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Iron deficiency and new insights into therapy.

Abstract Iron deficiency and iron deficiency anaemia remain prevalent in Australia. The groups at highest risk are pre-menopausal women, socially disadvantaged people and those of Indigenous background. Diagnosing iron deficiency using a full blood examination and iron studies can be difficult and can be further complicated by concomitant inflammation. Results of iron studies should always be interpreted as an overall picture rather than focusing on individual parameters. In difficult clinical scenarios, soluble transferrin receptor assays can be useful. Management of iron deficiency involves identification and treatment of the cause of iron deficiency, as well as effective iron replacement. Clinicians should always take a detailed history and perform a comprehensive physical examination of a patient with iron deficiency. Patients should be monitored even if a likely cause of iron deficiency is identified. Patients who fail to respond to iron replacement or maintain iron status should be referred for further investigation, including endoscopy to exclude internal bleeding. Both enteral and parenteral iron are effective at replacing iron. For most adult patients, we recommend trialling daily oral iron (30-100 mg of elemental iron) as the first-line therapy. Safety and efficacy of intravenous iron infusions have improved with the availability of a newer formulation, ferric carboxymaltose. Patients who fail to respond to oral iron replacement can be safely managed with intravenous iron. Blood transfusion for iron deficiency anaemia should be reserved for life-threatening situations and should always be followed by appropriate iron replacement.
PMID
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Authors

Mayor MeshTerms
Keywords

Iron deficiency

Journal Title the medical journal of australia
Publication Year Start




PMID- 28701129
OWN - NLM
STAT- MEDLINE
DA  - 20170713
DCOM- 20170724
LR  - 20170724
IS  - 1326-5377 (Electronic)
IS  - 0025-729X (Linking)
VI  - 207
IP  - 2
DP  - 2017 Jul 17
TI  - Iron deficiency and new insights into therapy.
PG  - 81-87
AB  - Iron deficiency and iron deficiency anaemia remain prevalent in Australia. The
      groups at highest risk are pre-menopausal women, socially disadvantaged people
      and those of Indigenous background. Diagnosing iron deficiency using a full blood
      examination and iron studies can be difficult and can be further complicated by
      concomitant inflammation. Results of iron studies should always be interpreted as
      an overall picture rather than focusing on individual parameters. In difficult
      clinical scenarios, soluble transferrin receptor assays can be useful. Management
      of iron deficiency involves identification and treatment of the cause of iron
      deficiency, as well as effective iron replacement. Clinicians should always take 
      a detailed history and perform a comprehensive physical examination of a patient 
      with iron deficiency. Patients should be monitored even if a likely cause of iron
      deficiency is identified. Patients who fail to respond to iron replacement or
      maintain iron status should be referred for further investigation, including
      endoscopy to exclude internal bleeding. Both enteral and parenteral iron are
      effective at replacing iron. For most adult patients, we recommend trialling
      daily oral iron (30-100 mg of elemental iron) as the first-line therapy. Safety
      and efficacy of intravenous iron infusions have improved with the availability of
      a newer formulation, ferric carboxymaltose. Patients who fail to respond to oral 
      iron replacement can be safely managed with intravenous iron. Blood transfusion
      for iron deficiency anaemia should be reserved for life-threatening situations
      and should always be followed by appropriate iron replacement.
FAU - Low, Michael Sy
AU  - Low MS
AD  - Monash Health, Melbourne, VIC [email protected]
FAU - Grigoriadis, George
AU  - Grigoriadis G
AD  - Monash Health, Melbourne, VIC.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Australia
TA  - Med J Aust
JT  - The Medical journal of Australia
JID - 0400714
RN  - 0 (Ferric Compounds)
RN  - 0 (ferric carboxymaltose)
RN  - 69-79-4 (Maltose)
RN  - E1UOL152H7 (Iron)
SB  - IM
MH  - Administration, Oral
MH  - Anemia, Iron-Deficiency/*epidemiology/etiology/*therapy
MH  - Australia/epidemiology
MH  - Blood Transfusion
MH  - Bone Marrow/pathology
MH  - Child
MH  - Female
MH  - Ferric Compounds/*administration & dosage/adverse effects
MH  - Humans
MH  - Infusions, Intravenous
MH  - Iron/administration & dosage/*blood/deficiency
MH  - Maltose/administration & dosage/adverse effects/*analogs & derivatives
MH  - Pregnancy
OTO - NOTNLM
OT  - Iron deficiency
EDAT- 2017/07/14 06:00
MHDA- 2017/07/25 06:00
CRDT- 2017/07/14 06:00
PHST- 2016/11/12 [received]
PHST- 2017/02/09 [accepted]
AID - 10.5694/mja16.01304 [pii]
PST - ppublish
SO  - Med J Aust. 2017 Jul 17;207(2):81-87.