Management Of Iron Deficiency Anemia Research Articles

Hematology Electronic Consultation As a Means for Effective Management of Iron Deficiency Anemia

Introduction: The use of non-visit electronic consultation (e-consult) can improve patient access to hematology care when an urgent in-person evaluation is not required. Prior studies have confirmed that e-consults have been rapidly adopted in certain settings, can resolve queries without the need for in-person follow-up, and, in turn, lead to an increase in total consult volume institutionally. Iron deficiency is a common reason for e-consult, however utilization trends, the efficacy and safety of iron repletion in this context, and the avoidance of face-to-face hematology consultation remain largely unknown. Methods: We performed a descriptive and retrospective electronic chart review of patients referred for iron deficiency or iron deficiency anemia from 1/2018 - 1/2020 at our single institution. Baseline patient demographics, underlying etiology of iron deficiency, pregnancy status, baseline and follow up laboratory values pre- and post-receipt of iron, type of iron formulation, and adverse events were obtained from detailed review of electronic medical records. Iron deficiency was defined as ferritin ≤ 50μg/L. The primary outcomes of interest included time to e-consult order placement to formal hematologist recommendation and time to intravenous (IV) iron infusion. Secondary outcomes included recurrence of iron deficiency, repeat e-consult, conversion to in-person evaluation, and whether the etiology of iron deficiency was appropriately assessed. We defined appropriate etiology assessment as either: 1) a determined etiology documented within the note of the requesting provider or by the hematology consultant, or 2) if evidence of workup to determine etiology had been recommended and initiated Results: A total of 180 e-consults for iron deficiency were reviewed over the 2-year study period. A summary of patient characteristics is included in Table 1. The median age of those referred was 40 years (interquartile range (IQR) 29-54). Sixty-eight percent of patients were Non-Hispanic White, 10% were Non-Hispanic Black, and there was a female predominance of 89%. Twenty-six percent lived outside the Portland metropolitan area. The most common attributed etiology of iron deficiency was uterine blood loss (27%), followed by gastrointestinal (17% blood loss, 13% malabsorption), and 7% of patients were pregnant at the time of e-consult placement. The most common IV iron formulations were low molecular weight iron dextran (43%) and ferumoxytol (30%), and adverse reactions were rare occurring in only 3.3% of patients. The median time from e-consult order placement to completion by hematology was 0.5 days (IQR 0-1) and from initial evaluation to IV iron infusion was 20 days (IQR 12-35) (Table 2). The median time of ferritin lab follow-up was 60 days when ordered by primary care provider and 37 days when ordered by hematology. Labs pre- and post-iron repletion rose from mean ferritin of 19.3 μg/L (standard deviation (SD) 33.1) to 166.9 μg/L (SD 127.2) and hemoglobin 11.7 g/dL (SD 1.8) to 12.7 g/dL (SD 1.6). Recurrence occurred in 58% of patients, and 13% of consults required in-person evaluation. The primary etiology was addressed in 45% of consults. Conclusion: The results from this analysis demonstrate that e-consults permit efficient and safe management of iron deficiency, improve access to hematology care, and generate cost savings for the healthcare system. With the growing utilization of e-consults for iron deficiency evaluation and management, wait times to initial hematology evaluation may improve while access to care is simultaneously increased. Future quality improvement efforts, such as standardizing note templates to document suspected etiology and automating follow-up labs at the time of iron infusion, should be considered to expedite appropriate workup, reduce risk of incomplete repletion and recurrence of iron deficiency, and optimize educational opportunities for ordering providers.

Pathophysiology and management of iron deficiency anaemia in pregnancy: a review.

According to World Health Organization (WHO), iron deficiency anaemia (IDA) is considered the most prevalent nutritional deficiency worldwide, affecting approximately 30% of the global population. While gastrointestinal bleeding and menstruation in women are the primary causes of IDA, insufficient dietary iron intake and reduced iron absorption contribute to the condition. The aim of IDA treatment is to restore iron stores and normalise haemoglobin levels in affected patients. Iron plays a critical role in various cellular mechanisms, including oxygen delivery, electron transport, and enzymatic activity. During pregnancy, the mother's blood volume increases, and the growing foetus requires a significant increase in iron. Iron deficiency during pregnancy is associated with adverse outcomes such as maternal illness, low birth weight, preterm birth, and intrauterine growth restriction. Iron supplementation is commonly used to treat IDA; however, not all patients benefit from this therapy due to factors such as low compliance and ineffectiveness. In the past, IV iron therapy was underutilised due to its unfavourable and occasionally unsafe side effects. Nevertheless, the development of new type II and III iron complexes has improved compliance, tolerability, efficacy, and safety profiles. This article aims to provide an updated overview of the diagnosis and management of IDA during pregnancy. It will discuss the advantages and limitations of oral versus intravenous iron and the pathophysiology, diagnosis, treatment, and overall management of IDA in pregnancy.

