From the Guidelines
Melissa should take an iron supplement like ferrous sulfate 325mg once daily to treat her anemia, along with vitamin C to improve absorption, as recommended by the British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults 1. The diagnosis of iron deficiency anemia can be made by blood testing, and the underlying cause should be investigated, as approximately a third of men and postmenopausal women presenting with IDA have an underlying pathological abnormality, most commonly in the GI tract 1.
Key Considerations
- The supplement should be taken on an empty stomach, but if it causes stomach upset, it can be taken with food.
- Melissa should also increase iron-rich foods in her diet, including red meat, spinach, beans, and fortified cereals.
- She should avoid taking iron with calcium supplements, dairy products, coffee, or tea, as these can reduce absorption.
- If her symptoms include severe fatigue, dizziness, or shortness of breath, she should consult a healthcare provider for evaluation, as severe anemia may require additional treatment.
Treatment Approach
The approach to treatment depends mainly on symptoms, the severity of anemia, and etiology, and treatment should be considered for all patients with a hemoglobin level below normal 2.
Monitoring and Follow-up
Long-term monitoring of patients successfully treated for anemia appears warranted in order to detect and treat those with recurrent anemia, and UC patients in remission, and those with mild disease, should be monitored every 12 and 6 months respectively 2.
Iron Supplementation
Iron supplementation should be initiated when iron deficiency anemia is present, and iron supplementation can be administered orally, intramuscularly, or intravenously, with the choice of supplementation method determined by the symptoms, etiology, and severity of the condition 2.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Pernicious Anemia Parenteral vitamin B12 is the recommended treatment and will be required for the remainder of the patient's life. A dose of 100 mcg daily for 6 or 7 days should be administered by intramuscular or deep subcutaneous injection. If there is clinical improvement and if a reticulocyte response is observed, the same amount may be given on alternate days for seven doses, then every 3 to 4 days for another 2 to 3 weeks. By this time hematologic values should have become normal This regimen should be followed by 100 mcg monthly for life.
The diagnosis of Melissa's anemia is not explicitly stated, but based on the provided drug label, Pernicious Anemia is a possible diagnosis. The treatment for pernicious anemia is Parenteral vitamin B12 administered by intramuscular or deep subcutaneous injection, with an initial dose of 100 mcg daily for 6 or 7 days. This should be followed by 100 mcg monthly for life 3. Folic acid should be administered concomitantly if needed. Key points for treatment include:
- Initial dose: 100 mcg daily for 6 or 7 days
- Maintenance dose: 100 mcg monthly for life
- Administration route: Intramuscular or deep subcutaneous injection
- Concomitant treatment: Folic acid if needed
From the Research
Diagnosis of Anemia
- The diagnosis of iron deficiency anemia can be confirmed by findings of low iron stores and a hemoglobin level two standard deviations below normal 4.
- In chronic kidney disease patients, the diagnosis of iron deficiency can be problematic due to inflammation, leading to false high circulating ferritin and false low transferrin saturation 5.
- A systematic approach to evaluation can help determine the etiology of anemia, and the severity of the anemia impacts clinical outcomes, particularly in critically ill patients 6.
Treatment of Anemia
- Iron supplementation is recommended in chronic kidney disease patients to prevent or minimize anemia symptoms or to reduce the need for treatment with erythropoiesis stimulating agents or blood transfusions 5, 7.
- Intravenous iron is recommended in patients on dialysis treatment, while a 1-3 month trial of oral iron can be tried in non-dialysis patients 5.
- Oral iron therapy can be initiated to replenish iron stores, and parenteral therapy may be used in patients who cannot tolerate or absorb oral preparations 4.
- The underlying cause of iron deficiency should be treated, and identifying the underlying cause is necessary to help guide management of these patients 8.
Considerations for Treatment
- The optimal amount of iron supplementation and the safety of various agents available in clinical practice are concerns that continue to pose dilemmas in clinical practice 7.
- A restrictive transfusion strategy (ie, for patients with a hemoglobin < 6-8 g/dL) is associated with better outcomes than a more liberal transfusion strategy 6.