Iron deficiency anemia medical therapy: Difference between revisions

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{{Iron deficiency anemia}}
{{Iron deficiency anemia}}
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==Overview==
==Overview==
Treatment of iron deficiency anemia includes iron supplementation and treating the cause of the iron deficiency. Treatment is given according to the severity of anemia.


==Medical Therapy==
==Medical Therapy==
* Iron supplementation is recommended among patients with iron deficiency anemia<ref name="pmid27913463">{{cite journal| author=Auerbach M, Deloughery T| title=Single-dose intravenous iron for iron deficiency: a new paradigm. | journal=Hematology Am Soc Hematol Educ Program | year= 2016 | volume= 2016 | issue= 1 | pages= 57-66 | pmid=27913463 | doi=10.1182/asheducation-2016.1.57 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27913463  }} </ref><ref name="pmid21705493">{{cite journal| author=Krayenbuehl PA, Battegay E, Breymann C, Furrer J, Schulthess G| title=Intravenous iron for the treatment of fatigue in nonanemic, premenopausal women with low serum ferritin concentration. | journal=Blood | year= 2011 | volume= 118 | issue= 12 | pages= 3222-7 | pmid=21705493 | doi=10.1182/blood-2011-04-346304 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21705493  }} </ref><ref name="pmid11506061">{{cite journal| author=Patterson AJ, Brown WJ, Roberts DC| title=Dietary and supplement treatment of iron deficiency results in improvements in general health and fatigue in Australian women of childbearing age. | journal=J Am Coll Nutr | year= 2001 | volume= 20 | issue= 4 | pages= 337-42 | pmid=11506061 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11506061  }} </ref><ref name="pmid12763985">{{cite journal| author=Verdon F, Burnand B, Stubi CL, Bonard C, Graff M, Michaud A et al.| title=Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial. | journal=BMJ | year= 2003 | volume= 326 | issue= 7399 | pages= 1124 | pmid=12763985 | doi=10.1136/bmj.326.7399.1124 | pmc=156009 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12763985  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15122863 Review in: ACP J Club. 2004 Mar-Apr;140(2):43] </ref><ref name="pmid28034892">{{cite journal| author=Achebe MM, Gafter-Gvili A| title=How I treat anemia in pregnancy: iron, cobalamin, and folate. | journal=Blood | year= 2017 | volume= 129 | issue= 8 | pages= 940-949 | pmid=28034892 | doi=10.1182/blood-2016-08-672246 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28034892  }} </ref>.
* Pharmacologic medical therapies for iron deficiency anemia include (either) oral iron supplements, parenteral iron supplements, erythropoetin and blood transfusion.


Before any treatment is commenced there should be definitive diagnosis of the underlying cause for iron deficiency, particularly in older patients who are most susceptible to [[colorectal cancer]] and the gastrointestinal bleeding it often causes. In adults, 60% of patients with iron deficiency anemia may have underlying gastrointestinal disorders leading to chronic blood loss.<ref name="pmid8179652">{{cite journal |author=Rockey D, Cello J |title=Evaluation of the gastrointestinal tract in patients with iron-deficiency anemia |journal=N Engl J Med |volume=329 |issue=23 |pages=1691-5 |year=1993 |id=PMID 8179652}}</ref>
=== Iron deficiency anemia ===
* '''1. Mild anemia'''
** '''1.1 Adults- (Hb -11.0-11.9 g/dL in women and 11.0-12.9 g/dL in men''')
*** Ferrous sulfate/ferrous gluconate/ferrous fumarate PO 100mg per day for 4 weeks.
** 1.2 Pediatrics- (Hb <9g/dl)
*** Ferrous sulfate 3mg/kg PO for 8-12 weeks.


