Management of Iron Deficiency Anemia

Abstract

Anemia affects one-fourth of the world's population, and iron deficiency is the predominant cause. Anemia is associated with chronic fatigue, impaired cognitive function, and diminished well-being. Patients with iron deficiency anemia of unknown etiology are frequently referred to a gastroenterologist because in the majority of cases the condition has a gastrointestinal origin. Proper management improves quality of life, alleviates the symptoms of iron deficiency, and reduces the need for blood transfusions. Treatment options include oral and intravenous iron therapy; however, the efficacy of oral iron is limited in certain gastrointestinal conditions, such as inflammatory bowel disease, celiac disease, and autoimmune gastritis. This article provides a critical summary of the diagnosis and treatment of iron deficiency anemia. In addition, it includes a management algorithm that can help the clinician determine which patients are in need of further gastrointestinal evaluation. This facilitates the identification and treatment of the underlying condition and avoids the unnecessary use of invasive methods and their associated risks.

Keywords: Anemia of chronic disease; hemoglobin; intravenous iron; iron deficiency anemia; iron replacement therapy; oral iron.

Figure

A proposed algorithm for the management of iron deficiency anemia (IDA). ^a Endurance athletes and pregnant women should be treated without further diagnostic testing. ^b Celiac serology, anti-parietal cell antibody, Helicobacter pylori (stool), and fecal occult blood test. EGD, esophagogastroduodenoscopy; GI, gastrointestinal; Hb, hemoglobin; IV, intravenous; Ob/Gyn, obstetrics/gynecology.