Iron Deficiency Anemia

There is very little need for use of intravenous iron to be given in the practice of medicine, but there are clear indications when it should be used. The body stores about four grams of iron in total; 1800mg are in the circulating blood; 1000mg in the liver; 800mg in the monoctyes distributed throughout the body, about 300mg in the muscles, and the remainder is distributed in the plasma, gastrointestinal tract and the other different organs. Men lose iron from bleeding anywhere along the gastrointestinal tract, coughing blood from the lungs, bleeding into the urine, or from the chronic break down of their red cells peripherally: Women lose iron for the same reasons as men but also during their monthly menses. Two milligrams of iron are absorbed daily from the duodenum and the body uses about twenty milligrams a day: the remaining eighteen milligrams come from re-utilizing iron from the breakdown of iron containing cells. The absorption of iron from the duodenum into the blood is an extremely complex mechanism not completely understood. The absorption of iron is regulated by the duodenal cells themselves and by signals they receive from the red cell producing organ. Only small amounts are absorbed each day and since the need for iron is great, iron deficiency occurs mostly due to loss and since this loss cannot quickly be replenished, then iron deficiency starts to occur. The production of new blood is slowed when iron is lacking and this leads to anemia. The number of red cells produced remains the same initially but the amount of hemoglobin in each cell is decreased leading to the evolution of a smaller red cell, carrying a decreased amount of oxygen-carrying hemoglobin. As time passes, less blood is produced and this leads to the production of symptoms, such as easy fatigability, constant tiredness, lack of pep and ultimately shortness of breath. Because we are born with three to four times as much blood as we need, the hemoglobin level can drop from 14 grams in a man and from 12 grams in a woman, all the way down to 4 grams before life threatening consequences will occur. By that time, the patient is pale in appearance, listless in behavior and has lost all desire to do anything due to the extreme shortage of iron. Patients who cannot absorb iron are extremely vulnerable and must be selected out from anemic patients and properly treated. This is the group that needs intravenous iron. They are a different subsets of patients and these are the ones that need intravenous iron verses those that can be treated with oral iron. There are four sub-sets of patients: Inability to absorb iron from the duodenum. As patients get older, they produce less and less gastric acid and this decreases the ability to convert ferric iron into ferrous, a form of iron that is better absorbed. Consequently iron has to be given intravenously as dietary or therapeutic iron is not absorbed in adequate amounts. If excessive bleeding is occurring from the Uterus during menses or blood is being lost chronically from the Gastrointestinal tract, ie, from a sliding hiatus hernia, ulcers, polyps or malignancy then giving iron dextrin intravenously is needed to replace the lost iron. Surgical interference of the stomach and duodenum for either previous ulcers or pancreatic carcinoma will also lead to decreased iron absorption and intravenous iron may have to be used to replenish needed iron. Some patients are intolerant of oral iron and cannot take it as the iron causes gastric pain and cramping, prolonged nausea and sometimes vomiting. Patients will refuse to take any of the different iron preparations and consequently intravenous iron has to be given to replenish the loss, due to any of the reasons mentioned above. Inability to absorb iron. A small number of patients become unable to absorb iron due to some of the reasons mentioned above and sometimes due to unknown reasons and this group can be tested by giving oral iron and then drawing blood for iron measurement one and two hours thereafter. No change in the iron level after a loading dose of oral iron may prove the inability to absorb iron. A lack of gastric acid in the stomach may exacerbate this condition. The addition of Vitamin C to oral iron preparations will sometimes improve absorption. How it is Given Iron Dextrin can be given under the skin but it usually causes life long yellow stains in the skin. It can be given intravenously but a test dose must be done to check for allergies as major reactions can occur. Only physicians and nurses familiar with the procedure and its complications should administer iron. Usually 100mg are given at each treatment but much larger amounts can be safely given if necessary. Iron must be administered slowly and if large amounts are needed, over 500mg, then a more prolonged infusion time is needed. I have safely administered up to 1500mg when it was needed. The toxic dose of iron is not known. Patients will complain of muscle aches, skin sensitivity and joints pains if too much iron is given too quickly . The amount of iron needed can be easily calculated from the level of hemoglobin in the patients and their body weight and size. Any anemia caused by a lack of iron demonstrates a significant need for iron.