Iron Deficiency and Anaemia: Iron Tablets, Syrups and Sachets Explained

Constant tiredness, a pale face, hair that is falling out, breathlessness on the stairs, and a craving to chew ice. Iron deficiency is the most common nutritional deficiency in the world, and in Pakistan it affects many women and children. The shelves at the pharmacy are full of iron products: tablets, syrups, sachets, drops. Which one is the right one, and how do you take it properly?

This guide explains the signs of iron deficiency, what causes it, how a doctor confirms it, the different types of iron medicine, how to take iron so that it works, side effects and when you may need an injection or drip.

What does iron do?

Iron is needed to make haemoglobin, the protein in red blood cells that carries oxygen around the body. When iron stores run low, haemoglobin falls, and this is called iron deficiency anaemia. Even before anaemia appears, low iron can cause fatigue and poor concentration.

Symptoms

• Tiredness, weakness and low energy.
• Pale skin, pale inner eyelids and nails.
• Shortness of breath and a fast heartbeat on effort.
• Headaches, dizziness and difficulty concentrating.
• Hair loss, brittle or spoon-shaped nails, and a sore tongue.
• Cold hands and feet, and restless legs.
• Craving for ice, clay, chalk or raw rice (called pica).
• In children: poor growth, irritability, poor school performance and frequent infections.

Why does it happen?

• Not enough iron in the diet, especially with little meat and many cereals, and in picky eaters. See our guide to picky eating in children.
• Heavy periods. See our guide to sanitary pads for the signs of heavy bleeding.
• Pregnancy and breastfeeding, when needs rise. Read our guide to pregnancy vitamins and supplements.
• Worm infections, especially hookworm, which cause blood loss in the gut.
• Bleeding from the gut: ulcers, piles, and, rarely, bowel cancer. In men and in women after menopause, iron deficiency needs a search for a source of bleeding.
• Poor absorption: coeliac disease, H. pylori infection, and long-term use of acid-reducing medicines. See acidity medicines.
• Tea with meals, which blocks iron absorption.

How doctors confirm it

A complete blood count (CBC) shows low haemoglobin and small red blood cells. A ferritin test shows iron stores, and is the best test for iron deficiency. Sometimes iron studies and tests for the cause, such as stool tests or an endoscopy, are needed. Do not start strong iron tablets without a test. Too much iron is harmful.

Types of iron medicine

Iron tablets and capsules

These are the most common choice for adults. They include ferrous sulphate, ferrous fumarate, and iron polysaccharide complex such as Ironic Tablet. Read about iron, ferrous sulphate and ferrous fumarate.

Iron syrups and drops

Suitable for children and for people who cannot swallow tablets. Serofer Syrup contains iron as a bisglycinate. Liquid iron can stain teeth, so rinse the mouth, and use a straw or a dropper to place it at the back of the mouth.

Iron sachets

Powder sachets such as Pinkofer Sachets can be mixed in water or juice, and some people tolerate them better.

Iron injections or drips

Intravenous iron, for example iron sucrose, is given in hospital for severe anaemia, for people who cannot absorb tablets or tolerate them, and in late pregnancy. It is a medical decision.

Folic acid and vitamin B12

Anaemia can also be due to low folate or B12. Folic Acid Tablet and Neuromax (mecobalamin, a form of B12) are examples. Read about folic acid and vitamin B12, and ask your doctor for the right test first.

See our anemia and iron category. Always follow the pack and the doctor’s directions on how much and for how long.

How to take iron so that it works

• Take it on an empty stomach if you can, since this improves absorption. If it upsets your stomach, take it with a little food, and not with milk or tea.
• Add vitamin C. A glass of orange or malta juice, or a fruit rich in vitamin C, helps absorption.
• Keep apart from tea, coffee, milk, calcium tablets and antacids. Leave a gap of two hours. Read our guide on calcium deficiency.
• Be patient. You may feel better in two to four weeks, but haemoglobin can take two months to normalise, and iron stores take longer. Doctors usually advise continuing for about three months after the haemoglobin has returned to normal. Your doctor will tell you.
• Repeat the blood test to confirm that it has worked.

Side effects

• Constipation, or sometimes diarrhoea.
• Nausea and stomach upset.
• Black or dark green stools. This is normal and harmless.
• A metallic taste.

If side effects are troublesome, ask your doctor about a gentler form, a lower dose or alternate-day dosing. Drink water, and eat fibre.

Important safety point: keep iron away from children

Iron overdose is a leading cause of poisoning in young children. Tablets can look like sweets. Keep all iron products and vitamins in a high, locked place. If a child swallows iron tablets, go to hospital immediately, even if they look well.

Foods that help

• Best sources: liver (kaleji), red meat, chicken and fish. The iron in meat is absorbed far better than iron from plants.
• Plant sources: daal, chana, rajma, lobia, dates, sesame seeds, jaggery (gur), spinach and other greens. Absorption is lower, but eating them with vitamin C helps.
• Cooking tip: cooking in an iron pan (karahi) adds a little iron.
• Avoid tea and coffee with meals. Wait for an hour or so.
• Treat worms in children as advised by the doctor.

When to see a doctor

• You have symptoms of anaemia that last more than a few weeks.
• You are a man or a woman after menopause with low iron.
• You see blood in your stool, or black tarry stools that are not due to iron.
• You have very heavy periods.
• You are pregnant, or planning pregnancy.
• Your child is pale, tired or not growing well.
• You have chest pain, severe breathlessness or fainting. This is an emergency.

Frequently asked questions

Can I take iron without a blood test?

It is better to test first. Symptoms of tiredness have many causes, and too much iron can be harmful.

Which is better, iron syrup or tablet?

The best form is the one you can tolerate and take regularly. Your doctor may suggest one over another.

Why are my stools black?

Iron turns stool dark. This is harmless. Black, sticky, foul-smelling stool with weakness or pain may be bleeding and needs a doctor.

Can iron cause constipation?

Yes, in many people. Drink water, eat fibre-rich food, and ask for a gentler type.

Order iron and vitamins from Khasmart, with delivery across Pakistan.

This article is for general information and is not a substitute for advice from your doctor or pharmacist. It does not include doses; your doctor decides the medicine and amount. Always follow the directions on the pack or from your doctor.