Iron comes from the diet. Sources of food containing high levels of iron include red meat and liver. Smaller amounts are found in white meats/fish, fortified breakfast cereals, beans, seeds/pulses, green vegetables, tofu and eggs.

Iron deficiency commonly causes tiredness, fatigue and pale skin.

If severe, it can also cause breathlessness on exertion, hair changes/hair loss, nail changes, tinnitus (ringing in the ears) and occasionally strange cravings for non-food substances (pica). This is most commonly a craving for ice, but can also include dirt, coal and other substances.

The doctor will ask questions to identify the most likely reason for iron deficiency from the above list. Tests would be guided by the most likely reason and may include blood tests (to identify absorption problems), investigations to identify blood loss from the intestine (stool test for blood), telescope tests on the upper and lower intestine (gastroscopy and/or colonscopy) or ultrasound of the pelvis in women with increased menstrual bleeding.

Iron deficiency is treated by taking iron replacement treatment.

A blood transfusion is different to iron replacement therapy. A blood transfusion is “pre-made” red blood cells from another person. As such it works much quicker than iron replacement therapy (where your own body makes the new red blood cells after the iron is given), but there are potential side effects from transfusions, and blood is a precious resource.

Blood transfusions in iron deficiency are used only for severe anaemia, with associated symptoms related to the heart or lungs (chest pains, palpitations, and breathlessness).

It is essential to identify the underlying cause for the iron deficiency anaemia. If this is identified and treated (eg. Diet changes, treatment for blood loss from the intestine), the iron deficiency will not recur.

Regular blood tests are recommended after treatment of iron deficiency, to monitor iron levels and identify drop in iron levels, prior to the development of anaemia.

There are three main common problems associated with having HS:

There is another uncommon potential problem for people who have Hereditary Spherocytosis associated with a viral infection called “Slapped cheek”. Slapped cheek is caused by a virus called Parvovirus which can infect bone marrow cells and put the red cell producing cells “to sleep”. Because patients with HS need the bone marrow to be rapidly replacing the fragile red cells, this infection can cause a severe anaemia; patients can become very pale and sometimes even require blood transfusions. Fortunately this problem is uncommon.

HS is now diagnosed with a simple blood test. It is also important for a doctor to examine patients with HS to see if they are jaundiced or have an increase in the size of the spleen.

Most patients with HS do not need to do much about their condition at all. The bone marrow has the capacity to increase the number of red cells it produces many fold and is able to keep up replacing the fragile cells.

A few things may be helpful:

Removing the spleen (splenectomy) has been used a lot in the past in the treatment and management of patients with HS; it stops the red cells from breaking down and solves the problems of HS.

Removing the spleen has problems however – the spleen is an important organ in the immune system and patients who do not have a spleen may be prone to getting serious infections. This risk is higher in younger children but may be less than previously expected because of newer vaccinations. It is now generally recommended to avoid splenectomy in children younger than 6 years and to ensure that children who may need a splenectomy have all the appropriate vaccinations.

Another approach for some of these young patients is to remove only a small part of the spleen – partial splenectomy. This is done in a few hospitals and there is some experience to say this may be very helpful for some patients.