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Feature Article

Iron deficiency anaemia in adults: an update

EVA ZHANG, STEPHEN J.N. TATTERSALL

Figures

© SEBASTIAN KAULITZKI/SPL
© SEBASTIAN KAULITZKI/SPL

Abstract

Iron deficiency, and therefore iron deficiency anaemia, may result from an increased physiological requirement for iron, insufficient dietary intake, reduced absorption or excessive loss. The gastrointestinal tract is the most important source of excessive iron losses in men and postmenopausal women.

Key Points

  • Iron deficiency anaemia (IDA) is commonly seen in primary care and management principles include: making a confirmed diagnosis of IDA; identifying the cause of iron deficiency; correcting the deficiency.
  • Serum iron level is not a useful marker for iron deficiency; the most specific serological marker for iron status is serum ferritin.
  • Iron deficiency may result from increased physiological requirements, insufficient dietary intake, reduced iron absorption or excessive iron losses.
  • The gastrointestinal tract is the most important source of pathological iron losses in men and postmenopausal women.
  • In menstruating women the most common cause of IDA is menstrual loss; however, clinicians should be vigilant for coexisting gastrointestinal causes.
  • Endoscopic investigation with gastroscopy and colonoscopy is indicated in medically fit men and postmenopausal women to exclude a gastrointestinal cause.
  • Wireless capsule endoscopy may be considered if the cause of IDA remains obscure after gastroscopy and colonoscopy.
  • Oral iron supplementation is practical, safe and well-tolerated. Alternate-day dosing can improve tolerability and iron absorption.
  • Intravenous (IV) iron infusion is indicated in select patients, including those who are intolerant of or refractory to oral supplementation. Newer IV formulations can provide adequate iron replenishment in one dose with short infusion times and excellent safety profiles.

Figures

© SEBASTIAN KAULITZKI/SPL
© SEBASTIAN KAULITZKI/SPL