Iron Deficiency Anemia, Oral and Intravenous Iron Therapy, Dose and Recommendations: Dr. Adil Ramzan

Iron deficiency anemia is not an uncommon disorder. A large number of population is of developing countries such as Pakistan is affected by iron deficiency anemia. Women are more affected as compared to men due to obvious reason such as menorrhagia, polymenorrhagia, Postpartum bleeding etc.

Signs on Physical Examination

Physical examination can show:

1. Tachycardia
2. Smooth tongue
3. Brittle nails
4. Koilonychia
5. Pallor
6. PICA
7. Esophageal webs. 

Stages of Iron Deficiency

Iron deficiency anemia is divided into three stages,

• Stage 1 is called negative iron balance, 
• More iron is used than intake, but there will be no anemia, no change in RBC morphology, but iron stores will be low.
• Stage 2 is called iron deficient erythropoiesis. 
• Iron stores are depleted, hypochromic picture may appear in the RBC morphology
• Stage 3 is the iron deficiency anemia
• Hemoglobin decreases with hypochromic and microcytic RBC morphology. 

Diagnosis of Iron deficiency Anemia

Diagnosis is simple, serum iron, ferritin and total iron binding capacity are some blood tests that are used to diagnose iron deficiency. On a simple blood complete profile, decreased Mean corpuscular volume (MCV) and Mean corpuscular hemoglobin (MCH) can be seen. 

Following diagram will help in explaining the different stages of iron deficiency anemia

Treatment of Iron Deficiency Anemia

Once iron deficiency is diagnosed, iron is given with the help of any of the following means.

1. Oral iron therapy

• Oran iron therapy is done by giving 200mg of elemental iron per day in the form of 3-4 tablets per day. Oran iron is availabe in different forms. 
2. Parenteral iron therapy 
• it is indicated when
• Patient can't tolerate or take oral therapy
• Severe iron deficiency, acute management is needed
• Parenteral iron preparation are diluted in 5% dextrose or 0.9% NaCl solution an infused over 60-90 minutes duration. Risk of anaphylaxis is more with iron dextran but less with newer preparations such as ferric gluconate, ferric carboxymaltose and iron sucrose. Blood transfusion
3. Blood transfusion
• It is indicated when;
• There are symptoms or anemia
• There is cardiac failure
• There is excessive blood loss.

Dr. Farida Tahir, the Associate Professor of Shaheed Zulfiqar Ali Bhutto Medical University, says during a teaching session at Medical Unit 2 of Pakistan Institute of Medical Sciences Islamabad,

"Continue oral iron therapy for atleast six more weeks after you achieve the desired hemoglobin level. This is to replenish the stores or iron. Moreover, oral and parenteral iron has almost similar bioavailability unless there is sever malbsorption or some gastrointestinal pathology, so we may preferable use the oral therapy" 

Last updated: 26th March 2016

        Dr. Adil Ramzan, MBBS, Resident MD Internal Medicine, Pakistan Institute of Medical 
            Sciences, Shaheed Zulfiqar Ali Bhutto Medical University PIMS