WORDS LIM TECK CHOON

It can be great to be a woman living in 2019. We have our first female Deputy Prime Minister and more women in our government than before. Women have more access to education, career and social rights than before. Things can be better, of course, hence this year, for International Women’s Day, we are calling for #BalanceforBetter.

However, making great strides require iron in both fortitude and health. No matter how strong one’s fortitude can be, one also requires iron – the mineral– as it is an essential component of health. Unfortunately, iron deficiency in women is far more common than it should be.

Hence, HealthToday is pleased to invite you to join us this month as two experienced experts have kindly shared with us their insight on this subject.

Iron Deficiency: It’s More Than Just Anaemia

Oxygen is essential to convert the calories in the food we eat into energy, which then powers many essential functions of the body. It is transported in red blood cells, and iron is needed to make these cells. Hence, if our body is a factory, then that of someone with iron deficiency (ID) is comparable to a factory that is running on low efficiency due to shortage of power.

Most people usually equate  ID to anaemia, a condition in which the red blood cells do not carry enough oxygen from the  lungs to the rest of the body. However, Dr Jameela Sathar explains that ID doesn’t spring up abruptly overnight – anaemia is actually the manifestation of advanced ID.

“You can go on for many years before developing anaemia,” she says about people who have ID.

We Need A Change In How We Usually Detect Id

In the blood, iron is stored in a protein called ferritin. Healthcare professionals measure the levels of ferritin in the blood as an indication of the levels of iron in the body, and someone with ID typically has less than 30 nanograms (ng) of ferritin for each millilitre (mL) of blood.

However, most hospital laboratories tend to diagnose someone with ID only when there is less than 13 ng of ferritin in 1 mL of blood. Dr Jameela feels that this value is too low as by that stage, the person already has developed anaemia.

Additionally, taking absolute numbers at their face value  may not give an accurate picture. For uncomplicated cases, the serum ferritin value of less than 30 ng/mL indicates ID, but Dr Jameela points out that for patients with inflammatory diseases (chronic heart failure, chronic kidney disease, rheumatoid arthritis, etc), serum ferritin below 100 ng/mL may also indicate ID.

Therefore, Dr Jameela advocates for a nationwide policy to adjust  the cut-off point in diagnosing someone with ID.

For members of the public, however, the take-home message is that we don’t necessarily have to develop anaemia if we have ID. Measures can be taken to improve ID before it reaches the anaemia stage.

The Hidden Consequences Of Anaemia

Aside from having to deal with the symptoms of ID listed previously, there are other downsides to having anaemia:

• Patients with anaemia undergoing surgery have a higher incidence of needing blood transfusions. This increases the overall treatment cost and the risk of possible side effects of blood transfusions (infections, lung injuries, etc).
• Higher risk of developing infections of the urinary and respiratory tracts.

Therefore, We Should See A Doctor If We Suspect That We Have Id

How do we know if we may have ID?

• Hair loss
• Brittle nails
• Headaches
• Pica (an appetite for substances with little nutritive value like ice)
• Fatigue
• Frequent infections
• Depression
• Concentration impairment
• Taste disturbance
• Anaemia/pallor.

The doctor will typically order a blood test that specifically measures our ferritin levels. If the test shows low ferritin levels, we will receive appropriate treatment.

Iron & The Pregnant Woman

During pregnancy, a woman needs even more iron than normal, as her body needs to increase red blood cell production in order to nourish the child she is carrying. Hence, iron intake is an important consideration, as it now potentially affects the well-being of both the mother and child.

How much iron does a pregnant woman need?

According to Assoc Prof Dr Ina Ismiarti Shariffuddin:

• A 55 kg woman requires about 1,000 mg of iron throughout her pregnancy.
• During the second and third trimester, she needs about 500 mg of iron for red cell expansion. 300-350 mg of iron needs to be transferred to the foetus through the placenta for foetal development, while the remaining 100-200 mg is stored as standby in case of blood loss during delivery.

Mothers-to-be should consult their gynaecologist on how much iron they should take in their diet.

ID symptoms that pregnant women should watch out for

These include:

• Breathing difficulties.
• Fainting.
• Tiredness.
• Heart palpitations (rapid heartbeat).
• Sleep difficulties.

Assoc Prof Dr Ina cautions that severe ID can lead to heart failure and further complications to the delivery at a later date. It can also increase the risk of developing perinatal infections, pre-eclampsia and bleeding. The baby can also be affected by severe ID, as he or she faces an increased risk of being prematurely born, halted growth while still in the womb, and low birth weight.

How ID in pregnant women is treated

Assoc Prof Dr Ina shares that iron pills and supplements containing iron, vitamin B12 and folic acid specially formulated for pregnant women can be offered to overcome ID.

Intravenous iron – which is given through a drip – is considered for those whose pregnancy has entered the second trimester onwards, as well as for those who do not respond well to iron pills.

Therefore, expecting mothers should see a gynaecologist if they suspect that they may be suffering from ID. Prompt measures to manage ID would go a long way to ensure the safe delivery of a healthy baby. HT