How I treat unexplained refractory iron deficiency anemia

Hershko, Chaim; Camaschella, Clara

doi:10.1182/blood-2013-10-512624

Cited by 140 publications

(157 citation statements)

References 96 publications

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“…Oral iron is incorporated into plasma transferrin after release from the basolateral membrane of intestinal cells, providing that no condition leading to malabsorption (i.e. celiac disease, autoimmune or HP-related chronic gastritis) is present [5]. Fig.…”

Section: Historical Considerationsmentioning

confidence: 99%

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Modern iron replacement therapy: clinical and pathophysiological insights

et al. 2017

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Iron deficiency, with or without anemia, is extremely frequent worldwide, representing a major public health problem. Iron replacement therapy dates back to the seventeenth century, and has progressed relatively slowly until recently. Both oral and intravenous traditional iron formulations are known to be far from ideal, mainly because of tolerability and safety issues, respectively. At the beginning of this century, the discovery of hepcidin/ferroportin axis has represented a turning point in the knowledge of the pathophysiology of iron metabolism disorders, ushering a new era. In the meantime, advances in the pharmaceutical technologies are producing newer iron formulations aimed at minimizing the problems inherent with traditional approaches. The pharmacokinetic of oral and parenteral iron is substantially different, and diversities have become even clearer in light of the hepcidin master role in regulating systemic iron homeostasis. Here we review how iron therapy is changing because of such important advances in both pathophysiology and pharmacology.

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Section: Historical Considerationsmentioning

confidence: 99%

“…This should prompt appropriate investigations to exclude malabsorption, i.e. due to celiac disease, helicobacter pilory infection, or autoimmune gastritis [5].…”

Section: The Traditional Prescription Be Aware Of Elemental Iron Rementioning

confidence: 99%

Modern iron replacement therapy: clinical and pathophysiological insights

et al. 2017

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“…20 Such a disorder is usually suspected in children or young patients whose anemia is persistent and refractory to oral iron treatment, in the absence of gastrointestinal conditions that limit iron absorption. 17 IRIDA has raised interest in the identification of genetic susceptibility to iron deficiency. Genome Wide Association Studies, including a recent meta-analysis, indicate that TMPRSS6 genetic variants associate with red cell and iron traits in Caucasian and Asian populations.…”

Section: Genetics and Iron Deficiencymentioning

confidence: 99%

“…17 C-reactive protein and a search for inflammatory/ neoplastic conditions are especially relevant in the elderly, because, besides dietary deficiency, multiple causes are possible including clonal hematopoiesis. In rare instances paroxysmal nocturnal hemoglobinuria, as well as other causes of chronic intravascular hemolysis, should be searched for in unexplained cases of iron deficiency.…”

Section: Searching For the Etiology Of Iron Deficiencymentioning

confidence: 99%

“…Medical disorders affecting the gastrointestinal tract (eg, rarely autoimmune atrophic gastritis, more frequently Helicobacter pylori gastritis and celiac sprue) impair iron absorption and lead to resistance to oral iron treatment. 16,17 In inflammatory bowel diseases iron deficiency may be due to both poor absorption and blood loss. A functional reduction of iron absorption secondary to high hepcidin and ferroportin degradation may occur in these disorders, as well as in any other chronic inflammatory conditions.…”

Section: Traditional and Emerging Causes Of Iron Deficiencymentioning

confidence: 99%

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Iron deficiency: new insights into diagnosis and treatment

2015

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Iron deficiency and iron deficiency anemia are common conditions worldwide affecting especially children and young women. In developing countries, iron deficiency is caused by poor iron intake and/or parasitic infection, whereas vegetarian dietary choices, poor iron absorption, and chronic blood loss are common causes in high-income countries. Erythropoiesis stimulating agents can result in functional iron deficiency for erythropoiesis even when stores are iron-replete. Diagnosis of iron deficiency is straightforward, except when it occurs in the context of inflammatory disorders. Oral iron salts correct absolute iron deficiency in most patients, because low hepcidin levels facilitate iron absorption. Unfortunately frequent side effects limit oral iron efficacy. Intravenous iron is increasingly utilized, because currently available preparations allow rapid normalization of total body iron even with a single infusion and are effective also in functional iron deficiency and in iron deficiency associated with inflammatory disorders. The evidence is accumulating that these preparations are safe and effective. However, long-term safety issues of high doses of iron need to be further explored. Learning Objectives• To diagnose absolute iron deficiency, iron deficiency anemia, and functional iron deficiency in the light of recent advances in iron metabolism • To evaluate advantages and disadvantages of oral and intravenous iron therapy

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