Rino hakahaka me korenga rino (mate rino) Low iron and iron deficiency anaemia
Iron is a mineral your body needs to make red blood cells, which carry oxygen to your body. It is also needed for your muscles and for healthy hair, skin and nails. Iron also helps with brain functioning. Your body stores some iron, mainly in your liver.
Causes of low iron and iron deficiency anaemia
You can become low in iron if you:
- are not getting enough iron from your food
- are losing blood — this could be because you have heavy bleeding during your period, or hidden bleeding from stomach ulcers or other problems that cause bleeding inside the body
- cannot absorb iron into your bloodstream — this can occur in conditions such as coeliac disease and Crohn's disease.
Some people have a higher risk of getting iron deficiency. This includes:
- babies, tamariki (children) and rangatahi (young people), because they are growing rapidly
- girls and women because of blood loss with periods
- pregnant women, who are building their baby's iron stores
- athletes
- vegetarians and vegans
- people on restrictive or fad diets.
Symptoms of low iron and iron deficiency anaemia
Low iron may cause no symptoms.
You may notice changes in your hair such as dryness or hair falling out. Your nails may break more easily or change shape. If your body gets very low in iron, you can get low red blood cells (anaemia).
Common anaemia symptoms are due to having less oxygen in the body. They include:
- feeling tired or having little energy
- feeling faint and dizzy
- looking pale
- feeling short of breath
- headaches
- faster heart rate or a thumping heart (palpitations).
Diagnosing low iron and iron deficiency anaemia
A simple blood test can check your red blood count and iron levels.
If you have iron deficiency anaemia, your healthcare provider will want to find the cause of your low iron. If the reason is not straightforward, such as blood loss from heavy periods or low iron in your food, you may need further tests to find the cause. This may include checking your bowel for hidden bleeding.
Self-care with low iron and iron deficiency anaemia
Make sure you get enough iron in your food. Many foods contain iron including all meats, fish, leafy vegetables, dried fruits and wholemeal bread.
Eat plenty of foods containing vitamin C to help absorb iron into your body.
Avoid tea and coffee with meals as this reduces the amount of iron you absorb.
Many foods have small amounts of iron. We absorb the iron in animal foods such as meat and fish more easily than the iron in plant foods, such as grains, nuts, seeds, vegetables and fruit.
Excellent sources of iron
- lean beef
- lean lamb
- kidney
- venison
- liver (limit to 100 grams a week if you are pregnant)
- shellfish such as paua and mussels.
The redder the meat, the higher the iron content.
Good sources of iron
- fish, especially oily fish such as sardines, tuna, salmon and mackerel
- lean chicken — the leg meat has more iron than the breast meat
- lean pork.
Useful sources of iron
- eggs
- wholemeal bread and fruit bread
- iron-fortified breakfast cereals — choose a cereal with at least 3 mg iron per serving
- dried fruit such as apricots, raisins and figs
- green leafy vegetables such as silverbeet, spinach and watercress
- nuts and seeds such as pumpkin, sesame and sunflower
- legumes such as kidney beans, chickpeas, lentils, split peas and baked beans
- tofu and tempeh (fermented soybeans)
- spreads such as Marmite, peanut butter, hummus and tahini (sesame seed paste).
Choose a variety of foods
This is the best way to get enough iron. Every day have food from all the main food groups:
- grain foods — choose mostly wholegrain and those naturally high in fibre
- vegetables and fruit
- milk and milk products
- lean meat, chicken, seafood, eggs, legumes, nuts and seeds.
Eat lean red meat regularly
- Have a serving of lean red meat at least 3 times a week. A serving is the size and thickness of the palm of your hand.
- Eat meat, chicken or fish and vegetables together. Meat, chicken and fish help your body absorb the iron in vegetables.
Get plenty of vitamin C
Vitamin C helps us absorb up to 4 times as much iron. You can get vitamin C from many fruits (berries, feijoas, kiwifruit, mandarin, orange, rock melon and tamarillo) and vegetables (broccoli, capsicum, cauliflower and tomato).
Try to include fruit or vegetables with every meal, especially if you are vegetarian or vegan.
Eat a variety of plant foods if you are vegetarian or vegan
Have plenty of green leafy vegetables and wholegrains. Regularly include legumes, tofu, tempeh, nuts and seeds.
