Iron Therapy for IDA –
Goals of therapy- supply sufficient iron to correct the HB deficit + replenish storage iron
Oral iron- treatment of choice for most patients because of its effectiveness, safety, and economy and always given preference over parenteral iron.
Dose - 100–200 mg of elemental iron Oral dose till HB correction and then empirically for an additional 4–6 months
M/C Adverse effects – GI – Alternative- reduce the dose / once daily dosing.
Costly iron preparations with additives, complexes/enteric coatings or in sustained-release forms do not appear to offer any advantages that cannot be achieved by dose reduction
Parenteral iron therapy Indications -
(1) remains intolerant of oral iron despite repeated modifications in dosage regimen;
(2) has iron needs not met by oral therapy because of either chronic uncontrollable bleeding sources of blood loss, such as hemodialysis/ coexisting chronic inflammatory state/ malignancy
(3) malabsorbs iron
(4) has IRIDA.
Life-threatening anaphylactic reactions constitute the most serious risk- max with iron dextran.
Response to Iron therapy - 1) reticulocytosis, which begins approximately 3–5 days, peak @ 8-10 days and 2) a significant increase in hemoglobin present by 3 weeks after iron therapy is begun, and persists until the hemoglobin concentration is restored to normal
Failure to Iron therapy- poor compliance with oral iron therapy; malabsorption of therapeutic iron; continuing blood loss; and the effects of coexisting conditions, especially infectious, inflammatory, or malignant disorders
Decompensated anemia – the only indication for RBC transfusion / chronic iron loss exceeds rate to replace with parental therapy.