Treatment of iron deficiency anemia: practical considerations

Abstract

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...

The Prevalence and Impact of Heavy Menstrual Bleeding (Menorrhagia) in Elite and Non-Elite Athletes

“…[ 5 ] Compromised iron stores cause adaptive changes, eventually resulting in limitations to the production of hemoglobin and a state of IDA. Menstruation is the most common single cause of IDA in females of a childbearing age,[ 6 ] with HMB specifically identified as the principal cause of iron deficiency and IDA in clinical practice in this population. [ 7 ] In a recent study of women with HMB, 63% of respondents reported being deficient in iron at some point.…”

Iron deficiency induces female infertile in order to failure of follicular development in mice

“…Our present findings suggest that even if superovulation treatment is used for patients with IDA, their fertility is not likely to improve. In humans, IDA can be treated with oral iron supplements [ 31 ]. The LFD-fed mice in this study that were later given the normal diet recovered from the effects of iron deficiency, including a return to the normal estrous cycle and fertility.…”

An audit of iron therapy in patients with iron deficiency anemia in a tertiary care hospital

“…4 This is the first study to analyze the treatment pattern in patients having IDA. In our study, majority of the patients were female (71%) and they were more than 15 years of age.…”