Iron deficiency: new insights into diagnosis and treatment

Abstract

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

The role of iron repletion in adult iron deficiency anemia and other diseases

“…Some patients may not have overt anemia but have low iron stores, a state known as latent iron deficiency (LID). See Table for laboratory parameters to evaluate iron status . Figure provides an overview of our practice's schema guided by supporting literature for risk categorization, recommended workup, and treatment for various patient populations .…”

“…See Table 1 for laboratory parameters to evaluate iron status. 10 Figure 1 provides an overview of our practice's schema guided by supporting literature for risk categorization, recommended workup, and treatment for various patient populations. [10][11][12] In premenopausal women, heavy menstrual bleeding (HMB) is a frequently encountered cause for IDA and mild cases may be treated with a trial of oral iron depending on patient tolerability.…”

A Comparative Study to Evaluate the Efficacy of Oral Lactoferrin Fortified Bovine Colostrum with Oral Iron in the Treatment of Iron Deficiency Anemia

“…While more than 2 billion people worldwide are known to be iron-deficient. 1 In India, the prevalence of iron deficiency anemia is nearly 74.3%. Women and children are the most commonly affected.…”

“…9 Children with iron deficiency anemia manifest psychomotor developmental delays. 1 It thus becomes increasingly essential to correct the deficiency in an individual. An individual is labeled anemic when the haemoglobin falls under 2 standard deviation (SD) of the mean hemoglobin of a population of same age, sex and altitude.…”

Severe iron deficiency anemia: red blood cell transfusion or intravenous iron?

“…More details on these aspects are available elsewhere . IDA can be determined by standard laboratory testing and the extent of the iron deficit measured using the Ganzoni formula (iron deficit [mg] = patient weight (kg) × (target – actual hemoglobin [Hb]) × 2.4 + 500) or a derivative of this formula . It needs to be emphasized that IDA is not a diagnosis but rather a secondary manifestation of the presence of an underlying abnormality, the cause of which needs also to be elucidated .…”