Adherence to ECCO Guidelines for Management of Iron Deficiency and Anemia in Inflammatory Bowel Diseases Among Israeli Adult and Pediatric Gastroenterologists.

The consensus guidelines of the European Crohn's and Colitis Organization (ECCO) for the diagnosis and treatment of iron deficiency anemia (IDA) were published in 2015. We examined the management practices of both adult gastroenterologists (AGs) and pediatric gastroenterologists (PGs) in Israel in treating ID among patients with inflammatory bowel disease (IBD). An 18-question multiple-choice anonymous questionnaire was electronically delivered to AGs and PGs. Questions explored 3 areas of interest: physician demographics, adherence to ECCO guidelines, and management practices of IDA in patients with IBD. Completed questionnaires were returned by 72 AGs and 89 PGs. Practice setting and years of practice were similar. A large majority of AGs and PGs (89% and 92%, respectively) measure complete blood count (CBC) and serum ferritin (S-Fr) at least every 3 months in outpatients with active IBD, as recommended by the ECCO guidelines. In contrast, in IBD patients in remission, only 53% and 26% of AGs and PGs, respectively ( P < 0.001), reported adherence to ECCO guidelines, measuring CBC and S-Fr every 6 months. The ECCO treatment guidelines recommend that intravenous (IV) iron should be considered the first-line treatment in patients with clinically active IBD, with previous oral iron intolerance and those with a hemoglobin level <10 g/dL. Study results indicate that only 43% of AGs recommend IV iron for these indications, compared to 54% of PGs ( P > 0.1). In this study we have demonstrated a relatively low level of adherence to ECCO guideline recommendations among both AGs and PGs, regarding the management of IDA in patients with IBD.

Correlation of sTfR, Hemoglobin, Serum Iron, and eGFR in Pre-dialysis CKD Patients at Sanglah Hospital

Patients with CKD usually have chronic inflammation and impaired antioxidant systems, which worsen with the degree of renal impairment. Anemia is one of the major complications in pre-dialysis CKD patients Examination of iron status that is commonly done today such as serum iron parameters, ferritin, and transferrin saturation is still influenced by the inflammatory process. As an alternative to assessing iron status, the soluble transferrin receptor (sTfR) is not affected by chronic disease or inflammation. The purpose of this study was to determine the correlation of sTfR, hemoglobin, serum iron, and estimation of glomerular filtration rate (eGFR) in pre-dialysis CKD patients. This research was conducted from February to June 2022 at the Nephrology Outpatient Clinic and Clinical Pathology Laboratory of Sanglah Hospital, Denpasar. This research is an observational analytic study with a cross-sectional study design. The research subjects involved were 61 pre-dialysis CKD patients who met the inclusion and exclusion criteria. The results showed that the research subjects consisted of 54.1% male and 45.9% female. The results of the Spearman correlation test showed a weak significant negative correlation between sTfR levels and serum iron in pre-dialysis CKD patients (r = -0.264; p=0.040), but no significant correlation with hemoglobin (r = -0.116; p=0.372) and eGFR ((r = 0.134; p=0.302). This study showed a significant correlation indicating that an increase in serum sTfR levels would affect a decrease in serum iron, so it could be considered as a marker for the management of iron deficiency anemia in CKD.

