What is the management of Iron Deficiency Anemia (IDA)?

From the Guidelines

Iron Deficiency Anemia (IDA) management involves iron repletion to improve quality of life and decrease the risk of complications related to anemia.

Diagnosis and Assessment

• The diagnosis of IDA is typically made using ferritin levels, with a cut-off value of 45 mg/dL recommended for individuals with anemia 1.
• However, in patients with inflammatory conditions, a ferritin level up to 100 mg/dL may still be consistent with iron deficiency 1.
• Transferrin saturation, soluble transferrin receptor, or reticulocyte hemoglobin equivalent may be helpful in confirming the diagnosis in these situations 1.

Treatment

• Oral iron supplementation is usually initiated first, with ferrous sulphate 200 mg twice daily being a common choice 1.
• However, intravenous (IV) iron may be given initially in patients with severe ID or conditions where oral iron may not be well absorbed 1.
• IV iron is more effective and better tolerated than oral iron in patients with clinically active inflammatory bowel disease (IBD), previous intolerance to oral iron, or hemoglobin below 100 g/L 1.
• The estimation of iron need is usually based on baseline hemoglobin and body weight 1.

Monitoring and Maintenance

• Laboratory monitoring is essential to recognize and manage treatment-emergent hypophosphatemia, a potential side effect of IV iron therapy 1.
• Patients should be monitored for infusion reactions, and accurate documentation of these reactions is crucial 1.
• After successful treatment of IDA with IV iron, re-treatment should be initiated as soon as serum ferritin drops below 100 mg/L or hemoglobin below 12 or 13 g/dL, according to gender 1.

From the Research

Management of Iron Deficiency Anemia (IDA)

The management of IDA involves several steps, including:

• Identification of ID/IDA 2
• Investigation of and management of the underlying etiology of ID 2, 3, 4, 5, 6
• Iron repletion, which can be achieved through oral or intravenous (IV) iron formulations 2, 3, 4, 5, 6

Iron Repletion Options

Iron repletion options include:

• Oral iron, which remains a therapeutic option for the treatment of ID in stable patients 2, 3, 4, 5, 6
• IV iron, which should be considered when there are no contraindications, when poor response to oral iron is anticipated, when rapid hematologic responses are desired, and/or when there is availability of and accessibility to the product 2, 3, 4, 5

Special Considerations

• Judicious use of red cell blood transfusion is recommended and should be considered only for severe, symptomatic IDA with hemodynamic instability 2
• Identification and management of ID and IDA is a central pillar in patient blood management 2
• The underlying cause of IDA should be treated, and oral iron therapy can be initiated to replenish iron stores 6
• Parenteral therapy may be used in patients who cannot tolerate or absorb oral preparations 6