It is likely that the cause of the iron deficiency will need treatment as well.
* 2. Moderate anemia
** 2.1- Adults( Hb 7-11g/dL)
*** Ferric carboxymaltose in a dose of 750mg ( 50mg/ml/min) IV once a week for 2-4 weeks.
** 2.2 Paediatrics- (Hb 5-9g/dl)
*** Iron sucrose in a dose of 200mg (30mg/ml/min) IV once a week for 2-4 weeks.
* 3. Severe anemia
** 3.1 Adults (Hb <7g/dl in individuals without co morbidities and <8g/dl in patients with heart diseases)
*** Blood transfusion- units of packed red blood cellsdepending on the Hb level
*** 2 units of blood increase 1 g/dl of Hb.
** 3.2 Paediatrics (Hb <5g/dl)
*** Blood transfusion- Units of packed red blood cells depending on the Hb level.
*** 1 unit given over 3-4 hours.


If the cause is dietary iron deficiency, [[iron supplements]], usually with [[iron (II) sulfate]], [[ferrous gluconate]], or iron amino acid chelate [[EDTA|NaFeEDTA]], will usually correct the anemia.
* Intravenous formulations of iron include ferric carboxymaltose, iron dextran, and iron sucrose.


Recent research suggests the replacement dose of iron, at least in the elderly with iron deficiency, may be as little as 15 mg per day of elemental iron <ref name="pmid16194646">{{cite journal |author=Rimon E, Kagansky N, Kagansky M, Mechnick L, Mashiah T, Namir M, Levy S |title=Are we giving too much iron? Low-dose iron therapy is effective in octogenarians |journal=Am J Med |volume=118 |issue=10 |pages=1142-7 |year=2005 |id=PMID 16194646 | doi = 10.1016/j.amjmed.2005.01.065}}</ref>.
* Iron deficient individuals need to consume iron rich diet.


There can be a great difference between iron intake and iron absorption, also known as [[bioavailability]].  Scientific studies indicate iron absorption problems when iron is taken in conjunction with milk, tea, coffee and other substances.  There are already a number of proven solutions for this problem, including:
* Source of iron rich foods is mentioned below:
* Fortification with [[ascorbic acid]], which increases bioavailability in both presence and absence of inhibiting substances, but which is subject to deterioration from moisture or heat.  [[Ascorbic acid]] fortification is usually limited to sealed dried foods, but individuals can easily take [[ascorbic acid]] with basic [[iron supplements|iron supplement]] for the same benefits.
* Microencapsulation with [[lecithin]], which binds and protects the iron particles from the action of inhibiting substances.  The primary benefit over [[ascorbic acid]] is durability and shelf life, particularly for products like milk which undergo heat treatment.
* Using an iron amino acid chelate, such as [[EDTA|NaFeEDTA]], which similarly binds and protects the iron particles.  A study performed by the Hematology Unit of the University of Chile indicates that chelated iron (ferrous bis-glycine chelate) can work with [[ascorbic acid]] to achieve even higher absorption levels <ref name="pmid9202099">{{cite journal |author=Olivares M, Pizarro F, Pineda O, Name JJ, Hertrampf E, Walter T.
|title=Milk inhibits and ascorbic acid favors ferrous bis-glycine chelate bioavailability in humans |journal=J Nutr |volume=127 |issue=7 |pages=1407-11 |year=1997 |month=Jul |id=PMID 9202099}}</ref>.
* Separating intake of iron and inhibiting substances by a couple of hours.
* Using goats milk instead of cows milk.
* Gluten-free diet resolves some instances of iron-deficiency anemia.
 
Iron bioavailability comparisons require stringent controls, because the largest factor affecting bioavailability is the subject's existing iron levels.  Informal studies on bioavailability usually do not take this factor into account, so exaggerated claims from health supplement companies based on this sort of evidence should be ignored.  Scientific studies are still in progress to determine which approaches yield the best results and the lowest costs.
 
If anemia does not respond to oral treatments, it may be necessary to administer iron [[parenteral]]ly (e.g., as iron [[dextran]]) using a drip or haemodialysis.  Parenteral iron involves risks of fever, chills, backache, myalgia, dizziness, syncope, rash, [[anaphylactic shock]]<ref name="globalrph">http://www.globalrph.com/irondextran.htm</ref> and secondary iron overload.  [[Epinephrine]] is used to counter [[anaphylactic shock]], and [[Chelation therapy]] is used to manage secondary iron overload <ref name="asheducationbook">{{cite journal |author=James P. Kushner, John P. Porter and Nancy F. Olivieri |title=Secondary Iron Overload |journal=Hematology  |year=2001 |id=PMID 11722978}} http://asheducationbook.hematologylibrary.org/cgi/content/full/2001/1/47</ref>.
 
