Iron deficiency is the most common nutritional deficiency in developing and developed countries1. It can affect any age and stage of life. More than 1 million Australians were iron deficient or anaemic in 2016.
The most common cause of anaemia is iron deficiency, which is recognised as a cause of underperformance2. Patients often present with non-specific symptoms of fatigue, poor cognitive function or exercise intolerance. Physical symptoms include restless legs or dizziness. Investigations reveal iron deficiency. If left untreated, patients will become anaemic. This is preventable if their iron deficiency is managed.
Most patients will be given oral supplements. Intravenous iron is indicated when oral iron is ineffective, not tolerated or there is a need for rapid replenishment3. Newer iron preparations allow for infusions to be given in infusion clinics and GP practices. Patients referred to the WA Specialist Clinic undergo prescreening and are asked about their symptoms and their impact.
The study focus was to see if patients reported an improvement in symptoms and quality of life post-infusion rather than outcomes being based purely on ferritin and haemoglobin levels.
A survey was developed listing 11 symptoms which patients scored from 0-10 (Table 1). There were also two questions asked to identify the statement that reflected their energy levels and impact on achieving daily tasks (Table 2).
Patients completed the survey on their infusion day, and again four weeks post-infusion. Participants were:
- Patients attending the clinic aged between 16-70 years.
- Pregnant women / patients attending to manage chronic conditions were excluded.
- 96% of the participants were female (representative of clinic demographics).
- 270 initial questionnaires were distributed over two, three-month periods.
- 122 patients completed the post infusion questionnaire.
- 45.18% completed both questionnaires.
The scores for each symptom were added together and the sum of the score was compared pre and post-infusion.
The results demonstrate a decrease in symptoms pre and post-infusion. But the sample size was not large enough to demonstrate a statistical difference in outcomes. Median scores were also compared.
The largest decrease in median score was noted in the symptoms of weakness where the score decreased from 7 to 2. The median scores also did not demonstrate a statistical difference.
The study demonstrates that the improvement of symptoms after iron infusion are as important as restoring iron balance.
Patients’ additional comments included frustration at having to endure low iron stores for long periods, being treated with iron tablets which they could not tolerate, and when their iron stores were in the low normal range, they had difficulty accessing iron supplementation.
The study shows a reduction in the severity of the patients’ symptoms. However, the sample size in this instance was too small to achieve the statistical outcomes that were predicted. Iron is an important element in many biochemical pathways.
Low iron levels are known to impact negatively on several conditions including heart disease and irritable bowel disease. Iron deficiency leads to many of the debilitating symptoms patients describe. Clinical assessment, including discussion regarding the impact on quality of life should be central in assessing iron deficiency.
ED: Full article with comparison graphs, and references are available on request.
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