Treatment

The cause of iron deficiency should be clearly established and any underlying cause should be corrected in order to prevent further iron loss (1).

The main aim of iron therapy is to restore haemoglobin concentration and red cell indices to normal and to replenish iron stores (1).

Iron deficiency can usually be treated by oral iron supplements. Advising the patient on foods rich in iron may suffice although patients are often prescribed iron.

Intravenous iron therapy (2):

• use of intravenous iron replacement therapy bypasses the hepcidin-ferroportin axis, the treatment has an improved clinical effect in the setting of inflammation, and does not have the same gastrointestinal side effects of oral iron
• previously parenteral iron preparations were highly labile and prone to the excessive release of free iron into the circulation, with an associated risk of side effects
  • development of newer, high-molecular-weight and more stable preparations has markedly reduced the incidence of these events (2)
  • therefore, administration of parenteral iron is becoming more widespread

Blood transfusion is usually considered for patients with symptomatic anaemia despite iron therapy or at risk of cardiovascular instability because of their degree of anaemia. The aim transfusion should be to restore haemoglobin to a safe level (not necessarily to normal levels) and then follow it up with iron treatment to replenish stores (1).

Reference:

• (1) Goddard AF et al. Guidelines for the management of iron deficiency anaemia. Gut. 2011;60(10):1309-16.
• (2) Avni T et al. The safety of intravenous iron preparations: systematic review and meta-analysis. Mayo Clinic Proc. 2015 Jan;90(1):12-23