Keep your meals tannin-free
The tannin in tea and coffee stops your body from absorbing as much iron. Drink tea and coffee between meals rather than with meals.
Treating low iron and iron deficiency anaemia
Sometimes you can boost your iron by eating plenty of iron-rich foods. But this is not usually enough to treat low iron by itself.
If the level of the iron in your blood is low, your healthcare provider may prescribe an iron supplement. You may need to take it for several months.
If the supplements are not enough to get your iron levels up, you may need to have an iron infusion.
Taking iron supplements
There are different types of iron supplements available. They come in tablet or liquid form. Some are available from your healthcare provider or dietitian. Your healthcare provider, pharmacist or dietitian can advise which is best for you.
Take the supplement as advised by your healthcare provider or dietitian, or follow the directions on the label. Measure doses for tamariki (children) accurately using a medicine measure.
Take the supplement with food if you get an upset stomach. Iron is better absorbed when you have no food in your stomach. But, it is more likely to upset your stomach this way. If this happens, take your supplement at mealtimes.
Take the supplement with vitamin C. Vitamin C helps the body to absorb up to 4 times more iron. Take your supplement with a vitamin C rich fruit. For example, berries, feijoas, kiwifruit, mandarin, orange, rock melon or tamarillo. You could also take your iron supplement with a small glass of orange juice or a vitamin C supplement.
Do not take with some foods and medications. Some drinks, foods and medications make it harder for your body to absorb iron. Take 1 hour before or 2 hours after having:
- tea or coffee
- milk, yoghurt or cheese
- calcium supplements
- antacids, such as Mylanta and Quick-Eze.
Some people have side effects when taking iron. The most common side effect is dark-coloured poos, which are not harmful. Other side effects can include feeling sick (nausea), an upset stomach, constipation or runny poos (diarrhoea).
You might be able to reduce side effects by:
- taking the iron supplement with food
- splitting the daily dose, for example, if you take 2 tablets a day, take one with breakfast or lunch and the other with dinner
- taking a lower dose until your symptoms settle down — halve the daily dose or take it every other day
- drinking at least 8 cups of fluid and having at least 5 servings of vegetables and 2 servings of fruit every day
- eating plenty of wholegrains, especially if you get constipated.
If you have tried all these things and you still have side effects, ask your healthcare provider, dietitian or pharmacist for advice. If you stop taking the supplement, your iron levels will not improve.
Liquid iron supplements can sometimes stain your teeth. To prevent or reduce these stains:
- mix each dose in water, fruit juice, or tomato juice — drink it through a straw to help keep the iron supplement from getting on your teeth
- if you are taking the supplement by a dropper or syringe, place the dose well back on your tongue and follow it with water or juice.
Iron infusions
Your healthcare provider may prescribe intravenous (IV) iron to boost your iron levels. This means you will get an iron solution directly into your bloodstream, through a needle that goes into one of your veins.
Your healthcare provider will ask some questions to make sure an iron infusion is the right treatment for you. They will want to know if you:
- have any health conditions that may affect or be affected by the infusion, including allergies, infections or inflammation in your liver or kidneys
- are taking any other medicines, including any you have bought at a supermarket, pharmacy or health food store.
- are pregnant or planning to become pregnant
- have had an iron infusion before.
IV iron can have side effects. Your healthcare provider will talk to you about the possible side effects. Your nurse will monitor you during the infusion to check if you are having any side effects.
The most common side effect of IV iron is a headache. Usually this happens soon after having the infusion and goes away if you take paracetamol. Other side effects include:
- feeling dizzy or sick
- staining of your skin around the injection site.
There is a very low risk you may have an allergic reaction called anaphylaxis. This can make your face, mouth and tongue swell and can make it difficult to breathe. It is most likely to happen soon after the treatment. This is very rare, but it is a serious reaction. It is why you need to wait for 30 minutes after the infusion to check you have no problems.
If you are feeling unwell or think you may be having side effects, either during or after the treatment, it is very important to tell the doctor or nurse looking after you.
You will have to wait 30 minutes after your treatment to make sure you do not have any side effects.
If you are at home and could be having an allergic reaction such as your face or tongue swelling, collapsing or difficulty breathing, call 111.
If you take iron tablets, you will need to stop taking them for 3 months.
It can take some time for your iron levels to improve. Your healthcare provider will ask you to have a repeat blood test 6 to 12 weeks after your treatment. You may need a second treatment if your iron levels are still low.