Case study 32.1

There are many causes of IDA:

  • Inadequate diet: due to poverty, vegetarian diet.
  • Malabsorption: coeliac disease, previous gastrointestinal surgery, irritable bowel syndrome.
  • Blood loss: gastrointestinal or urogenital bleeding. Menorrhagia.

You should advise Amy that she will experience some side effects from the iron supplement (common side effects include constipation, stomach pain, and/or diarrhoea) and to contact the clinic if these are very troublesome. You should also advise Amy that her stools will be very dark in colour and not to be worried by this. You should also advise Amy about importance of taking her iron with orange juice (this is to aid absorption but not to overdo it because high levels of vitamin C can interfere with iron absorption) and not drinking tea or coffee around the time of taking her supplement because the tannin in these drinks blocks iron absorption.

You should talk to Amy about her diet and the importance of taking iron rich foods daily. Amy is a vegetarian so you should advise her on non-meat foods rich with iron, such as nuts, fish, tofu, eggs, dried fruit, pulses and beans.

You should also arrange for Amy to be screened for coeliac disease. Coeliac disease causes malabsorption of micronutrients and often occurs in first degree relatives (Amy’s older sister was diagnosed with coeliac disease five years ago). If the iron supplements fail to improve the haemoglobin level satisfactorily, other avenues that cause a low haemoglobin should be investigated, such as heavy bleeding with periods, the use of non-steroidal drugs, abdominal pain to rule out a gastric ulcer, and refer appropriately for specialist consultation.