Iron Deficiency in Pregnancy: A Brief Review

This paper highlights iron deficiency anaemia in pregnancy; its prevalence, causes, screening, and management. Iron deficiency is a spectrum that ranges from iron depletion to iron deficiency anaemia. Iron deficiency is the most common and leading cause of anaemia in pregnancy both in developed and underdeveloped countries. The incidence of iron deficiency anaemia varies worldwide depending on differences in race, socioeconomic factors, nutritional status, health condition, and the frequency of parasitic illnesses. Untreated Iron deficiency has significant adverse foetal and maternal consequences. The management of iron deficiency anaemia includes education regarding dietary modification, specifically ways to enhance iron absorption and iron supplementation. Although oral supplementation is typically the mainstay of treatment, more severe cases of iron deficiency anaemia may require intravenous supplementation.

Reducing Barriers for Successful Management of Iron Deficiency Anemia in Pregnancy

Reducing Barriers for Successful Management of Iron Deficiency Anemia in Pregnancy

Management of iron deficiency anaemia in children

No abstract available Sri Lanka Journal of Child Health, 2023: 52(2): 204-208

Iron Preparations in the Management of Iron Deficiency Anemia in Infants and Children: A Systematic Review and Meta-Analysis

Iron Preparations in the Management of Iron Deficiency Anemia in Infants and Children: A Systematic Review and Meta-Analysis

Diagnostic Accuracy of complete Blood Count versus Serum Ferritin in Diagnosis of iron deficiency Anemia in Pregnant Women

Objective: To determine the frequency of confirmation of iron deficiency anemia in pregnant female on serum Ferritin who are labeled to have iron deficiency anemia on CBC in third trimester. Study Design: Cross-sectional study Study duration: October 2021 to March 2022. Setting: Department of Obstetrics &amp; Gynecology Lady Willingdon Hospital. Patients and Methods: A total of 200 patients who came to OPD were selected. Detailed history was obtained from patients and physical examination performed. CBC and serum ferritin was determined for every patient. All data was entered into the especially designed proforma. Results: Anemia was diagnosed in 74(37%) women. Highest frequency of anemia was seen in women in age group 20-30 years (33.78%), and in women with household income of Rs.15000/- to 50000/- per month. Mean hemoglobin of women was 11.41±1.05 gm. /dl. Mean MCV of women was 83.12±8.45 fl. Minimum and maximum MCV was 68 and 95 fl respectively. Mean serum ferritin level of women was 13.14±2.34 µ/l .Anemia was diagnosed in 75(37.50%) women as per complete blood count criteria. Anemia was diagnosed in 74(37%) women as per serum ferritin level criteria. Practical implication: This study will significantly contribute to the understanding and management of iron deficiency anemia in pregnant women, particularly during the third trimester. By confirming diagnoses through serum Ferritin tests in addition to complete blood count (CBC), the study can enhance the accuracy of diagnosis and treatment. Accurate detection of iron deficiency anemia will allow for more targeted and efficient treatment, thereby improving maternal and fetal health outcomes. Furthermore, this research could inform public health policies and intervention strategies aimed at preventing and managing iron deficiency anemia in pregnancy, ultimately improving the overall well-being of the community. Conclusion: Results of this study revealed that Serum ferritin level is a better diagnostic test for early detection of iron deficiency anemia in pregnant women. Keywords: Confirmation, Iron deficiency, Anemia, Pregnant, Serum Ferritin, Complete blood Count, Third trimester.

Analysis of Erythrocyte Indices and Reticulocyte Hemoglobin Equivalent in Iron Deficiency Anemia on Treatment

Assessment of treatment response is needed in the management of iron deficiency anemia (IDA). This study aims to analyze erythrocyte indices (MCH, MCV, MCHC) and Ret-He as indicators of IDA diagnosis and treatment response. A prospective cohort study in children ages 2-18 years old in orphanages throughout Makassar. Grouped into normal group and therapy group, consisting of IDA and iron deficiency groups. Elemental iron therapy 3mg/kg/day was given. Levels of MCV (fl), MCH (pg), MCHC (g/dL), and Ret-He (pg) were measured before and on the 8th day of therapy. The normality test of numerical variable data used the Kolmogorov-Smirnov test. The statistical test used the Mann-Whitney test, Wilcoxon Signed Rank test, and the Kruskal-Wallis test. Diagnostic value and cut-off determination using ROC curve analysis. Test results were significant if p&lt;0.05. The sample consisted of 40 subjects each in both normal and therapy groups. The therapy group was divided into 7 IDA and 33 iron deficiency. ROC IDA curve on MCV obtained a cut-off of 76 fl, a sensitivity of 100%, a specificity of 95%, NPP of 77.8%, NPN of 100%, MCH obtained a cut-off of 25 pg, a sensitivity of 100%, 97.5% specificity of 97.5%, NPP of 87.5%, NPN of 100%, Ret-He obtained cut-off 29 pg, sensitivity of 100%, specificity of 95%, NPP of 77.5%, NPN of 100%. MCV levels increased by 7.3% (p&lt;0.05) while Ret-He increased by 19.6% (p&lt;0.05) after therapy. The ROC curve coordinate on IDA showed that cut-off levels of MCV 76 fl, MCH 25 pg, and Ret-He 29 pg provided optimal sensitivity and specificity. Increasing MCV after therapy described increasing levels in erythrocyte and hematocrit synthesis. Increasing Ret-He after therapy described improving erythropoiesis quality. MCV, MCH, and Ret-He as indicators of diagnosing IDA. MCV and Ret-He monitor the success of IDA treatment response.

