Anaemia, iron deficiency - Treating iron deficiency anaemia

Treatment for iron deficiency anaemia usually involves taking iron supplements and changing your diet to increase your iron levels, as well as treating the underlying cause.

Iron supplements

Your GP will prescribe an iron supplement to restore the iron missing from your body. The most commonly prescribed supplement is ferrous sulphate, which is taken as a tablet, usually twice a day.

Some people can experience side effects when taking iron supplements, including:

• abdominal (tummy) pain
• constipation or diarrhoea
• heartburn
• feeling sick
• black stools (faeces)

These side effects should settle down over time. However, your GP may recommend taking the tablets with food or shortly after eating if you have troublesome side effects.

Your GP may also advise you to only take one or two tablets a day, instead of three, if you're finding side effects difficult to cope with.

If you can't take ferrous sulphate because you get severe side effects, you may be prescribed a different iron supplement called ferrous gluconate.

This supplement should cause fewer side effects because it contains a less concentrated dose of iron. However, it may take longer for the iron levels in your body to be restored.

In a few cases ‐ for example, if you have chronic kidney disease (CKD) ‐ iron injections may be recommended instead of tablets.

As with all medications, it's important to store iron supplements out of the reach of children. An overdose of iron supplements in a young child can be fatal.

Dietary advice

If a lack of iron in your diet is thought to be contributing to your iron deficiency anaemia, your GP will tell you how to up your intake.

Iron-rich foods include:

• dark-green leafy vegetables, such as watercress and curly kale
• iron-fortified cereals or bread
• brown rice
• pulses and beans
• nuts and seeds
• white and red meat
• fish
• tofu
• eggs
• dried fruit, such as dried apricots, prunes and raisins

Your diet should include foods from all the major food groups to ensure it's healthy and balanced. In particular, food and drink containing vitamin C are important as vitamin C helps your body absorb iron.

However, consuming large amounts of some foods and drinks, as well as certain medicines, may make it harder for your body to absorb iron. These include:

• tea and coffee
• calcium ‐ found in dairy products, such as milk
• antacids and proton pump inhibitors (PPIs) ‐ medications used to relieve indigestion
• wholegrain cereals ‐ although wholegrains are a good source of iron themselves, they contain phytic acid, which can stop your body absorbing iron from other foods and pills

You may be referred to a nutrition specialist called a dietitian if you're finding it difficult to include iron in your diet. They'll be able to give you detailed, personalised advice about how you can improve your diet.

Treating the underlying cause

Your GP will also need to ensure the underlying cause of your anaemia is treated so it doesn't happen again.

For example, if non-steroidal anti-inflammatory drugs (NSAIDs) are causing bleeding in your stomach, your GP may prescribe a different medicine to help minimise the risk of stomach bleeding.

Heavy periods can be treated with medication or ‐ in particularly severe cases ‐ surgery. Read more about treating heavy periods.

Monitoring

Your GP will ask you to return two to four weeks after you've started taking iron supplements to check how well you've responded to the treatment. You'll have a blood test to check your haemoglobin levels.

If your blood test results show an improvement, you'll be asked to continue taking iron supplements and return in two to four months for another blood test.

Once your haemoglobin levels and red blood cells are normal, your GP will usually recommend continuing to take iron supplements for three months to help build up the iron levels in your body.

After this, you should be able to stop taking the supplements, depending on the cause of your iron deficiency anaemia. Your condition will be monitored every three months over the course of a year, and again a year later.

Continuing treatment

Sometimes after a person's iron levels have been replenished, they start to fall again.

This could happen if you don't get enough iron in your diet, you're pregnant, or you have consistently heavy periods.

In such cases, you may be prescribed an ongoing iron supplement to help stop your anaemia returning. This will usually be a tablet, which you'll have to take once a day.

If treatment is ineffective

If your iron levels don't improve, your GP will ask how regularly you've been taking your iron supplements.

Some people are put off taking the medication because of the side effects. However, your condition won't improve if you don't take the supplements.

If you've been taking the supplements as prescribed and your iron levels still haven't improved, your GP may refer you to a specialist for an assessment.