It’s something we hear often enough: someone feels a bit rundown, tired, headache-prone and maybe a bit cranky; but it’s “nothing” they say - and they just put up with it.
But it may not be ‘nothing’ and it may be something relatively easy to fix - enough to get many people jumping for joy again - according to three medical specialists looking into the impact of iron deficiency on the population.
About iron deficiency
“The first thing to clarify is that ‘iron deficiency’ is not anaemia,” explains Professor Andrew Sindone, a cardiologist with Sydney’s Concord Hospital.
“You can be iron deficient but not anaemic; and you can be both – which is not good. But iron deficiency is caused by factors such as inadequate diet, chronic blood loss, inability to absorb iron and vigorous exercise; whereas you can be anaemic for other reasons.”
Professor Sindone and two research colleagues, Associate Professor Al Khalafallah, a haematologist at Launceston General Hospital and Dr Bernd Froessler, an anaesthetist at Adelaide’s Lyell McEwin Hospital, say that iron deficiency is much more common than the community – including other healthcare professionals – think.
The three doctors are at the forefront of new research into the impact of iron deficiency on pregnant women and heart patients.
“Iron deficiency affects two billion people worldwide and affects more women than any other health problem,” says A/Professor Khalafallah.
He says one in four Australian women and one in six men are affected, with rates as high as 40% amongst Indigenous Australian women.
People suffering from iron deficiency are at increased risk of chronic illness and health complications such as kidney disease, heart failure, poor foetal development and risks during birth, delays in cognitive function and depression.
“There are consequences and impacts of iron deficiency in respect of the general population, on pregnant women and for those requiring surgery,” says A/Professor Khalafallah. “Iron deficiency has terrible associated health costs and can result in poor pregnancy outcomes, a lower quality of life, unnecessary blood transfusion, low operative and surgical outcomes and shorter duration of breastfeeding.”
Iron deficiency in pregnancy
Dr Froessler says that women need more iron during pregnancy to allow for the needs of the baby also.
“In many instances, pregnant women who require blood transfusions are often having the symptom treated rather than the cause. This can treat anaemia, but not iron deficiency,” he says.
If a mother is iron deficient then it is likely her baby will be too.
“This potentially has long term consequences including poor locomotive development, delayed cognitive development, behavioural issues and brain biochemistry, and can have an impact on issues such as mother-child bonding.”
Dr Froessler would like to see more screening of pregnant women specifically for iron deficiency.
“We have identified in the past few years that iron deficiency is the more common in pregnant women than previously thought, and undiagnosed in most. The importance of screening is not well understood and often underestimated.”
He recommends checks for iron deficiency from the very first appointment with an obstetrician.
Iron deficiency and heart disease
Professor Sindone says that many of his patients with chronic heart failure are also iron deficient.
“The effect of iron deficiency on heart failure is staggering. We don’t yet know what the causal relationship is – whether iron deficiency is a marker in heart failure or whether the iron deficiency is part of the problem – but we do know that iron deficient heart patients have an increased mortality rate and a decreased quality of life.”
He says that more than half of the heart failure patients attending the Concord Heart Failure Unit are iron deficient.
“More than 300,000 Australians are living with some form of heart failure. A further 30,000 are diagnosed each year. 50% of these people are dead within three years.
“What if many of these people could have better health outcomes simply by treating their iron deficiency? Imagine the impact not only for the individual but on the cost to the economy,” he says.
So what’s the answer?
The doctors believe that if someone is feeling ‘generally lousy’ for no apparent reason, is pre-menopausal, pregnant or has a chronic illness such as heart disease, they should ask their medical practitioner to check whether they are iron deficient by testing their ferritin level.
“Ferritin is a protein in the body which binds to iron, and is the most effective indicator of how much iron is stored in the body,” said A/Professor Khalafallah.
He said this will not be the cause in every case and, in those instances, individuals should continue to seek medical advice.
“However, because of the high prevalence of iron deficiency in Australia and globally, we recommend the testing of ferritin level as part of a general blood test.
“There are new intravenous treatment regimes available for iron deficiency today which are relatively inexpensive, simple to administer and over and done with in 15 minutes for the patient.”
He says diagnosis and proper treatment of iron deficiency can have a huge impact on quality of life.
“This condition is costing Australians and our health system millions of dollars each year in lost productivity, decreased educational performance, prolonged stays in hospital after surgery, increased morbidity and potentially mortality,” A/Professor Khalafallah said.
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