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FAQ for Iron deficiency anaemia

What is iron deficiency anaemia ?

Anaemia means:

you have less red blood cells than normal, or

you have less haemoglobin than normal in each red blood cell.

In either case, a reduced amount of oxygen is carried around in the bloodstream. The most common cause of anaemia in India is a lack of iron. This is called iron deficiency anaemia.

What are the symptoms of iron deficiency anaemia ?

General symptoms are tiredness, lethargy, light headed, ringing in the ear. If you have underlying heart disease, then you may feel breathless and can even have chest pain.

How is iron deficiency anaemia diagnosed ?

A blood test can confirm that you are anaemic, and measure the amount of iron in the blood. If your anaemia is due to lack of iron, the cause for the low level of iron needs to be explained.

What are the causes of iron deficiency anaemia ?

A normal balanced diet will usually contain enough iron for the body's needs. A low level of body iron leading to anaemia can result from various causes. Some are more serious than others, and include the following.

Diet

Dietary deficiency of iron is the commonest cause of iron deficiency in our country. Foods rich in iron include jaggery, spinach, lentil (dal), dry fruits, dates (khajur), and finally chocolate!! Animal food is also rich in iron.

Heavy menstrual periods/span>

About 1 in 10 women will become anaemic at some stage due to heavy periods. The amount of iron that you eat may not be enough to replace the iron that you lose with the blood each period. Having heavy periods does not always lead to anaemia. Anaemia is more likely to develop if you have heavy periods and eat a diet that contains little iron.

Pregnancy

The growing baby needs iron and will take it from the mother. Anaemia is common in pregnant women. It is more likely to develop during pregnancy if you eat a diet that has little iron.

Hookworm infection

This infection is one of the most common cause of iron deficiency anaemia in India. The worm feeds off blood inside the gut (intestine).

Poor absorption of iron

Some conditions of the gut (intestines) lead to poor absorption of various foods, including iron. Coeliac disease is an example.

Bleeding from the guts (intestines)

Several conditions of the gut can lead to 'internal bleeding'. Sometimes this is sudden, for example, after a burst duodenal ulcer. Vomiting or passing blood is then obvious. 
However, often the bleeding is not obvious. A constant trickle of blood into the gut can be passed unnoticed in the stools (faeces). The iron that you may lose with the bleeding may be more than you eat. Conditions causing this include: stomach or duodenal ulcers, colitis, inflammation of the oesophagus (gullet), piles (haemorrhoids), tumours(cancers) of the bowel, and other rare bowel disorders. If you have one of these problems, you may have other gut symptoms such as stomach pains, constipation, or diarrhoea. However, in the early stages of these conditions, you may not have any symptoms, and anaemia may be the first thing that is noticed.

Medication

Some medicines which you may take for other conditions can sometimes cause bleeding into the gut without causing symptoms. The most common example is aspirin. Other anti-inflammatory painkillers, such as ibuprofen, naproxen, diclofenac, etc, also have this side effect in some people.

Bleeding from the kidney

A small but regular trickle of blood from diseases of the kidney or bladder may not be noticed in the urine. However, enough may be lost to cause anaemia.

Do I need any tests ?

It is important to find the cause of the iron deficiency. The cause may be obvious in some people. For example, anaemia is common in pregnancy, and in women with heavy periods. In these situations, if you are otherwise well, then no further tests may be needed. However, further tests may be advised if the cause is not clear. For example:

Tests to look into the gut may be advised to see if there is any internal bleeding, even if you do not have gut symptoms. The tests may include looking into the stomach with a special telescope (endoscopy). Checking the rectum and bowel may also be advised. This is sometimes done with a special X-ray examination (barium enema). Another method is by using a special telescope (sigmoidoscopy or colonoscopy).

We will check your stool for worms.

A biopsy (small sample) of the lining of the gut may be taken if coeliac disease is suspected as the cause.

Other tests may be advised if the cause is still unclear.

What is the treatment for iron deficiency anaemia ?

Iron tablets are usually prescribed to correct the anaemia. Other treatments may also be advised, depending on the underlying cause.

Iron tablets

Various iron tablets and liquid medicines are available. We will advise on one. The length of course will vary depending on how bad the anaemia is. A blood test after a few weeks will show if the treatment is working. Drinking tea with your meal will reduce the amount of iron absorbed, so it is best to avoid it. Instead, have a Vitamin C-rich drink such as fruit juice. Also, if you are taking iron supplements it is important not to drink milk, or eat a milk-based product (eg Mithai) for one hour before or after taking the tablets. This is because milk can interfere with the action of the the tablet. 
Side-effects from taking iron occur in some people. These include: feeling sick (nausea), an upset stomach, constipation, or diarrhoea. Tell us if side-effects are a problem. Don't stop the iron, as the anaemia will not get better. Possible ways to reduce the problem with side-effects are:

Take the iron tablets with meals. Food reduces the absorption of the iron and so you may need to take a longer course to correct the anaemia.

Take a lower dose, but again a longer course will be needed to correct the anaemia.

Iron tablets may make your stools (faeces) black. This is normal and nothing to worry about. 

REMEMBER to keep iron tablets away from children. An overdose of iron tablets can be very dangerous in children (who may think that they are sweets). 

Some patients cannot tolerate the iron tablets very well or in some the iron is not absorbed. In such cases we can give the iron in the form of injections (over a period of few weeks) or as a single injection. It has to be given after a test dose as some people may have reactions to the injection. 

If you are taking Homeopathic and Ayurvedic medications, please let us know.

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