hematology and oncology
Iron Deficiency Anemia
Treatment of Iron Deficiency Anemia
Oral supplemental iron Parenteral iron Iron therapy without pursuit of the cause is poor practice; a bleeding site should be sought even in cases of mild anemia. (eg, ferrous sulfate, ferrous gluconate, ferrous fumarate) or saccharated iron given 30 minutes before meals (food or antacids may reduce absorption). A typical initial dose is 65 mg of elemental iron (eg, as 325 mg of ferrous sulfate) given once a day or every other day ( Treatment reference ). Larger doses are largely unabsorbed due to increased hepcidin production but increase adverse effects, especially constipation or other GI upset. causes a more rapid therapeutic response than oral iron does but can cause adverse effects, most commonly allergic reactions or infusion reactions (eg, fever, arthralgias, myalgias). Severe Anaphylactoid reactions were mostly caused by high molecular weight Patients who do not tolerate oral iron Patients for whom oral iron is ineffective Patients who steadily lose large amounts of blood because of capillary or vascular disorders (eg, Hereditary Hemorrhagic Telangiectasia ) Patients with a need for expedient iron repletion due to severe anemia, elective surgery, or third trimester of pregnancy The dose of parenteral iron is calculated based on weight and current hemoglobin level but generally an initial cumulative dose of 1000 mg is sufficient. Oral iron therapy should continue for≥6 months after correction of hemoglobin levels to replenish tissue stores, and iron studies should be rechecked at least 4 weeks after parenteral iron to ensure adequate repletion. The response to treatment is assessed by serial Hb measurements until normal RBC values are achieved. Hb rises little for 2 weeks but then rises 0.7 to 1 g/week until near normal, at which time the rate of increase tapers. Anemia should be corrected within 2 months. A subnormal response suggests continued hemorrhage, underlying infection or cancer, insufficient iron intake, or malabsorption of oral iron. If the symptoms of anemia, such as fatigue, weakness, and shortness of breath, do not abate following resolution of the anemia, an alternative cause should be sought. 1.Moretti D, Goede JS, Zeder C, et al: Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women.Blood126(17):1981-1989, 2015. doi: 10.1182/blood-2015-05-642223 