Australian clinicians leading iron deficiency research
Thursday, 11 April 2013
A new look at an old problem
The significant proportion of Australians suffering from iron deficiency are at increased risk of chronic illness and health complications such as heart failure, poor foetal development and risks during birth, cognitive function and depression, with ground-breaking new research looking at the improved health outcomes from treating the iron deficiency.
Doctors in Australia are at the forefront of new research into the impacts of iron deficiency with two pioneer clinical studies currently underway investigating the effectiveness of treatments in reducing risks to mothers and their unborn babies and improving quality of life in heart disease.
Two Australian centres, in Adelaide and Hobart, are part of a world-first international clinical study looking at the treatment of iron deficiency and iron deficiency anaemia in pregnancy with University of Adelaide Clinical Senior Lecturer and Lyell McEwin Hospital anaesthetist Dr Bernd Froessler the principal investigator in the FER-ASAP trial in Adelaide.
“We have identified in the past few years that iron deficiency is more common in pregnant women than previously thought and undiagnosed in most,” Dr Froessler said.
“There is plenty of evidence showing iron deficiency and iron deficiency anaemia has a very negative impact on a woman and her developing foetus with a higher risk of mothers needing a blood transfusion during birth, premature birth, babies born smaller and often underdeveloped as well as the future development of the child.
“The importance of screening is not well understood and often underestimated; checks for iron deficiency should be initiated by obstetricians from the very first appointment.
“After birth the baby itself is likely to suffer from iron deficiency causing developmental delays, immune issues and a higher susceptibility to infections. We are hoping that by treating iron deficiency in the mother, we can benefit both her and the child.”
Heart failure trial
Concord Hospital Heart Failure Unit and Department of Cardiac Rehabilitation Director Professor Andrew Sindone said the EFFECT-HF study, which is investigating the link between iron deficiency and heart failure, is a landmark study on heart failure in Australia.
“The effect of iron deficiency on heart failure is staggering. We don’t understand whether iron deficiency is a marker in heart failure patients or causing the problem but we have found it increases patient mortality rates and decreases their quality of life,” Professor Sindone said.
“Over 300,000 Australians are living with heart failure, with a further 30,000 diagnosed each year – 50 per cent are dead within three years.
“These patients are more likely to be sicker, female, older, have other health issues including diabetes and kidney problems and have larger heart attacks.
“Of the 100 heart failure patients attending the Concord Heart Failure Clinic, more than half have iron deficiency. It is something we are still trying to understand.”
Broader effects and treatments
Leading iron deficiency authority and Launceston Hospital haematologist Associate Professor Al Khalafallah said iron deficiency and iron deficiency anaemia were widespread and underdiagnosed both in Australia and globally.
“Iron deficiency has terrible associated health costs such as poor pregnancy outcomes, a lower quality of life, unnecessary blood transfusion, depression, low operative and surgical outcomes, shorter duration of breastfeeding and delayed cognitive and motor functions in new-borns,” Assoc Prof Khalafallah said.
“Up to one in four Australian women and one in six Australian men are iron deficient*, placing them at higher risk of these problems and conditions; however, very little Australian data exists for a condition with such broad implications*.”
Assoc Prof Khalafallah said changes to treatment options were already showing dramatic results.
“We know that correcting iron deficiency alone can be very beneficial and with new treatments available, particularly intravenous iron, this is having a huge effect on how iron deficiency is being treated in chronically ill patients, for elective surgery and in pregnancy.
“This condition is costing Australians and our economy millions of dollars each year including in lost productivity, decreased educational performance, prolonged stays in hospital after surgery, increased morbidity and potentially mortality,” Assoc Prof Khalafallah concluded.
* McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993-2005. Public Health Nutr. 2009 Apr;12(4):444-54.