at King's College Hospital with an interest in the diagnosis and management of fatigue whether it is due to anaemia, thyroid disease, adrenal failure, the menopause or testosterone deficiency, or other metabolic disturbance.

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