If you have been diagnosed with chronic heart failure, you will probably have regular appointments with your doctor to see how you are feeling, and to check your medication. However, if you are experiencing symptoms of iron deficiency it is important that you discuss this with them.
Knowing if you have iron deficiency or not is important as it can have a big impact on your life, and also on your prognosis. If you have chronic heart failure and iron deficiency, you will be less able to exercise and could have a lower quality of life than someone with chronic heart failure alone.1,2
This might mean you need to have a rest during the day and have difficulty doing things like gardening or spending time with family.2
Having iron deficiency can also mean you are more likely to need a heart transplant than someone without iron deficiency and your risk of dying increases too.3
If you think you may have iron deficiency you can use the Symptom Browser to find out more, and also to help you prepare notes for when you see your doctor. It’s useful to think beforehand about what your doctor might need to know to understand your symptoms and what might be causing them, but also to write down any questions you have for them.
For example, your doctor might want to know:
- Have you been taking your medication regularly?
- Are you following any dietary advice you have been given?
- How often to you get out for a walk, or do exercise?
- Do you feel tired every day? Do you take a nap every day?
Questions you might ask:
- I’m so tired all the time, could I be anaemic?
- I get out of breath doing the simplest thing, is there anything I can do?
- Was my haemoglobin checked at the last blood test? What were the results?
Anaemia occurs when there aren’t enough red blood cells in your blood or you have low haemoglobin levels.4 Haemoglobin carries oxygen in the blood from the lungs to the rest of the body. Your doctor can check whether or not you are anaemic by performing a Complete Blood Count. This helps your doctor to find out the number of red blood cells and amount of haemoglobin in your blood.5
The table beneath shows the haemoglobin level that may be considered ‘low’ by your doctor. The cut-off values that define anaemia can be different for different groups of people.
| Gender/Age | Blood Test | Guideline Values Your Doctor May Use When Checking for Anaemia* |
|---|---|---|
| Men > 15 years old | Haemoglobin count to define anaemia | Below 13 g/dL6 |
| Women > 15 years old (non-pregnant) | Haemoglobin count to define anaemia | Below 12 g/dL6 |
| Women > 15 years old (Pregnant) | Haemoglobin count to define anaemia | Below 11 g/dL6 |
*The guideline values and the units provided in this table are for your reference only and it is possible that your doctor uses different guideline values or units. Talk to your doctor about what your results mean.
Your doctor may also test your blood for iron deficiency either as part of the first blood test, or in a follow-up test. Several different results from your blood test can help a doctor to understand whether or not you are iron deficient. These include:
- TSAT, or transferrin saturation, a test to measure the amount of iron that is being transported in your body7
- Serum* ferritin, which indicates the amount of iron stores you have in your body8
- Serum* iron, the total amount of iron present in the serum of your blood7
* Where mentioned, serum is the fluid part of the blood once the blood cells have been removed
The table beneath shows the values that may be used by your doctor to determine if you are low in iron.
| Blood Test | 2016 ESC Guideline For Heart Failure value recommendations9* |
|---|---|
| Serum Ferritin | <100 µg/L |
| Ferritin | 100-299 µg/L |
| Transferrin saturation (TSAT) | < 20%10 |
*The guideline values and the units provided in this table are for your reference only and it is possible that your doctor uses different guideline values or units. Talk to your doctor about what your results mean.
If it turns out that you have iron deficiency or iron deficiency anaemia, your doctor will be able to recommend the best treatment option for you. This could be a simple change to your diet to include more iron-rich foods, over-the-counter iron supplements, or a prescription of oral or intravenous iron. For more information on ways to manage iron deficiency click on Treatment Options.
If you have chronic heart failure, then having iron deficiency as well can have serious consequences, reducing your quality of life2 as well as increasing your risk of death.3 Therefore it is important that your iron deficiency is treated. Effective treatment can improve your quality of life as well as reduce your risk of being hospitalised with worsening heart problems.11
Treating iron deficiency can improve quality of life11 and reduce risk of hospitalisation11
There are several ways in which iron deficiency can be treated, depending on why you are iron deficient and how low your iron levels are. Your doctor will assess all the options, and any medication you are already on, before choosing which is best for you.
