Anaemia and low iron stores

I am a strong advocate for optimising iron stores, particularly in pre-menopausal women where iron deficiency is often a major contributor to fatigue. Many individuals can benefit from optimisation of their iron stores, even in the absence of anaemia, and I am always happy to advise people on supplementing iron stores.

While iron deficiency is a haematological concern, it’s important to identify and address the root causes, which often requires collaboration with specialists in other fields. Where the cause of low iron stores is not clear, I would usually first advise for people to consult with a gastroenterologist +/- gynaecologist to ensure that the underlying cause has been sufficiently investigated.

Gastroenterology: Conditions such as gastrointestinal bleeding, ulcers, Crohn's disease, or Coeliac disease can contribute to chronic iron loss. Endoscopic procedures or investigations may be needed to identify and treat these underlying conditions.

Gynaecology: For women, heavy menstrual bleeding or conditions like fibroids can lead to significant iron loss. Gynaecological assessments, including imaging or procedures, might be necessary for accurate diagnosis and management.

 

What is Iron Deficiency?

Iron is an essential mineral that your body needs to make haemoglobin, the protein in red blood cells that carries oxygen around your body. Iron deficiency occurs when your body does not have enough iron to produce healthy red blood cells, leading to symptoms such as fatigue, shortness of breath, dizziness, pale skin, and difficulty concentrating.

Common Causes of Iron Deficiency

Iron deficiency can be caused by:

  • Blood loss – This is the most common cause, particularly in women with heavy periods, after surgery, or from gastrointestinal bleeding (e.g., ulcers, colon polyps, or bowel conditions like Crohn’s disease).

  • Increased iron demand – Pregnancy and growth spurts in children and adolescents increase the body's iron requirements.

  • Insufficient dietary intake – A diet low in iron-rich foods can contribute to deficiency, especially in vegetarians and vegans.

  • Poor absorption – Conditions like coeliac disease, inflammatory bowel disease, and stomach surgery (e.g. gastric bypass surgery).

 

Options for Iron Supplementation

If you have iron deficiency, there are several ways to increase your iron levels:

1. Dietary Supplementation

Eating iron-rich foods can help boost your iron levels naturally, though it is difficult to take in as much iron through dietary adjustment alone as with oral iron supplements. . Good sources of iron include:

  • Haem iron (easily absorbed): Found in red meat, poultry, and fish.

  • Non-haem iron (less easily absorbed): Found in plant-based foods such as leafy greens (spinach, kale), legumes (lentils, chickpeas), fortified cereals, nuts, and seeds.

  • Vitamin C helps absorption: Eating vitamin C-rich foods (e.g., citrus fruits, tomatoes, bell peppers) alongside iron-rich foods improves absorption.

  • Avoid inhibitors: Tea, coffee, calcium-rich foods, and high-fibre foods can reduce iron absorption if eaten with iron-rich meals.

2. Oral Iron Supplements

For those who cannot meet their iron needs through diet alone, iron tablets may be recommended. Prescription iron such as ferrous fumarate, ferrous sulphate or ferrous gluconate contain significantly more iron than most over-the-counter preparations, which often have a relatively low level of elemental iron by comparison.

Best way to take iron tablets:

  • Take on an empty stomach, ideally around 1 hour before or 2 hours after food.

  • If stomach upset occurs, take with a small amount of food (but avoid dairy and tea/coffee).

  • Take with vitamin C (e.g., orange juice) to improve absorption.

  • Avoid taking with calcium supplements or antacids, as these reduce absorption.

  • Frequency: For most people once daily dosing is typically optimal; higher frequencies often cause gastrointestinal side effects and iron absorption is rarely improved with more frequent dosing (absorption is limited by the amount of available transferrin (a protein that binds to iron in the blood)). Some people find taking it every other day may reduce side effects (such as nausea, constipation, and stomach upset) while still improving absorption.

3. Intravenous (IV) Iron Therapy

For patients who cannot tolerate oral iron, have severe deficiency, or need a rapid increase in iron levels, IV iron may be an option.

We can deliver this on the IVAS unit at Frimley Park Hospital, or at Spire Clare Park Hospital, where indicated.

  • When is IV iron recommended?

    • Severe iron deficiency anaemia requiring quick correction.

    • Malabsorption conditions preventing oral iron absorption.

    • Chronic conditions like kidney disease or inflammatory bowel disease.

    • Pregnancy when oral iron is not effective or tolerated.

  • Risks of IV Iron:

    • Allergic reactions (uncommon but can be serious, in very rare cases can cause anaphylaxis).

    • Temporary side effects such as headache, nausea, muscle pain, or flu-like symptoms.

    • Skin staining at the injection site if the iron leaks outside the vein (IV watch device is used at Frimley to minimise this risk).

    • Risk of low blood pressure during infusion.

    • Electrolyte imbalances, including low phosphate levels

Get in Touch

If you have concerns about possible or confirmed iron deficiency, I offer consultations on iron replacement therapy. If the cause of iron deficiency is unexplained, it is usually best to first seek advice from a gastroenterologist +/- gynaecologist to address the underlying cause.