Iron deficiency (aka Low iron stores) is a major public health goal and an important aspect of care for many patients. This is normally suspected especially in patients with anaemia ( a medical term for Low haemoglobin levels )
This problem affects a large proportion of the world’s population, in some studies as much as 1 in 5 persons! A latest 2020 study in England confirmed that prevalence of iron deficiency to be higher in women than men (10.9 % vs 6.3%)
You can get iron deficiency screening at any health screening centers (we get many such requests at integrated wellness clinic!) or even your nearby GP/polyclinic as almost all labs perform the iron deficiency panel.
The guidelines for iron deficiency screening is not well defined (especially for patients who have no symptoms). In practice, most Doctors would routinely add on an iron panel during the blood tests for these groups of patients :
(1). Symptoms of anaemia
- excessive tiredness
- frequent headaches
- exertional breathlessness/weakness
- less commonly pica (a psychological disorder characterised by cravings to eat/chew ice!) and restless leg syndrome (uncomfortable sensation in legs and urge to move the legs especially at nights)
(2). When we examine patients and find
- pale looking
- dry rough skin and spoon shaped nails
- tongue changes associated with dry mouth/tongue pain
- hair loss (alopecia)
- when a blood count is done for other medical indications and we notice Low haemoglobin counts associated with small sized cells
(3). Risk factors for iron deficiency
Chronic kidney disease
heavy flow of menses (use of many pads and blood clots - most common requesting group of patient in my practice)
gastrointestinal losses (frequent heavy bleeding from haemorrhoids or inflammatory bowel disease)
gastrointestinal malabsorption problems
It is very important to note that there are MANY causes of anaemia hence other tests may be necessary to determine the cause before treatment.
In my practice, I confirm diagnosis of iron deficiency in two ways.
Firstly, in my blood tests i include an iron panel : serum iron levels, TIBC (total iron binding capacity)/transferrin and serum ferritin.
In a typical patient with iron deficiency - the serum iron is Low, the TIBC is high, and Low ferritin (normally <30ng/mL).
A low iron levels alone is not sufficient to diagnose iron deficiency as other causes of anaemia can cause Low iron counts.
These tests are suggestive to a high degree of certainty and your doctor will be able to interpret the results. If I feel that the loss in iron is due to a gut problem or a gynaecological issue, I may refer to the specialist for a possible endoscopy/further procedures to solve the loss issue.
Secondly, in a complementary manner, I also start patients on iron supplements for those at high risk or have strongly suggestive symptoms of iron deficiency. This is out of the scope of the topic but in general we can use oral supplements or sometimes even intravenous iron replacement as an alternative for patients who cannot tolerate oral iron replacement due to the side effects of constipation or bloating.
You should seek the advise of your doctor to discuss what methods are best for you.
