Iron-deficiency anemia can also cause strange food cravings, such as the desire to eat starch or clay, which is referred to as pica. Serum iron, iron binding capacity, and transferrin saturation/fraction saturation are not routinely useful for investigating iron deficiency anemia. Table 1: Common causes of and risk factors for iron deficiency and IDA in adults. Refer to the BC Guideline: C-Reactive Protein and Erythrocyte Sedimentation Rate Testing for information on the use of CRP. fish and seafoods Symptoms of high iron levels vary and can include: Exhaustion Also greater risk of developing iron-deficiency anemia, Signs and Symptoms of Severe Iron Deficiency and Anemia, NIH: National Heart, Lung, and Blood Institute: Iron-Deficiency Anemia, Expert Review of Hematology: Impact and Management of Iron Deficiency Anemia in Women's Health, The Journal of Nutrition: Increasing Iron Status through Dietary Supplementation in Iron-Depleted, Sedentary Women Increases Endurance Performance at Both Near-Maximal and Submaximal Exercise Intensities, PLoS One: The Relationship Between Iron-Deficiency Anemia and Sexual Function and Satisfaction Among Reproductive-Aged Iranian Women. Refer to Table 2 for guidance on interpreting ferritin levels. unexplained GI bleeding, unexplained iron deficiency anemia) proceed directly to specialist referral for possible endoscopic investigation.17,18 If any doubt remains about whether to refer for GI investigations, referral is strongly encouraged due to the potentially severe consequences of delayed identification of colorectal cancer. Severe iron deficiency can result in anaemia. in Nutrition and Dietetics. Low iron levels may indicate a nutritional deficiency that may require a change in diet or supplement. Heme iron is more bioavailable, which means it's easier for your body to absorb, than nonheme iron. The exception is: patients with microcytic anemia should not be given iron supplements until iron deficiency is confirmed by testing ferritin. That's because you lose blood every month during menstruation. IRON INTAKE. Age-specific risk for colon and rectal cancer is elevated among those born circa 1990 compared to older cohorts.19. Refer to Associated Documents for recommended daily intake values, and foods high in iron. The diagnosis of absolute iron deficiency is challenging in the elderly.39 Serum ferritin below 50 ug/L should be investigated for iron deficiency in the elderly2 though cut-offs between 30 and 100 mg/L have been proposed.39 Serum ferritin levels may also be increased by comorbidity. , Primary care providers are encouraged to consult with colleagues including local gastroenterology services or the RACE line to obtain rapid advice and avoid unnecessary travel and wait times. If you already have an underlying health issue, your iron-deficiency anemia may impair your treatment or worsen your condition. If necessary, intravenous iron is considered to be safe for the second and third trimester (refer to Appendix B: Intravenous Iron Formulations and Adult Doses (PDF, 110KB)).33. Questions about the collection of information can be directed to the Manager of Corporate Web, Government Digital Experience Division. The frequency of subsequent monitoring depends upon the severity of the anemia, the underlying cause of the iron deficiency, and the clinical impact on the patient. While iron is essential for carrying oxygen to all the cells, tissues and organs in your body, that's not its only job. We cannot respond to patients or patient advocates requesting advice on issues related to medical conditions. Symptoms to look out for that may indicate low iron levels include: You may also notice that your nails are brittle or spoon-shaped. • Ferritin is the test of choice for the diagnosis of iron deficiency. This guideline provides recommendations for the diagnosis, investigation and management of iron deficiency in patients of all ages. To determine if you have iron-deficiency anemia, your doctor may consider various blood tests to look at specific markers, including testing your complete blood count, hemoglobin, mean corpuscular volume (MCV) and ferritin. dishes. Long term iron therapy is harmful for these patients. Continue iron therapy an additional 4 to 6 months (adults) after correction of anemia to replenish the iron stores. Note: Please refer to Iron Deficiency in Children and Iron Deficiency in Obstetrics for causes and risk factors in children, pregnancy and