Expert consensus on improving iron deficiency anemia management in obstetrics and gynecology in Asia.

Iron deficiency anemia (IDA) is a major health burden among women in Asia. Key issues in IDA management in Asia are under-diagnosis and under-treatment. The lack of Asia-specific guidelines, and suboptimal utilization of treatment compounds the management of IDA. To address these gaps, a panel of12 experts in obstetrics, gynecology, and hematology from six regions in Asia convened to review current practices and clinical evidence and provide practical guidance on IDA diagnosis and management in Asian women. The Delphi approach was used to obtain objective opinions and attain consensus on statements pertaining to awareness, diagnosis, and management of IDA. In total, 79 statements attained consensus and are summarized to provide guidance on raising awareness of IDA and approaches for improved diagnosis and treatment of IDA among women in various settings: pregnancy, postpartum, heavy menstrual bleeding, gynecologic cancers, and perioperative care. This clinician-led consensus integrates appropriate recommendations based on clinical evidence and best practices and is intended to guide decision making in the management of iron deficiency/IDA in women. The expert panel raises a call for timely diagnosis and utilization of appropriate treatment, including use of high-dose intravenous iron, stringent blood management, and interdisciplinary collaboration, for optimization of IDA management among women in Asia.

An active new formulation of iron carried by aspartyl casein for iron-deficiency anemia: results of the ACCESS trial

Oral iron supplementation is the cornerstone for the management of iron-deficiency anemia. A new oral formulation of iron conjugated with N-aspartyl-casein (Fe-ASP) (Omalin®, Uni-Pharma) is studied in the ACCESS double-blind, double-dummy randomized clinical trial; 60 patients were randomized to 12-week oral treatment twice every day either with oral ferrous sulfate (FeSO4) delivering 47 mg elementary iron or oral Fe-ASP delivering 40 mg elementary iron. Participants had hemoglobin less than 10 g/dl, decreased red blood cell (RBC) count, and ferritin lower than 30 ng/ml; patients with a medical history of malignancy were excluded. The primary endpoint was the increase of Hb in the first 4 weeks of treatment, and the study was powered for non-inferiority. A new score of global improvement was introduced where all participants were given one point for any at least 10% increase of Hb, RBC, and reticulocytes. At week 4, the mean (SE) change of Hb was 0.76 g/dl in the FeSO4 group and 0.83 g/dl in the Fe-ASP group (p: 0.876). The odds for worse allocation of the global score were 0.35 in the Fe-ASP group compared to the FeSO4 group. Patients in the Fe-ASP group experienced a significant decrease in the number of IDA-related physical signs by week 4. No differences were found between the two groups in any of the patient-reported outcomes of fatigue and of gastrointestinal adverse events either at week 4 or at week 12. ACCESS is the most recent clinical trial showing the non-inferiority of Fe-ASP to FeSO4 for the primary endpoint of the Hb change.

Iron supplementation for iron-deficiency anaemia

Background: In recent years, iron supplementation has increased significantly because of the damaging systemic effects of iron deficiency anaemia (IDA) being reported. The standard first-line therapy is oral iron tablets, with over 70% of recipients experiencing gastrointestinal adverse effects. Methods: This recent review of high-quality literature compares the effectiveness and adverse effects of tablet and liquid forms of iron supplementation in patients with IDA. Findings: The evidence to date indicates that both forms of iron supplementation are equally effective. However, the literature consistently and strongly supports the use of the liquid form of iron supplementation (ferrous sulfate) over the tablet form (ferrous sulphate or ferrous fumarate) in terms of adverse effects. Conclusions: Healthcare professionals should consider recommending the use of liquid iron formulation for the management of IDA and switch patients to this form if they experience gastrointestinal adverse effects. This may help to effectively manage IDA.

