Preparations containing 40-50 mg of elemental iron per tablet can be used as dietary supplements.
There are cases where the desired result is not achieved, and this may be due to:
Alternative routes of iron intake
In some cases when it is not possible to take iron orally: such as in children, in non-normal individuals, in people who donate blood regularly, in patients who do not tolerate oral therapy especially in patients with ulcerative colitis, Crohn's disease, Osler's disease, tropical sprue, in hemodialyzed patients, in patients using erythropoietin, it is taken via parenteral route (I/V or I/M).
In these cases, it should be noted that when taken I/V there is a possibility of anaphylactic reactions, therefore it should be done in the presence of a doctor. Whereas when given I/M it should be administered deeply, continuously changing the site because it may stain (dark spots) the skin and cause pain at the injection site.
Initially, a hypersensitivity test should be performed by injecting 0.5 ml I/M and after 1 hour the full dose is administered. Whereas when to be injected I/V, after the hypersensitivity test is performed, if the preparation is in a 2 ml vial it is administered undiluted at 1 ml/min (USA) while another method is to combine the entire dose to be given to the patient in 100 ml physiological solution 0.9% and to administer at 1 ml/min for the first 5 minutes and then gradually increase the dose to 2-3 ml/min (United Kingdom).
It is also a confirmation of the diagnosis (therapeutic diagnosis). The diagnosis of IDA is fully established after 1 month from the start of treatment, because the therapeutic criterion is also needed.
As a rule, Hb should increase by 2 gr/dl every 3 weeks (0.15-0.2 gr/dl/day). The increase in Hb is more pronounced the deeper the anemia. On day 7-8 (day 5-10) from the start of treatment, a reticulocyte crisis is expected (the increase in reticulocytes that begins on day 3-4 of treatment and peaks on day 7-10) which is greater the more pronounced the anemia is.
Treatment with blood transfusion in a patient with iron deficiency anemia may cause an increase in reticulocytes due to the iron content in it (450 ml of whole blood contains about 250 mg iron). However, Iron Deficiency Anemia is a chronic anemia and rarely, especially in younger ages who tolerate anemia well, requires blood transfusion. For 4-6 weeks of regular treatment with a therapeutic dose, the clinical and laboratory should normalize, except for ferritinemia which theoretically requires another 6 weeks of treatment to normalize.
In mild and moderate stages of anemia, a significant reticulocyte response is not expected. Three months after starting the iron preparation, a full evaluation of the treatment should be done with: the evaluation of Hb and Ht values, erythrocyte constants (MCV, MCH, MCHC), erythrocyte population in the red series and the value of iron reserves in the body (ferritinemia, sideremia and transferrin saturation).
In mild and moderate stages of anemia, a significant reticulocyte response is not expected. Three months after starting the iron preparation, a full evaluation of the treatment should be done with: the evaluation of Hb and Ht values, erythrocyte constants (MCV, MCH, MCHC), erythrocyte population in the red series and the value of iron reserves in the body (ferritinemia, sideremia and transferrin saturation).
In the beginning, the treatment (not only iron for Iron Deficiency Anemia, but also vitamins used for the treatment of Megaloblastic Anemia) affects the improvement of the clinic (and laboratory changes) and after these normalize it will move to replenishing the stores. In cases where the cause is not removed, the treatment will continue to keep the stores filled (to not empty them again).
Treatment may continue even after three months if the desired result (normalization of ferritinemia) has not been achieved, which may come from: irregular medication intake, persistence of the cause, etc.
Red series indicators may normalize later than the normalization of Hb. When remission occurs, the hypochromic microcytic population will be replaced by the normochromic, normocytic population. As for epithelial lesions, regenerations in the tongue and nails are faster. The regeneration of the papillae begins 1-2 weeks from the start of treatment and normalizes completely after 3 months. Nail changes are fully regulated after 3-6 months. Atrophic gastritis generally does not respond to treatment especially in older people, while in those under 30 years of age it can almost fully regenerate. The same goes for dysphagia.
The recurrence of the disease (relapse) can be associated with incomplete treatment or when the cause has not been eliminated.
In case of accidental intake of a large amount of iron, gastric lavage, lavage with NaHCO3 1% solution should be done and deferoxamine can also be used orally.