the perinatal period. BC Guidelines is always looking for knowledgeable practitioners to chair and serve on our working groups. The LIVESTRONG Foundation and LIVESTRONG.COM do not endorse However, ferritin values may be falsely elevated in chronic disease as ferritin is an acute phase reactant. Oral iron preparations may cause nausea, vomiting, dyspepsia, constipation, diarrhea or dark stools. egg and cheese dishes Some patients may be asymptomatic. Ferritin is the test of choice for the diagnosis of iron deficiency. Iron absorption from iron salts can be enhanced by taking them on an empty stomach (at least 1 hour before or 2 hours after eating), or with 600-1200 mg vitamin C. This does not apply to other types of iron preparations such as polysaccharides or polypeptides whose absorption is not affected by food. Guidance for the investigation and management of iron deficiency in the setting of specific chronic diseases is provided: If ferritin is unexpectedly elevated, in a patient without chronic disease, active inflammation, or malignancy, C-reactive protein (CRP) can help support the diagnosis of an inflammatory process. Measuring your MCV gives more insight into the type of anemia as it measures the average size of your blood cells. Iron from food is available in two forms: heme iron and nonheme iron. Anemia should correct in 2-4 months. Ensure adequate dietary intake is established and maintained (refer to Associated Documents and consider dietitian referral; patients can also call 8-1-1 for dietitian services). - Iron intake IV iron should not be considered a routine treatment. One preparation is not preferred over another; patient tolerance should be the guide. Consider iron supplementation, Toddlers frequently have intercurrent viral infections that can falsely elevate ferritin, Ferritin >20 ug/L indicates normal iron stores in pre-pubertal children. Iron is also necessary for normal growth and development, proper functioning of your cells, formation of connective tissue and synthesizing certain hormones. By comparison, adult men of all ages only need 8 milligrams of iron each day. Oral iron replacement is almost always preferred to intravenous (IV) therapy. iron deficiency can occur in infancy, during periods of rapid growth, of the iron from food. Continue oral iron for 4-6 months after anemia corrects to replenish iron stores. Investigation of anemia in the elderly is recommended if the life expectancy is more than a year.40 An individualised approach is recommended, recognizing the risks of invasive investigations and surgeries to elderly patients with increasing frailty and multimorbidity.41. You may be diagnosed with iron-deficiency anemia if either your blood iron levels are low or your ferritin levels are low. Without iron, your body wouldn't be able to make hemoglobin, which carries oxygen in your blood, or myoglobin, which carries oxygen to your muscles. those with inflammatory bowel disease) is: The clinical approach for such patients is the same as for iron deficiency in otherwise well patients (investigate for cause, supplement with iron and refer as appropriate). Access to IV iron and the processes to order it depend on local availability and protocols. It happens most often during the third trimester. The Clinical Practice Guidelines (the guidelines) have been developed by the guidelines and Protocols Advisory Committee on behalf of the Medical Services Commission. sweets Iron deficiency anemia (IDA): anemia due to insufficient body iron stores.1 The following laboratory findings are typical for IDA: microcytic anemia, hypochromia, and decreased ferritin. Refer to Appendix B: Liquid Iron Formulations and Pediatric Doses for recommended treatment doses, strengths and bottle sizes of liquid iron products for use in children, and guidance on tolerability. This is a functional decrease that does not indicate iron deficiency. Judicious transfusion is indicated for very severe anemia in the setting of hemodynamic compromise/severe signs of anemia requiring emergent correction. total iron binding capacity), pregnancy status and number of pregnancies, history of blood loss, including GI bleeding, hematuria, menorrhagia, and blood donation, GI symptoms including changes in bowel habits, abdominal pain, dyspepsia, and unexplained weight loss, family history including colorectal cancer, referral for GI investigations (upper/lower endoscopy), screening for GU bleeding with urinalysis.