Management of IDA
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Oral iron
Oral iron is the cornerstone of therapy for IDA, an effective first line strategy for most patients provided the dose and duration are adequate.
Adequate doses of oral iron (100–200 mg of elemental iron per day in adults) can raise the haemoglobin level by around 20 g/L in a few weeks. This is equivalent to 2 units of red cells.
There are more than 100 iron containing preparations available over the counter in Australia but few contain a therapeutic dose for the treatment IDA.
Multivitamin-mineral supplements should be avoided because the elemental iron content is low (frequently 5 mg or less) and they may contain other ingredients that limit absorption.
To avoid confusion, write the name of the preparation down for the patient to take to the pharmacy.
Intravenous iron
Oral iron can not cover the needs of all patients, and intravenous iron is sometimes required in selected patients, in consultation with a specialist. Currrent preparations can be safely administered in day patient treatment centres and are relatively inexpensive.
In patients with IDA, intravenous iron can provide rapid iron repletion when this is clinically important, such as to prevent decompensation or transfusion (and its associated hazards).
Uncertainty about when and how to administer IV iron preparations is an important contributor to underutilisation in patients with indications: where the benefits outweigh the risks (and are less than transfusion). Timely consultation with a relevant expert is needed to ensure unnecessary transfusion is avoided and appropriate iron therapy is provided.