The level of ferritinemia (serum ferritin) is the most reliable indicator of iron stores. Exceptions are liver diseases, tumors, treated IDA. In infants with iron deficiency, there is an increase in serum ferritin to normal values in the first weeks of treatment. Although the hematological response occurs in the first 3 weeks, there is no increase in ferritinemia, so in adults, ferritinemia will not increase until Hb reaches normal values (this study indicates that standard treatment of iron deficiency anemia in adults does not cause a rise in serum ferritin until hemoglobin levels are normal).
In case of anemia, collapse, shock, the organs which are most important (heart, brain, lungs, kidneys) will be supplied with blood and the supply to other organs (skin, GI system, muscles) will be reduced. Iron deficiency is expressed initially or pushes you to go to the doctor with the presentation of iron deficiency anemia (or at least the clinic of the impairment of the function of iron-proteins which do not transport O2 is not given due attention until the deficiency of iron becomes fully clear).
Anemia is a common concern in pediatric age. In this group, anemia can significantly have more complications than in young adults and can significantly harm the quality of life. The prevalence of anemia fluctuates from 8-44% with higher prevalence in males over 85 years old.
The NHANES-III and WHO study found a prevalence of anemia up to 11% in males and 10.2% in females over 65 years old.
Multiple pathophysiologic abnormalities in a single patient are well known. Identifying each of these abnormalities significantly contributes to the overall improvement of physiological parameters as well as quality of life.
Populations at risk of developing iron deficiency should be considered for prophylactic iron therapy (pregnancy and breastfeeding, women with menorrhagia, preterm infants, children, women in the reproductive period, regular blood donors, patients using continuous aspirin therapy, strict vegetarian diet users).
Pregnant women have been given iron supplements since World War II. Usually, it is given in capsules containing vitamins-microelements (among others calcium and iron). If a pregnant woman is anemic (hemoglobin <11 g/dL), iron is used at a different time of day than calcium because calcium inhibits iron absorption. The practice of routine iron administration in pregnant women has been challenged recently; however, prophylactic iron therapy during the second half of pregnancy (even more so in those with IDA and treated according to protocol) is valuable as well as the measurement of serum iron and ferritin.
Iron supplements in the diet of children (infants) are publicly advisable. Premature infants need more than infants. Infants who grow rapidly and consume cow's milk need more iron because the high concentration of calcium in cow's milk inhibits iron absorption. Usually, children get iron from fortified foods (milk, biscuits, cereal).
Iron supplementation in populations that follow a vegetarian diet is advisable due to the lower bioavailability of inorganic iron than heme iron. Iron fortification in foods in those countries where meat consumption is a significant part of the diet is a matter of debate and in some cases may be harmful.
The gene for familial hemochromatosis (HFe gene) is common (8% of US white population). In Albania, it is not known. But it is known that we have 7-8% of the population with hemoglobinopathy (some areas and more), which as a rule have normal or excessive amounts of iron in the body. Excess iron is a cause of coronary artery disease, heart attacks, some carcinomas, neurodegenerative diseases since iron plays a significant role in the formation of free oxygen radicals.
IDA is a pathology that is easily treated with very good results if the cause is eliminated and the iron stores are replenished. But it can be a manifestation of diseases with a poor prognosis such as neoplasia. The prognosis can be complicated if the patient has accompanying cardiac or cardiopulmonary diseases.
Medical staff and people in general should show greater awareness of iron deficiency, its early diagnosis, and the identification of causes (etiology). Public Health personnel in geographic regions where iron deficiency is common should be aware of the importance of iron deficiency, its impact on work performance, the importance of iron intake in pregnant women and children. Iron fortification in foods used in these areas may reduce this problem.
Limitation of activity is usually not required. In moderate and severe forms, especially in elderly patients and those with cardiopulmonary disease, they should limit their activity until iron therapy yields results. These patients, when they become hypoxic or develop coronary insufficiency, should be hospitalized and stay in bed until their anemia is corrected with blood transfusion. It should be emphasized that these measures are taken individually.
March hemoglobinuria can cause iron deficiency and in this case, treatment will also require modification of activity. Avoiding jumps or using appropriate sneakers when running usually reduces hemoglobinuria.
Hospitalization for the treatment of a patient with simple IDA is rarely required. It may be necessary when it's required to identify the etiology of the anemia (e.g., identifying sources of bleeding when there are occult blood stools through endoscopic or angiographic examinations or for the treatment of aggravated cardiopulmonary pathologies from anemia, or for the treatment of major diseases (neoplasia, ulcerative colitis).