Expert irons out issues around measuring iron levels in the body
Iron deficiency (ID) is a very common problem that is often caused by a poor iron intake combined with normal blood loss. Despite this, serious health problems can also cause ID. An inherited tendency to over-absorb iron, a disorder that is potentially fatal, is fairly common as well. Iron is essential for life but it’s also a potentially toxic element with a dark side, and accurately measuring the amount of it in the body is very important.
“Most elements are controlled by both absorption and excretion where our body takes what it needs and excretes the excess. This doesn’t happen with iron because there is no regulatory mechanism to excrete it. We therefore take what we need and store the excess in our body as a cell protein complex called ferritin,” explained Dr Michael Harrison, CEO and Managing Partner of Sullivan Nicolaides Pathology in Brisbane.
Iron has a dark side as well. Dr Harrison said it is potentially toxic and can cause cells to oxidise when it isn’t bound with a protein (this is known as free iron). Think of this as creating internal rust! It is clearly not an element to mess with, and either too much or too little creates serious problems for us.
“Iron deficiency is the most common nutritional deficiency in the world. Apart from not consuming enough iron in the diet, iron can be lost through blood loss such as during menstruation, and in pregnancy supplying the developing baby during a woman’s reproductive years.”
Dr Harrison said about one third of Australian women in their reproductive years are iron deficient, and this proportion increases to 70% during the third trimester of pregnancy.
“The mother’s body supplies the foetus with iron which depletes her stores, and the risk of iron deficiency increases with every pregnancy.”
Despite these statistics, Dr Harrison said individual people should know their iron status and also the reason for it being high or low before starting any form of treatment, including taking an iron supplement.
“It’s wrong to assume that iron deficiency is always due to benign reasons such as diet or menstruation or pregnancy, because there can be other causes such as undetected bleeding in the upper gut or bowel cancer.”
Iron stores can be assessed by the serum ferritin level or with a group of interrelated tests called iron studies. The skill is in knowing when to use what test.
“Serum ferritin is adequate as a screening test, such as part of routine prenatal investigations, because it is a marker of total body iron stores. But if a person has a number of conditions such as an underlying inflammatory process, liver or kidney disease, or if they are post-menopausal, a normal or elevated serum ferritin level won’t rule out iron deficiency or accurately diagnose iron overload.”
Dr Harrison said about five per cent of the Australian population of Northern European descent carry the gene for haemochromatosis. This is a disease where people absorb too much iron from their diet and store the excess their body. If it is undetected and untreated, this excess iron can cause organ or tissue damage and potentially result in premature death.
The bottom line is that iron is vital for our health but it clearly has a dark side. Measuring a person’s iron stores with the right test based on their clinical presentation is therefore important to ensure this potentially toxic element is afforded the respect it deserves.
Haemochromatosis is covered in the August 2014 and August 2011 editions of ePathWay. Iron studies is covered in the June 2013 edition.
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This article appeared in the July 2017 Edition of ePathWay which is an online magazine produced by the Royal College of Pathologists of Australasia (http://www.rcpa.edu.au/Library/Publications/ePathway).
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