A follow up [[blood test]] is essential to demonstrate whether the treatment has been effective.
 
Note that iron supplements must be kept out of the reach of children, as iron-containing supplements are a frequent cause of poisoning in the pediatric age group.
 
===Food sources of Iron===
Iron deficiency can have serious health consequences that diet may not be able to quickly correct, and iron supplementation is often necessary if the iron deficiency has become symptomatic. However, mild iron deficiency can be corrected, and prevented, by eating iron-rich foods. Because iron is an absolute requirement for most of the earth's plants and animals, a wide range of food can provide iron. However, these foods are absorbed and processed differently by the body; for instance, '''iron from meat ([[heme]] iron source)''' is more easily broken down and absorbed than '''iron in grains (nonheme iron source)''', and minerals and chemicals in one type of food may inhibit absorption of iron from another type of food eaten at the same time.[http://www.nlm.nih.gov/medlineplus/ency/article/002422.htm] Because iron from plant sources is less easily absorbed than the heme-bound iron of animal sources, [[vegetarian]]s and [[vegan]]s should have a somewhat higher total daily iron intake than those who eat meat, fish or poultry.[http://www.vrg.org/nutrition/iron.htm] [[Legume]]s and dark-green leafy vegetables like broccoli, kale and oriental greens are especially good sources of iron for vegetarians and vegans. However, spinach and swiss chard contain oxalates  which bind iron making it largely unavailable for absorption. Iron from nonheme sources is more readily absorbed if consumed with foods that contain either heme-bound iron or [[vitamin C]].
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==References==
==References==
{{Reflist|2}}
{{reflist|2}}
 
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[[Category:Hematology]]
[[Category:Gastroenterology]]
[[Category:Endocrinology]]

Latest revision as of 22:25, 29 July 2020

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Overview

Treatment of iron deficiency anemia includes iron supplementation and treating the cause of the iron deficiency. Treatment is given according to the severity of anemia.

Medical Therapy

  • Iron supplementation is recommended among patients with iron deficiency anemia[1][2][3][4][5].
  • Pharmacologic medical therapies for iron deficiency anemia include (either) oral iron supplements, parenteral iron supplements, erythropoetin and blood transfusion.

Iron deficiency anemia

  • 1. Mild anemia
    • 1.1 Adults- (Hb -11.0-11.9 g/dL in women and 11.0-12.9 g/dL in men)
      • Ferrous sulfate/ferrous gluconate/ferrous fumarate PO 100mg per day for 4 weeks.
    • 1.2 Pediatrics- (Hb <9g/dl)
      • Ferrous sulfate 3mg/kg PO for 8-12 weeks.
  • 2. Moderate anemia
    • 2.1- Adults( Hb 7-11g/dL)
      • Ferric carboxymaltose in a dose of 750mg ( 50mg/ml/min) IV once a week for 2-4 weeks.
    • 2.2 Paediatrics- (Hb 5-9g/dl)
      • Iron sucrose in a dose of 200mg (30mg/ml/min) IV once a week for 2-4 weeks.
  • 3. Severe anemia
    • 3.1 Adults (Hb <7g/dl in individuals without co morbidities and <8g/dl in patients with heart diseases)
      • Blood transfusion- units of packed red blood cellsdepending on the Hb level
      • 2 units of blood increase 1 g/dl of Hb.
    • 3.2 Paediatrics (Hb <5g/dl)
      • Blood transfusion- Units of packed red blood cells depending on the Hb level.
      • 1 unit given over 3-4 hours.
  • Intravenous formulations of iron include ferric carboxymaltose, iron dextran, and iron sucrose.
  • Iron deficient individuals need to consume iron rich diet.
  • Source of iron rich foods is mentioned below:
Template:Col-2
Selected Food Sources of Heme Iron
Food Serving
size 		Miligrams
per serving 		% DV*
Chicken liver (cooked) 3˝ ounces 12.8 70
Oysters(breaded and fried) 6 pieces 4.5 25
Beef, chuck (lean, braised) 3 ounces 3.2 20
Clams (breaded, fried) 1 cup 3.0 15
Beef tenderloin (roasted) 3 ounces 3.0 15
Turkey ( dark meat, roasted) 3˝ ounces 2.3 10
Beef, eye of round (roasted) 3 ounces 2.2 10
Turkey, light meat (roasted) 3˝ ounces 1.6 8
Chicken, leg, meat only (roasted) 3˝ ounces 1.3 6
Tuna, fresh bluefin (cooked) 3 ounces 1.1 6
Chicken breast (roasted) 3 ounces 1.1 6
Halibut (cooked) 3 ounces 0.9 6
Blue crab (cooked) 3 ounces 0.8 4
Pork loin (broiled) 3 ounces 0.8 4
Tuna white (canned in water) 3 ounces 0.8 4
Shrimp (mixed species, cooked) 4 large 0.7 4