Comparative study on intravenous iron sucrose versus intravenous ferric carboxymaltose in the management of iron deficiency anaemia in pregnancy in a tertiary care hospital, Bengaluru

Background: Iron deficiency is the most common nutritional deficiency worldwide; it affects 1.6 billion people Iron deficiency (ID) and iron deficiency anemia (IDA) are often encountered in the general population, particularly among children and women with abnormal uterine bleeding (AUB) and during pregnancy as well as postpartum period Intravenous (IV) iron replacement can deliver the total amount of required iron over a short period. Currently, the most commonly used IV iron formulations are iron sucrose (IS) and ferric carboxymaltose (FCM) [4-6]. Iron sucrose does not require test dose and is safe. Ferric carboxymaltose (FCM) is the latest I.V. iron formulation which can be used at high doses and allows rapid administration (up to 1000 mg in a single dose infused in 15 minutes) The present study was a comparative study of parenteral iron therapy (intravenous iron sucrose versus intravenous ferric carboxymaltose in the management of iron deficiency anaemia in pregnancy.Methods: In the present study, 50 pregnant women with IDA were randomly distributed into two groups of 25 each. Group - A: 25 receiving intravenous iron sucrose therapy; Group - B: 25 receiving intravenous ferric carboxymaltose therapy.Results: Majority of the study participants in Group A had gestational age between 20–25 weeks (48%). The mean age of the study participants in Group A was found to be 22.86+4.42 weeks. Majority of the study participants in Group B had gestational age between 20-25 weeks (36%). The mean age of the study participants was found to be 23.01+3.01 weeks. Majority of the study participants in Group A had nil parity (40%). 36% of the study participants in Group B had nil parity. 60% of the study participants in group A had Mild degree of anaemia with 52% in group B having mild degree of anaemia. 40% and 44% of the study participants in group A and group B had Moderate degree of anaemia respectively. The association was found to be statistically significant between the mean Hb and Ferritin values pre-treatment, 3rd and 6th week follow-up post treatment and the 2 groups of study participants. The adverse effects were comparatively lower among Group B (IV ferric carboxymaltose) than Group A (IV iron sucrose) of the study participants.Conclusions: IV ferric carboxymaltose administration increases the hemoglobin level more rapidly as compared to iron sucrose in women with iron deficiency anemia in the pregnancy. It also stores iron more rapidly. No serious adverse effects were recorded. Ferric carboxymaltose is well tolerated, safe and effective alternative to iron sucrose in iron deficiency anemia of pregnancy. FCM has the advantage of a large dose administration per sitting and early rise in hemoglobin level.

A clinical study on the homoeopathic management of iron deficiency anaemia in women of reproductive age group

A clinical study on the homoeopathic management of iron deficiency anaemia in women of reproductive age group

Knowledge, attitude, and practices of general female population toward iron deficiency anemia in Al-Jouf, Saudi Arabia

Background: Iron deficiency anemia (IDA) is a major public health issue in all countries. Considering the link between IDA and the lack of suitable knowledge, attitude, and practice, IDA could be prevented. Thus, this study aimed to determine the awareness and management of IDA among the general female population in the Al-Jouf region, Saudi Arabia. Methods: This was a cross-sectional study conducted among females in the general population of Saudi Arabia from August to October 2022. Data were collected from participants through an online self-administered questionnaire via Google Forms. A convenient non-probability sampling technique was used to select the study participants. Results: A total of 382 participants were involved in this study. Most of the participants were aged between 26 and 30 years (43.5%) and the majority of them were graduated. It was found that the mean knowledge score was 12.4 ± 5.5 points and the highest proportion of participants had poor knowledge (76.2%). Doctors or healthcare professionals were the main sources of knowledge about IDA. Regarding attitude and practice, iron supplements/tablets were prescribed to 40.3% of the participants however, most of them (31.7%) occasionally followed the recommended dose of iron supplements. Furthermore, it was found that age, nationality, marital status, number of children, occupation, and monthly income were significantly associated with knowledge about IDA (p &amp;lt; 0.001). Conclusion: The general female population in the Al-Jouf region in Saudi Arabia had inadequate knowledge, negative attitudes, and practice toward IDA. Several socio-demographic variables were found to be significantly associated with knowledge about IDA.

