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Anaemia

Why does this matter?

Anaemia means having a low level of haemoglobin (Hb) in your blood. Haemoglobin carries oxygen around your body, so when levels are low, your body doesn’t get enough oxygen. Anaemia is common, and if you have it at the time of your operation, you are less likely to recover as well as those without anaemia. It can lead to:

  • Poor wound healing
  • Slower recovery
  • Increase the risk of complications

There are different types of anaemia, and each needs a different treatment. The most common type is iron deficiency anaemia. Some treatments take time to work – for example, oral iron usually takes 4 weeks to improve haemoglobin and 3–6 months to replenish iron stores. Other types of anaemia include vitamin B12 or folate deficiency anaemia.

You need to keep an eye on your health and have regular check-ups if you have any type of anaemia. If iron deficiency anaemia is not well managed, it can:

  • Increase your risk of illness and infection (low iron affects the immune system)
  • Put extra strain on your heart and lungs, leading to problems like fast heartbeat (tachycardia) or heart failure
  • Cause complications during pregnancy and birth

Treating anaemia before surgery helps keep you safe and supports a smoother recovery. If your haemoglobin levels are not checked and managed, your surgery might be delayed.

Now – not just before surgery – is the best time to follow the advice you have been given. Improving your anaemia and overall health can make a big difference.

What you need to do:

  • Eat foods rich in the nutrients you are lacking (see note below)
  • Take your medicines for anaemia as prescribed (see note below if prescribed iron tablets)
  • Attend your routine reviews with your practice pharmacist, GP or practice nurse and follow the advice given during these reviews
  • Attend any tests or appointments as recommended by your hospital team

If you are prescribed oral iron:

  • The prescribed dose for treating anaemia is much higher than the amount in shop bought supplements
  • Ideally take iron tablets on an empty stomach (1 hour before or 2 hours after food) - absorption can drop by up 75% if taken with food
  • You may experience side-effects, but these usually settle with time
  • If you can’t tolerate the dose prescribed, taking your iron tablets on alternate days may help, discuss this with your practice pharmacist or GP
  • Avoid taking iron with milk, tea or with phytates (found in beans, seeds, nuts or grains) as these reduce absorption
  • It may change the colour of your stools (poo)
  • Keep iron tablets out of the reach of children - an overdose can be fatal

Food tips for anaemia

Many people have anaemia due to low intake of essential nutrients.

Foods rich in iron:

Animal sources:
  • Red meat (beef, lamb, pork) and offal (e.g., liver) are the richest, most easily absorbed sources of iron
  • Fish and poultry are also high in iron

Note: UK healthy eating guidance suggests keeping red meat (such as beef, lamb and pork) and processed meats (such as sausages, bacon, ham and corned beef) to about 70g per day on average. This works out at roughly three portions a week.

To make this easier to picture:

  • Portion of Sunday roast - 3 thin-cut slices of roast lamb, beef or pork (each about the size of half a slice of bread) = 90g
  • Cooked breakfast (2 standard British sausages and 2 thin-cut rashers of bacon) = 130g
  • Slice of ham = 23g

Follow this link to find out more about meat in your diet

Plant-based sources
  • Beans, peas, lentils
  • Dark green vegetables (spinach, kale, broccoli)
  • Nuts and seeds
  • Wholemeal bread and wholemeal flour
Foods fortified with iron

Many foods are fortified with iron, for example, in the UK

  • All non‑wholemeal bread must be fortified with iron (as well as calcium, thiamine and niacin)
  • Many breakfast cereals also contain added iron
Food label tips
  • The nutrient reference value (NRV) for iron is 14 mg/day
  • To list iron on the label, a food must contain at least 15% of the iron NRV per 100 g (2.1 mg), many fortified foods contain more
Foods rich in vitamin C

These could also be eaten with iron-rich foods and may improve the absorption of iron

  • Citrus fruits, kiwi fruit, strawberries
  • Red and green peppers, broccoli, Brussel sprouts
Foods rich in vitamin B12
  • Meat (especially liver)
  • Eggs
  • Milk, cheese, yogurt
  • Fish and shellfish
Foods rich in folate
  • Green leafy vegetables (spinach, broccoli, cabbage, lettuce)
  • Brussel sprouts
  • Beans and legumes
  • Nuts and seeds
  • Poultry
  • Liver
  • Shellfish
  • Eggs
  • Wholegrains

Follow this link to find out more about iron deficiency anaemia

Follow this link to find out more about vegetarian sources of iron, vitamin B12

Follow this link to find out more about vegan sources of iron, vitamin B12

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