Iron Deficiency Anemia - Diagnosis and Management
• Etiology: ↑ loss due to chronic bleeding (PUD/UGIB [↑BUN], colon CA/LGIB, menses, intravascular hemolysis), ↑demand (Epo, pregnancy, blood donation), ↓intake (malnutrition) or ↓ absorption (IBD/post-gastrectomy/celiac). If unexplained or refractory to PO iron, eval. for celiac, AI gastritis, H. pylori, which accounted for 5%, 27%, 19% of unexplained IDA
• Treatment: PO 325 mg FeSO4 x3 QD or QOD (↑ absorption w/ QOD). ~6wk to correct anemia, ~3-6mo to replete stores. Absorp. ↑ on empty stomach, w/ VitC, ↓ w/ Ca foods, antacids. GI SE: constipation, epigastric pain, N/V.
• IV repletion (if excessive SEs, CKD, malabsorption, IBD, intolerant to PO, or CHF). Calc. iron deficit (weight (kg) x 2.3 x (target Hb – pt Hb) + 500) & replete up to 1000mg. Typical dose: iron sucrose 200mg QOD x5 or 300mg QOD x3. SE: n/v, pruritus, flushing, myalgia/arthralgia, CP; typically resolve in 48h. Anaphylaxis rare w/ Fe-gluconate & Fe-sucrose.
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