Intravenous Iron Sucrose versus Intramuscular Iron Sorbitol in management of iron deficiency anemia during pregnancy

Intravenous Iron Sucrose versus Intramuscular Iron Sorbitol in management of iron deficiency anemia during pregnancy

Sorbet Made from Moringa Leaves and Red Guava as an Alternative for the Management of Iron Deficiency Anemia in Adolescent Girls

Moringa leaves (Moringa oleifera) contain high iron (Fe) but low bioavailability of Fe because it contains calcium and tannins. Vitamin C in red guava fruit (Psidium guajava) can increase Fe absorption. Sorbet made from red guava and Moringa leaves can be an alternative to overcome iron deficiency anemia in adolescent girls. This study aims to analyze the level of acceptance, levels of Fe, Ca, vitamin C, and tannins, as well as the bioavailability of Fe sorbet made from red guava and Moringa leaves. Sorbet consists of 5 formulas including, F1 (strawberry sorbet), F2 (red guava sorbet), F3 (Moringa leaf sorbet), F4 (red guava sorbet + 18% Moringa leaves), and F5 (red guava sorbet + 22% Moringa leaves). Acceptance level was tested with the hedonic method (appearance, smell, taste, and texture) and statistically analyzed using Friedman and Wilcoxon test. The Fe and Ca were analyzed using X-Ray Fluorescence (XRF) method, vitamin C and tannins were analyzed using High-Performance Liquid Chromatography (HPLC) and spectrophotometry methods. Fe bioavailability test was performed using the inverted bowel bag method. The level of preference for each attribute was significantly different (p &lt; 0.05). The level of preference chosen was F2. The mean levels of Fe, Ca, vitamin C, and tannins in F4 were 0.95 ± 0.14, 5.91 ± 0.73, 26.29 ± 0.13, and 135.65 ± 0.91 mg/100 g. The mean levels of Fe, Ca, vitamin C, and tannins in F5 were 0.21 ± 0.29, 6.03 ± 0.67, 46.72 ± 0.69, and 87.76 ± 0.40 mg/100 g. The highest Fe bioavailability was F5 while the lowest was F3. The best formula based on the parameters of preference, Fe, Ca, vitamin C, and tannin levels, as well as Fe bioavailability, was sorbet F5.

Management of nutritional iron deficiency anemia for young children in the emergency department.

Guidelines for young children with nutritional iron deficiency anemia (IDA) presenting to the emergency department (ED) are lacking, leading to variability in care. We aimed to standardize management of these patients through the development and implementation of an evidence-based algorithm using quality improvement methodology. Baseline data of the target population (n=42; 60% male; median age 22.5 months, median hemoglobin 5.3g/dl) identified variability across four key measures of clinical management: laboratory evaluation, therapy choice, therapy administration, and patient disposition. Literature review and consensus from pediatric hematology providers informed a draft algorithm that was refined in an iterative multidisciplinary process. From September 2020 to June 2021, we aimed to increase IDA management per the algorithm by ≥20% relative to baseline for the four key outcome measures using sequential Plan-Do-Study-Act (PDSA) cycles. Process measures focusing on provider communication/documentation and balancing measures involving efficiency and therapy-related adverse events were assessed concurrently. Thirty-five patients were evaluated among four PDSA cycles and shared similar characteristics as the baseline population. Improvements of ≥20% above baseline adherence levels or 100% adherence were achieved for all outcome measure across four PDSA cycles. Adherence to recommended laboratory evaluation improved from 43 (baseline) to 71%, therapy choice from 78 to 100%, therapy administration from 50 to 83%, and disposition from 85 to 100%. ED length of stay remained stable. Implementation of a standardized algorithm for young children with nutritional IDA in the ED increased adherence to evidence-based patient care.

Clinical progress note: Inpatient management of iron deficiency anemia.

Clinical progress note: Inpatient management of iron deficiency anemia.