Anaemia & Iron Disorder Specialists in Melbourne
Anaemia means there are too few red blood cells, or too little haemoglobin, to carry oxygen efficiently around the body. It is not a diagnosis by itself. Anaemia can result from iron deficiency, vitamin deficiency, blood loss, inflammation, kidney disease, haemolysis, bone marrow disorders or inherited conditions, and more than one cause can occur at the same time. Symptoms can include fatigue, shortness of breath on exertion, palpitations, dizziness, headaches or reduced exercise tolerance, although mild anaemia may be found on a routine blood test before symptoms are obvious.
Iron deficiency is one of the most common causes of anaemia. It can occur because iron intake or absorption is inadequate, because the body has greater iron requirements, or because blood is being lost. Heavy menstrual bleeding, gastrointestinal blood loss, pregnancy, coeliac disease, bariatric surgery and other gastrointestinal disorders are common considerations. Ferritin is useful but can be affected by inflammation, so iron studies need to be interpreted in context. Treatment may include oral iron or an intravenous iron infusion. Importantly, replacing iron is only one part of care: unexplained iron deficiency may also require investigation of why iron stores became depleted.
Vitamin B12 and folate are required for normal red blood cell production. Deficiency can cause anaemia with large red blood cells and, in the case of B12 deficiency, neurological symptoms such as altered sensation or balance problems. Causes include dietary deficiency, impaired absorption, autoimmune pernicious anaemia, gastrointestinal surgery and some medicines. Treatment is usually straightforward once the cause is identified, but severe or longstanding B12 deficiency should be recognised promptly because neurological complications may not always fully reverse. A haematologist can also help when the blood count pattern is atypical or when vitamin deficiency does not fully explain the abnormal results.
Iron overload occurs when excess iron accumulates in the body. Hereditary haemochromatosis is a common genetic cause in people of European ancestry, but a raised ferritin does not automatically mean haemochromatosis: inflammation, liver disease, alcohol use, metabolic conditions and other factors can also increase ferritin. Assessment may include fasting iron studies, HFE genetic testing where appropriate, liver tests and occasionally imaging or specialist liver assessment. For patients with clinically significant iron overload, regular venesection can remove iron safely over time and reduce the risk of organ injury.
Investigation of anaemia is guided by the size and appearance of the red blood cells, the reticulocyte response, iron and vitamin status and the wider clinical history. Kidney and liver function, thyroid disease, inflammation, medications and evidence of bleeding may also be relevant. If the pattern suggests a marrow problem, paraprotein disorder or another haematological condition, more specialised testing may be required.
Some people are referred with a ferritin that is high rather than low. The key is to separate true iron overload from ferritin elevation caused by inflammation or liver/metabolic disease. The interpretation is often more meaningful when ferritin is considered alongside transferrin saturation, liver tests, genetics and the patient’s clinical background.
Treatment is matched to the cause. Oral iron is suitable for many patients with iron deficiency, while intravenous iron can be useful when oral iron is not tolerated, is not absorbed adequately, is too slow for the clinical situation or has failed to restore iron stores. Vitamin replacement, treatment of bleeding, management of autoimmune haemolysis or venesection for iron overload may be recommended as appropriate.
Northern Blood & Cancer Care can coordinate investigation and treatment with GPs, gastroenterologists, gynaecologists, obstetricians and other specialists when the anaemia reflects a broader medical problem. This collaborative approach is particularly useful when iron deficiency recurs, blood loss is suspected, pregnancy is involved or the blood count remains abnormal despite apparently adequate replacement.
Specialist assessment may be useful when the cause is unclear, the abnormality persists despite initial treatment or the pattern is more complex than straightforward iron deficiency. Common reasons for referral include:
Northern Blood & Cancer Care brings together Melbourne specialists with complementary clinical, hospital and research appointments. The clinicians most closely associated with this service include:
Effective treatment of anaemia starts with understanding why it has developed. Northern Blood & Cancer Care’s haematologists investigate persistent and recurrent anaemia, iron deficiency, iron overload and haemolysis, with the expertise to distinguish common deficiencies from more complex blood disorders and coordinate treatments such as iron infusion or venesection when appropriate.
Northern Blood & Cancer Care brings together a highly experienced team of haematologists, medical oncologists and specialist physicians, with consultations available at Northern Private Hospital in Epping.
Contact our team to arrange an appointment or discuss a referral.
