Anaemia and iron deficiency in Pakistan: symptoms, ferritin test and iron tablets

Anaemia (khoon ki kami) means your blood has less haemoglobin than normal, so less oxygen reaches the body. It is very common in Pakistan, especially in women of childbearing age, pregnant women and young children. The most common cause is iron deficiency, but not every anaemia is due to low iron.

Symptoms

• Tiredness, weakness, getting breathless on stairs.
• Pale skin, lips, inner eyelids or nails.
• Dizziness, headaches, cold hands and feet.
• Hair fall, brittle or spoon-shaped nails.
• Craving to eat ice, clay or mud (pica).
• In children: poor appetite, slow growth and poor concentration.

The tests

• CBC: shows haemoglobin and the size of red cells (MCV). Small red cells (low MCV) suggest iron deficiency or thalassaemia trait. Read what a CBC shows.
• Serum ferritin: the best test for the body's iron stores. A low ferritin (often below about 15 to 30 ng/mL) confirms iron deficiency. Ferritin can look falsely normal during infection or inflammation.
• Serum iron and TIBC: sometimes added.
• Hb electrophoresis: finds thalassaemia trait, which also causes small red cells but is not treated with iron.
• Vitamin B12: when red cells are large instead of small.

Why thalassaemia trait matters

Pakistan has a high number of beta-thalassaemia carriers (trait). A carrier is usually healthy but has small red cells that can look like iron deficiency on a CBC. Taking iron for months does not help them and can be harmful. If iron does not raise your haemoglobin, or there is thalassaemia in the family, ask your doctor about Hb electrophoresis. Couples should be tested before marriage: if both are carriers, each child has a 1 in 4 chance of thalassaemia major.

Iron tablets: how to take them

Doctors usually start oral iron such as ferrous sulphate, ferrous fumarate or other iron preparations, often with folic acid in pregnancy.

• Take iron on an empty stomach or as advised, ideally with water or a little orange juice (vitamin C helps absorption).
• Do not take it with tea, milk or calcium, and keep 2 hours away from antacids; they block absorption.
• Black stools are normal with iron. Constipation or stomach upset can happen; taking it on alternate days or with food can help, but ask your doctor.
• Haemoglobin usually starts to rise in 2 to 4 weeks, but you need to continue for about 3 months after it becomes normal to refill iron stores.
• Keep iron tablets away from children: an overdose can be dangerous.

For severe deficiency, pregnancy or when tablets do not work, doctors may give iron through a drip, such as iron sucrose or ferric carboxymaltose, in a clinic or hospital.

Food that helps

Red meat, liver, chicken, fish, eggs, lentils (daal), chickpeas (chanay), spinach (palak), dates and jaggery (gur). Eat them with fruit or lemon, and drink tea between meals rather than with them.

Find the cause

Iron deficiency in men and in women after menopause can mean slow blood loss from the gut. Your doctor may check further, for example with a stool occult blood test. Heavy periods and worm infections are other common causes.

See a doctor quickly if

Breathlessness at rest, chest pain, fainting, black tarry stools or vomiting blood. In an emergency call 1122.

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