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50 ANAEMIA FROM PAGE 49 Ms Freeman expanded on the signs of low iron: “Struggling to concentrate, you get quite breathless easily, heart palpitations quite vigorously, sometimes hypertension. Some people can crave high-iron foods or loss of appetite.” Trouble in concentrating is a significant one, she adds, as “iron has a really important role with brain function”. “If you have younger children or children on vegetarian or low-iron diets, you have to be particularly careful if they’re experiencing eating disorders or not eating properly,” Ms Freeman said. “You’ve got this kind of window where your brain isn’t developing properly. After a certain age, once you’re into your 20s, it can cause a lot of damage.” To ensure that someone’s iron levels are up, initial focus is on diet alteration. Ms Freeman cites two main types of iron. “What we call heme iron is the iron we get from animal sources, like red meat,” she said. “That type of iron is really well absorbed into the body. “The other type of iron is non-heme iron, and that’s the type you get from broccoli and spinach \\\\\\\[for example\\\\\\\]. There’s a bit of iron in those foods, but it’s actually a different type of iron. That’s partly because it doesn’t break down as well.” Iron can be absorbed from certain non- animal foods, which include dried beans and lentils, and wholegrain bread. “Including vitamin C-rich foods, like orange and berries, capsicum, etc \\\\\\\[is important\\\\\\\],” Ms Freeman said. Treatments and tips for pharmacy assistants Ms Freeman notes that she believes if someone is going down the vegetarian route, they should first speak to a dietitian. “Depending on the severity, they may need some iron supplements,” she said. “Vitamin B12 can also be a contributing factor, again problematic with a vegan diet, so they may need B12. Folic acid is important. Those key nutrients need to be checked and supplemented if needed.” Ms McRae-Field says pharmacy assistants must be aware of these different types of treatments and ensure their knowledge of anaemia is adequate. “It’s important for pharmacy assistants “I think the pharmacy assistant has a really critical role in screening this initial concern about anaemia.” to know these signs, as we need to be able to flag symptoms and piece together potential illnesses,” she said. “However, in the case of anaemia, it’s important to flag these symptoms and then refer the customer to their GP, as anaemia isn’t something we can diagnose and treat within pharmacy. “A GP must be involved and diagnose with a blood test to ensure it’s the correct deficiency diagnosis and that it’s treated correctly. Incorrect diagnosis of anaemia can lead to iron becoming toxic to patients.” Ms Freeman agrees, adding that if the patient already knows they’re anaemic, and looking for supplements, pharmacy assistants should be aware of the effects that may arise from taking these supplements. “If they’re buying the higher dose of B12 or iron supplements, they need to be aware of constipation and gut challenges,” she said. “I think the pharmacy assistant has a really critical role in screening this initial concern about anaemia. If people are just buying supplements because they think they need it, there can be some problems and consequences of taking high-dose iron if they don’t need it.” Ms McRae-Field’s final piece of advice to fellow pharmacy assistants is that “helping customers with anaemia is about ensuring you’re asking protocol questions and ensuring that the patient has been seen by their GP – and if in doubt, always refer to or liaise with the pharmacist.” References 1. Anaemia, 2019. Australian Government Department of Health. health.gov.au/resources/ pregnancy-care-guidelines/part-f-routine-maternal- health-tests/anaemia RETAIL PHARMACY ASSISTANTS • APR 2021