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Iron-Deficiency Anemia

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Management of Anemia

Abstract

Iron deficiency and the anemia that results occur worldwide and determining that iron deficiency is the sole or a contributing factor for the anemia is crucial in initiating appropriate treatment. Signs and symptoms of iron deficiency are subtle and nonspecific. In the absence of inflammation, a TSAT <15% and a ferritin <30 ng/mL indicate iron deficiency. Inflammation through its effects on transferrin and ferritin alters these parameters. Marrow erythroblast through erythroferrone suppresses liver-derived hepcidin to optimize iron mobilization and absorption when iron is needed for Hb synthesis. Availability of iron at the level of the bone marrow is best assessed by the reticulocyte hemoglobin content or the percent of hypochromic cells. Treatment of iron deficiency must correct the underlying cause. Oral therapy, even at doses <100 mg/day are effective and produce less side effects than higher doses. IV iron should be reserved for iron-refractory iron-deficient anemia and that accompanying chronic inflammation. The role of iron in congestive heart failure and in some myopathic states is still being evaluated.

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  1. Department of Nephrology, Stanford University, 291 Campus Drive, Rm LK3C02, Stanford, CA, 94305, USA

    Anatole Besarab B.S.Ch.E., M.D.

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  1. Anatole Besarab B.S.Ch.E., M.D.
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  2. Stefan Hemmerich Ph.D.
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Correspondence to Anatole Besarab B.S.Ch.E., M.D. .

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  1. Department of Nephrology, St. John Hospital & Medical Center/DaVita Healthcare Partners, Detroit, Michigan, USA

    Robert Provenzano

  2. University of Illinois at Chicago College of Medicine/Advocate Christ Medical Center, Oak Lawn, Illinois, USA

    Edgar V. Lerma

  3. Durham Nephrology Associates, Durham, North Carolina, USA

    Lynda Szczech

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Besarab, A., Hemmerich, S. (2018). Iron-Deficiency Anemia. In: Provenzano, R., Lerma, E., Szczech, L. (eds) Management of Anemia. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-7360-6_2

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