The aims of this article, which is directed primarily at generalists, are to outline the relevant features of iron metabolism, to summarize the indications for treatment of IDA, and to compare the advantages and disadvantages of treatment with oral and intravenous iron. We shall then focus particularly on practical aspects of treatment with iron. Topics which we shall not cover include investigation of the cause of IDA (for guidance, see Goddard et al 3 ) and use of blood transfusion. We shall also omit the mention of therapy with erythropoietin, as this is a specialist treatment restricted primarily to patients with chronic kidney disease or having cancer chemotherapy.Iron metabolism As a background to our focus on the management of IDA, we provide below a brief overview of iron metabolism (for a comprehensive recent review, see Waldvogel-Abramowski et al 7 ).Iron absorption and turnover The human body contains from 30 to 40 mg/kg body weight of iron. It is mostly contained in hemoglobin (Hb), ferritin, and other heme and nonheme proteins. Iron is an essential element, being a constituent of a range of enzymes involved in redox reactions and oxygen delivery. Red blood cells have the highest demand for iron of all cells.Introduction Anemia is common in all populations worldwide and is frequently caused by iron deficiency. In developed countries, the prevalence of iron deficiency anemia (IDA) is from 2% to 5% in adult men and postmenopausal women and about 10% in women of child-bearing age; it is much more common in hospitalized patients. [1][2][3] Iron deficiency occurs when iron losses exceed its intestinal absorption. This happens in patients with decreased iron intake, malabsorption of iron, increased demand for iron, or through ongoing iron loss. In the Western world, while IDA is often multifactorial, menstruation is the most common single cause. Reduced dietary intake of iron (vegetarians and the elderly being particularly at risk), bleeding from the gastrointestinal tract (for example, due to neoplasia or use of aspirin or nonsteroidal anti-inflammatory drugs), malabsorption (particularly in celiac disease), pregnancy, and blood donation are other frequent causes. 3,4 IDA is associated with worsened quality of life, impaired physical and cognitive performance, 2,5 and in hospitalized patients, longer length of hospital stay and poorer clinical outcomes. 1,6 It also increases the likelihood of patients receiving blood transfusions with their attendant risks.1 Therefore, effective treatment of patients with IDA is extremely worthwhile. Key wordsanemia, intravenous iron, iron deficiency, hypersensitivity reactions, oral iron AbstrActIron deficiency anemia is a common problem worldwide, and doctors of all specialties need to be competent in its treatment. While most patients respond well to oral iron preparations, a substantial minority have side effects that make them adhere poorly to their treatment. For oral iron-intolerant patients, those responding poorly despite good adherence, and those with severe...

At our institution, a large tertiary referral centre for vascular surgery, patients are often admitted directly to the ward and clerked by foundation year one (FY1) doctors. We found that these clerkings frequently fell short of national record keeping standards, potentially leading to an increased risk for patients during their hospital stay. In addition, we found that junior doctors did not feel confident in clerking vascular surgery patients.A literature review found that high quality clerkings were strongly linked to improved patient safety, and that the use of a pro forma was one method to improve compliance with documentation guidelines. We devised a clerking pro forma based on national guidelines and introduced it to the department.We found that the use of a pro forma significantly improved documentation standards across a number of domains, including patient demographics, presenting complaint, and family and social histories (p <0.05). Examinations were significantly more comprehensive, with cardiac and vascular examination as well as peripheral pulses documented (p <0.05).In conclusion, we found that using a pro forma helped to aid junior doctors in clerking new patients, and significantly improved the quality of their history and examinations. This leads to a potential positive impact on patient safety during their inpatient stay, and should be rolled out more widely across the hospital.

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