Template:Col-2

Selected Food Sources of Nonheme Iron
Food Serving
size 		Miligrams
per serving 		% DV*
Ready-to-eat cereal (100% iron fortified cup 18.0 100
Oatmeal, instant, fortified (prepared with water 1 cup 10.0 60
Soybeans, mature (boiled) 1 cup 8.8 50
Lentils (boiled) 1 cup 6.6 35
Kidney beans mature (boiled) 1 cup 5.2 25
Lima beans large, mature (boiled) 1 cup 4.5 25
Navy beans mature (boiled) 1 cup 4.5 25
Ready-to-eat cereal (25% iron fortified) 1 cup 4.5 25
Black beans mature (boiled) 1 cup 3.6 20
Pinto beans mature (boiled) 1 cup 3.6 20
Molasses (blackstrap) 1 tablespoon 3.5 20
Tofu (raw, firm) ˝ cup 3.4 20
Spinach (boiled, drained) ˝ cup 3.2 20
Spinach (canned, drained solids) ˝ cup 2.5 10
Black-eyed peas (cowpeas) (boiled) ˝ cup 1.8 10
Spinach (frozen, chopped, boiled) ˝ cup 1.9 10
Grits (white, enriched 1 cup 1.5 8
Raisins (seedless, packed) ˝ cup 1.5 8
Whole wheat bread 1 slice 0.9 6
White bread (enriched) 1 slice 0.9 6

References

  1. ↑ Auerbach M, Deloughery T (2016). "Single-dose intravenous iron for iron deficiency: a new paradigm". Hematology Am Soc Hematol Educ Program. 2016 (1): 57–66. doi:10.1182/asheducation-2016.1.57. PMID 27913463.
  2. ↑ Krayenbuehl PA, Battegay E, Breymann C, Furrer J, Schulthess G (2011). "Intravenous iron for the treatment of fatigue in nonanemic, premenopausal women with low serum ferritin concentration". Blood. 118 (12): 3222–7. doi:10.1182/blood-2011-04-346304. PMID 21705493.
  3. ↑ Patterson AJ, Brown WJ, Roberts DC (2001). "Dietary and supplement treatment of iron deficiency results in improvements in general health and fatigue in Australian women of childbearing age". J Am Coll Nutr. 20 (4): 337–42. PMID 11506061.
  4. ↑ Verdon F, Burnand B, Stubi CL, Bonard C, Graff M, Michaud A; et al. (2003). "Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial". BMJ. 326 (7399): 1124. doi:10.1136/bmj.326.7399.1124. PMC 156009. PMID 12763985. Review in: ACP J Club. 2004 Mar-Apr;140(2):43
  5. ↑ Achebe MM, Gafter-Gvili A (2017). "How I treat anemia in pregnancy: iron, cobalamin, and folate". Blood. 129 (8): 940–949. doi:10.1182/blood-2016-08-672246. PMID 28034892.

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