What are the assessment and treatment options for Anemia (Iron Deficiency Anemia)?

From the Guidelines

Anaemia assessment and treatment should begin with a complete blood count to determine hemoglobin levels, followed by iron studies and further evaluation to identify the underlying cause, with treatment depending on the specific type of anaemia, as recommended by the most recent guidelines 1.

Anaemia Assessment

Anaemia assessment begins with a complete blood count to determine hemoglobin levels, with values below 13 g/dL in men and 12 g/dL in women indicating anaemia. Further evaluation should include a peripheral blood smear, reticulocyte count, and iron studies (ferritin, transferrin saturation) to identify the underlying cause, as ferritin is the most commonly used marker for diagnosing iron deficiency, with a recommended cut-off value of 45 mg/dL in individuals with anaemia 1.

Treatment of Iron Deficiency Anaemia

For iron deficiency anaemia, oral iron supplementation usually is initiated first, but often is tolerated poorly because of side effects such as nausea, abdominal pain, and constipation, and intravenous (IV) iron formulations may be given initially in some patients with severe ID or conditions in which oral iron may not be well absorbed 1. The goal of treatment is to improve quality of life and decrease the risk of complications related to anaemia, with iron repletion needed to achieve this goal.

Key Considerations

• Iron replacement therapy should be accompanied by treatment of the underlying cause of iron deficiency, such as gastrointestinal pathologies or chronic blood loss 1.
• Bidirectional GI endoscopy is the standard diagnostic approach to examination of the upper and lower GI tract, though radiological scanning is an alternative in some situations for assessing the large bowel 1.
• Wireless capsule endoscopy plays an important role in assessment of the small bowel in recurrent or refractory iron deficiency anaemia 1.
• Multidisciplinary management including gastroenterologists, hematologists, and nutritionists often is needed in complex cases, with nutritional consultation often helpful to increase dietary iron intake, and a hematology consultation can help with complex anaemia situations or if there is difficulty accessing intravenous (IV) iron 1.

From the FDA Drug Label

Evaluate iron status before and during treatment and maintain iron repletion. Correct or exclude other causes of anemia before initiating treatment ( 2.1). In patients with CKD: Initial dose: 50 to 100 Units/kg 3 times weekly (adults) and 50 Units/kg 3 times weekly (pediatric patients). Use the lowest PROCRIT dose sufficient to reduce the need for red blood cell (RBC) transfusions [see Warnings and Precautions (5.1)].

The assessment and treatment of anemia involves:

• Evaluating iron status before and during treatment and maintaining iron repletion
• Correcting or excluding other causes of anemia before initiating treatment
• Using the lowest dose of PROCRIT sufficient to reduce the need for red blood cell (RBC) transfusions
• Initial dose for patients with CKD: 50 to 100 Units/kg 3 times weekly (adults) and 50 Units/kg 3 times weekly (pediatric patients) 2 Key considerations:
• Evaluate iron stores and nutritional factors before and during treatment
• Monitor response to therapy and adjust dose as needed
• Use the lowest dose that will maintain a hemoglobin level sufficient to reduce the need for RBC transfusions 2
• Individualize dosing and use the lowest dose of PROCRIT sufficient to reduce the need for RBC transfusions 2

From the Research

Anaemia Assessment and Treatment

• Anaemia is a condition characterized by a decrease in the amount of iron in the body, leading to hypochromic anemia and poor hemoglobin synthesis 3.
• Iron deficiency anaemia can be caused by insufficient intake of iron-rich foods, increased necessities during growth period, pregnancy, erythrocytes hyperregeneration, high-performance sportsmen, increased loss by digestive way, genito-urinary way, respiratory, hemorrhagic syndromes 3.
• Laboratory investigations useful for diagnosis include microcytic, hypochromic anemia, decreased serum iron level, total capacity of iron binding increased, medullar iron store absent, good response to iron therapy 3.

Treatment Options

• Oral iron supplementation is often the first-line treatment for the acute and chronic management of iron deficiency due to its ease and accessibility 4.
• Ferro-Folgamma is one of the most indicated medicines in iron deficiency anemia, due to its components, including iron, folic acid, and B12 vitamin 3.
• Iron polymaltose complex (IPC) is a novel oral iron formulation with better absorbability, predictable haematinic response, and less side effects compared to oral ferrous fumarate 5.
• A combination ferrous fumarate product was found to be significantly more effective than a ferric iron polysaccharide complex in a 12-week study, with a slightly higher frequency of gastrointestinal side effects 6.

Response to Treatment

• Treatment with iron increased significantly serum folate and vitamin B12 from baseline in young adult women with iron deficiency anaemia 7.
• An haematological response was obtained in 97.2% of patients at 4-month follow-up, with significant increases in glucose, uric acid, total cholesterol, HDL cholesterol, and bilirubin, and a decrease in urea 7.
• Daily low dose and every other day dosing protocols have attempted to bypass the physiologic bottleneck of iron absorption, allowing for effective absorption and limiting side effects 4.