For sluggish patients, low iron's a total drag

By Judah Issa

Symptoms for iron deficiency anemia — which affects one in 500 Canadians — are so subtle your patients may not even realize they have it. "They'll just feel lousy and tired," says hematologist Jerry Teitel, spokesperson for the Anemia Institute. "Sometimes less common symptoms will turn up like a swollen tongue, cracking around the lips or trouble swallowing," he adds.

Teenagers going through growth spurts, women with heavy periods, pregnant or lactating mums sharing their iron stores with their babies and members of some ethnic groups like Indo-Canadians who have a genetic predisposition are all at high risk of becoming iron deficient. Advise these patients to boost their dietary iron uptake. Warn them that, untreated, a deficiency can lead not just to lower energy levels, but also to developmental delays and impaired immune function.

Here's some information you can share with your patients to help prevent, detect and treat it.

IRON-CLAD DIAGNOSIS
Do the blood test "If your patient feels that their health is declining or they're getting sluggish, do a blood test," Dr Teitel advises. A serum ferritin test is the best for diagnosing iron deficiency - a ferritin concentration under 15mg/L for adults and under 12mg/L for kids is considered deficient.

Check for bleeding "Iron deficiency is usually a reflection of bleeding," says Dr Teitel. Ask your female patient if she has heavy periods — that would make her a prime candidate for iron deficiency. Bleeding in the GI tract is another common cause, brought on by peptic ulcers or aspirin and NSAIDs use. Treating the ulcer and switching your patient to other anti-inflammatory meds like COX-2 inhibitors when possible, will slash the risk of bleeding.

Look for underlying causes Some cancers and inflammatory conditions cause iron deficiency. But they also give a false 'normal' result in the ferritin test. A complete blood count or a stool test might reveal the deficiency. Start your patient on the appropriate treatment along with iron supplements to quickly bring their levels up to normal.

TREAT THE SYMPTOMS
If your patient is already past the early signs and has full-blown iron deficiency anemia, dietary changes won't correct it, says Dr Teitel. They'll need supplements. In fact, pregnant or breastfeeding women should take supplements right off the bat, he adds.

Move on to iron pills "All types of iron salts available are generally formulated the same way," says Dr Teitel. "The maximum dose is three tablets per day, but you can tell your patient that it's OK to take a smaller number of pills, it'll just take longer to correct the deficiency."

Watch for side effects The most common side effects are upset stomach, nausea or constipation, according to Dr Teitel. "But some people do get terrible side effects and can't absorb it, so we can give them iron by injection into a muscle or vein," he adds. It's not the preferable route, but your patients at least have an alternative.

Switch the time of the antacids Your peptic ulcer patient is already on antacids, but the calcium and magnesium in antacids hinder iron absorption. Tell your patients to take their antacids at a different time of day from their iron supplement to maximize their iron uptake.