New data-driven iron guidance aims to slash deficiencies worldwide

07 Dec 2020 --- New evidence-based guidance for managing iron deficiency has been published in a review in The Lancet.

Australian and European researchers have released the information to encourage best practices for clinicians to diagnose and manage this major cause of anemia.

Oral iron therapy is the first line of treatment in most cases. However, these may result in gastrointestinal discomfort or have other undesirable side effects. 

Modern parenteral iron formulations show promise to enable rapid, safe total-dose iron replacement. 

The researchers also emphasize the importance of looking for an underlying cause as iron deficiency can also be a sign of other serious health conditions.

The guidance recommends screening for celiac disease and bleeding gastrointestinal lesions in men and postmenopausal women presenting with iron deficiency anemia. 

“Our review has provided clear guidelines for how to test for iron deficiency, and the best approaches to treat it both in Australia and internationally,” says Associate Professor Sant-Rayn Pasricha, the review’s co-author and hematologist at The Royal Melbourne Hospital.

Iron deficiency is often caused by a lack of iron in the diet, but it can also be a sign of serious health problems including bowel cancer or celiac disease.Pasricha also leads the World Health Organization’s (WHO) Collaborating Centre for Anaemia Detection and Control in Australia. WHO has undertaken the mission to halve anemia among women of reproductive age by 2025.

“We hope this review will provide clear information for doctors in Australia and around the world, improving the management of iron deficiency – which will have widespread benefits on people’s health,” he affirms. 

Guidance for the globe
Implementing these new practices in the guidance would lead to significant long-term health benefits both in Australia and around the world, write the authors. 

“We recently discovered that approaches to treating iron deficiency should be tailored to different countries,” says Pasricha. 

“In Australia, there have been many advances in how iron deficiency is managed in the last two decades, but as a hematologist, I can see that some people are still not getting the best care. For example, some people who might benefit from intravenous iron are not being offered this, despite clear evidence it can quickly restore iron levels,” he adds. 

Recently, a different study in The Lancet found that an iron infusion can be more effective than common iron supplements to treat women with iron-deficiency anemia after childbirth in low-income settings in sub-Saharan Africa. 

Other underlying causes are possible
While iron deficiency is often caused by a lack of iron in the diet, it can also be a sign of serious health problems including bowel cancer or celiac disease, says Jason Tye-Din, associate professor, co-author of the review and gastroenterologist at the Royal Melbourne Hospital.

“It’s important that the cause of iron deficiency is properly investigated, rather than patients just being instructed to take iron supplements,” he says. 

“If doctors don’t take iron deficiency seriously and investigate why it is happening, serious health problems could be overlooked. In some cases, these can be potentially life-threatening. This is something we’ve really highlighted in the review.”

The consequences of iron deficiency 
Iron deficiency is a common problem worldwide, including in Australia, where it impacts all ages from young children through to the elderly. 

Twelve percent of Australian women are currently iron deficient, and one in ten Australians has been iron deficient at some point in their lives.

It is estimated that two billion people worldwide experience a lack of oxygen-carrying red blood cells or hemoglobin, which can have serious long-term health consequences.

“A range of health problems can be caused by iron deficiency, including heart problems. When pregnant women or children are iron deficient, the child is at risk of developmental problems,” details Pasricha. 

In line with WHO’s goal to halve anemia rates of women of reproductive age by 2025, the International Alliance of Dietary/Food Supplement Associations (IADSA) recently launched the Mind the Gap online platform resource highlighting how important iron supplementation can be in reducing anemia.

Edited by Missy Green