Q: My daughter is 15 years old. Four months ago, she was diagnosed with anaemia (haemoglobin 7%) due to iron deficiency (all kinds of tests were done and the doctor came to the conclusion that it was due to iron deficiency). She was given Haem-up two capsules per day (one each after lunch and dinner). The major problems like fatigue, headache etc. got cured. In the first month haemoglobin went upto 9%. In the second month haemoglobin went upto 12%. Then the doctotr reduced the dose to one capsule per day which is continuing for the last two months and he advised to take it for one month more and get a blood test. If the reports of this test is OK, then the medicine can be stopped. Could you please tell me, if there are any side effect of this medicine? What if the haemoglobin goes down after stopping the medicine? Should we continue with the iron rich diet that we give her at home? She also used to get a headache while menstruating. Her periods last for 6 days and the flow is a little heavy though not too much. Could this be related to her haemoglobin?

A:Anaemia is a condition in which the number of red blood cells or the amount of haemoglobin is below normal for age and sex of the individual. It is defined as a decrease in red blood cell (RBC) mass and is usually discovered and quantified by measurement of the RBC count, haemoglobin (Hb) concentration, and hematocrit (Hct). Anaemia is suggested in males with Hb levels less than 13.0 g/dl and in females with Hb levels less than 12.0 g/dl (less than 11.5 g/dl in pregnant women). It may be due to decreased production of red blood cells, blood loss (haemorrhage) or red cell breakdown (haemolysis). Anaemia is a symptom of disease that requires investigation to determine the underlying cause. It is twice as common in women than in men, especially during the childbearing years due to menstrual blood loss and pregnancies. One of the commonest cause of anaemia in our country is nutritional deficiency - iron deficiency &/or folic acid/vitamin B12 deficiency. The commonest cause in children is iron deficiency which is due to recurrent or chronic infections, malnutrition, reduced immunity and because this is a period of rapid growth and dietary adjustments. Absorption of iron from food is influenced by multiple factors. One important factor is the form of the iron. Haeme iron, found in animal sources, is highly available for absorption in contrast to non-haeme iron found in vegetable sources. Vegetarians need more iron in their diets than non-vegetarians because the iron from plant foods is not as well absorbed as it is from animal foods. Vegetarians should choose several iron-rich plant foods daily. Grains, beans and lentils, vegetables (green-leafy ones, tomato, potato, green & red chillies etc), fruits, nuts and seeds are rich sources of non-haeme iron. The absorption of non-haeme iron can be improved when a source of haeme iron meat/fish/poultry is consumed in the same meal or iron absorption enhancing foods like fruits/fruit juices are consumed. But coffee/tea and calcium if consumed along with a meal impair iron absorption. Treatment of most patients with iron deficiency is with oral iron therapy. The cheapest and most effective form is ferrous iron. The side effects experienced on taking iron tablet are proportional to the amount of iron available for absorption. The iron preparation you give should contain between 30-100 mg elemental iron. Avoid enteric-coated or prolonged-release preparations. The dose should be sufficient to provide between 150-200 mg elemental iron per day and the tablet may be taken 2 to 3 times a day about 1 hour before meals. Though ferrous sulphate is recommended to treat iron deficiency, often patients complain of gastrointestinal discomfort, bloating and other distress. Ferrous gluconate, which is roughly equivalent in cost, produces fewer problems, and is preferable as the initial treatment of iron deficiency. Ascorbic acid supplementation enhances iron absorption. Polysaccharide-iron complex is a more recent option. The polar oxygen groups in the polysaccharide form complexes with the iron atoms and the well-hydrated microspheres of polysaccharide iron remain in solution over a wide pH range. Most patients tolerate this form of iron better than the iron salts, even though the 150 mg of elemental iron per tablet is substantially greater than that provided by iron salts (50 to 70 mg per tablet). The underlying cause too needs to be corrected so that deficiency does not recur. Please consult a gynaecologist with regard to her irregular menstrual cycle as she is likely losing excessive blood (and thus iron). The treatment should be continued for 3 months after the haemoglobin has returned to normal so that the body iron stores are replenished. Response to treatment is confirmed by doing a reticulocyte count after 10-12 days of treatment and the rate of rise of haemoglobin (with adequate dose of iron it is about 1 g/dl per week).