One option is to increase the amount of iron in your diet by including iron-rich food such as red meat, liver, enriched cereals and leafy vegetables.12 However, a change in diet may not be enough to correct your iron levels, or be a fast enough change. Other options are:
- Oral iron supplements available over-the-counter or on prescription12
- Intravenous iron where iron is given via an injection directly into your blood stream13
Oral iron tablets are widely used but they maybe be associated with side-effects such as constipation, nausea and heartburn.
The choice between oral supplements or intravenous iron treatment will depend on your condition. While oral supplements are widely accessible and used, IV treatments may be suggested by your doctor if oral iron supplements are considered ineffective, cannot be used or if there is a need to deliver iron rapidly.
If you have chronic heart failure your doctor may suggest you iv iron therapy when oral iron preparations are ineffective or oral iron preparations cannot be used or there is a clinical need to deliver iron rapidly.
Talk to your doctor about your treatment options and your symptoms so you can decide together on the best way to get your iron levels back on track.
- Jankowska E a, Rozentryt P, Witkowska A, et al. Iron deficiency predicts impaired exercise capacity in patients with systolic chronic heart failure. J Card Fail. 2011;17(11):899-906. doi:10.1016/j.cardfail.2011.08.003.Comín-Colet J, Enjuanes C, González G, et al. Iron deficiency is a key determinant of health-related quality of life in patients with chronic heart failure regardless of anaemia status. Eur J Heart Fail. 2013;15(10):1164-72. doi:10.1093/eurjhf/hft083.
- Comín-Colet J, Enjuanes C, González G, et al. Iron deficiency is a key determinant of health-related quality of life in patients with chronic heart failure regardless of anaemia status. Eur J Heart Fail. 2013;15(10):1164-72. doi:10.1093/eurjhf/hft083.
- Jankowska E a, Rozentryt P, Witkowska A, et al. Iron deficiency: an ominous sign in patients with systolic chronic heart failure. Eur Heart J. 2010;31(15):1872-80. doi:10.1093/eurheartj/ehq158.
- Wood MM, Elwood PC. Symptoms of iron deficiency anaemia: A community survey. Br J Prev Soc Med. 1966;20:117-121.
- Dean L. 1. Blood and the cells it contains. Blood Groups Red Cell Antigens. 2005:1-6. Available at: http://www.ncbi.nlm.nih.gov/books/NBK2263/.
- Sullivan KM, Mei Z, Grummer-Strawn L, Parvanta I. Haemoglobin adjustments to define anaemia. Trop Med Int Health. 2008;13(10):1267-71. doi:10.1111/j.1365-3156.2008.02143.x.Suominen P, Punnonen K, Rajamäki a, Irjala K. Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits. Blood. 1998;92(8):2934-9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9763580.
- Yip R, Parvanta I, Cogswell M, et al. Recommendations to prevent and control iron deficiency in the United States. Morb Mortal Wkly Rep. 1998;47(RR-3):1-29. Available at: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Recommenda.... Accessed October 19, 2013.
- Suominen P, Punnonen K, Rajamäki a, Irjala K. Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits. Blood. 1998;92(8):2934-9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9763580.
- Ponikowski P et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016 May 20. doi: 10.1002/ejhf.592. [Epub ahead of print]
- Fishbane S, Pollack S, Feldman HI, Joffe MM. Iron indices in chronic kidney disease in the National Health and Nutritional Examination Survey 1988-2004. Clin J Am Soc Nephrol. 2009;4(1):57-61. doi:10.2215/CJN.01670408.
- Ponikowski P, van Veldhuisen DJ, Comin-Colet J, et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J. 2014:657-668. doi:10.1093/eurheartj/ehu385.
- Alleyne M, Horne MK, Miller JL. Individualized treatment for iron-deficiency anemia in adults. Am J Med. 2008;121(11):943-8. doi:10.1016/j.amjmed.2008.07.012.
- Mcdonagh T, Macdougall IC. Iron therapy for the treatment of iron deficiency in chronic heart failure : intravenous or oral ? Iron deficiency : a common co-morbidity in heart failure. Eur J Heart Fail. 2015.