What is the management of iron deficiency anemia (IDA)?

From the Guidelines

Management of iron deficiency anemia primarily involves oral iron supplementation, with ferrous sulfate 325 mg (containing 65 mg elemental iron) taken 1-3 times daily being the standard first-line treatment, as recommended by the British Society of Gastroenterology guidelines 1. This should be taken on an empty stomach with vitamin C to enhance absorption, though it can be taken with food if gastrointestinal side effects occur.

• Treatment should continue for 3-6 months: 3 months to correct anemia and an additional 3 months to replenish iron stores.
• Common side effects include constipation, nausea, and black stools. For patients who cannot tolerate oral iron, intravenous iron formulations like iron sucrose or ferric carboxymaltose are options, especially in cases of malabsorption, inflammatory bowel disease, or when rapid correction is needed, as suggested by the European Crohn's and Colitis Organization guidelines 1. The underlying cause of iron deficiency must be identified and addressed, whether it's blood loss (menstrual, gastrointestinal), poor dietary intake, malabsorption, or increased requirements during pregnancy.
• Dietary counseling should complement supplementation, encouraging consumption of iron-rich foods like red meat, beans, leafy greens, and fortified cereals. Hemoglobin levels typically improve within 2-4 weeks of starting treatment, with complete normalization expected within 2 months in uncomplicated cases, as noted in the ESPEN guideline on clinical nutrition in inflammatory bowel disease 1. Regular monitoring of hemoglobin, ferritin, and transferrin saturation is recommended to assess treatment response, with re-treatment with intravenous iron 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 FDA Drug Label

Venofer is indicated for the treatment of iron deficiency anemia (IDA) in patients with chronic kidney disease (CKD). Venofer must only be administered intravenously either by slow injection or by infusion. The dosage of Venofer is expressed in mg of elemental iron. Each mL contains 20 mg of elemental iron.

The management of iron deficiency anemia involves administering iron sucrose (IV), with the dosage and administration varying depending on the patient's condition, such as:

• Hemodialysis Dependent-Chronic Kidney Disease (HDD-CKD): 100 mg undiluted as a slow intravenous injection or as an infusion of 100 mg diluted in a maximum of 100 mL of 0.9% NaCl.
• Non-Dialysis Dependent-Chronic Kidney Disease (NDD-CKD): 200 mg undiluted as a slow intravenous injection or as an infusion of 200 mg in a maximum of 100 mL of 0.9% NaCl.
• Pediatric Patients: 0.5 mg/kg, not to exceed 100 mg per dose, every two or four weeks for 12 weeks. It is essential to follow the recommended dosage and administration guidelines to ensure safe and effective treatment of iron deficiency anemia 2, 2, 2.

From the Research

Management of Iron Deficiency Anemia

The management of iron deficiency anemia involves several steps, including:

• Identification of iron deficiency and iron deficiency anemia (IDA) 3, 4, 5
• Investigation of and management of the underlying etiology of iron deficiency 3, 4, 6
• Iron repletion using oral or intravenous (IV) iron formulations 3, 4, 7, 6

Iron Repletion Options

Iron repletion options include:

• Oral iron, which remains a therapeutic option for the treatment of iron deficiency in stable patients 3, 4, 7
• 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 3, 4, 6

Blood Transfusion

Judicious use of red cell blood transfusion is recommended and should be considered only for severe, symptomatic IDA with hemodynamic instability 3

Patient Management

Nurses can support the management of iron deficiency anemia by:

• Identifying possible causes 5
• Ordering blood tests 5
• Advising on diet and iron supplementation 5
• Referring patients for additional investigations as required 5

Treatment Approaches

There are limited data to support current treatment approaches regarding oral iron preparation, dosing, monitoring, and duration of therapy 4 New intravenous iron agents have improved safety profiles, which may foster their increased utilization in the treatment of patients with IDA 4 Clinical trials focused on improving current treatment standards for IDA are sorely needed 4