Iron Therapy for IDA

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.