Iron Deficiency Anemia

Author: Dian Han PharmD candidate. Reviewed by Dr.King Chen PharmD

The red blood cell is the vital component of blood that transports oxygen to the different areas of the body. Anemia is a medical condition where there are not enough red blood cells in your blood, leading to ineffective oxygen transport and unusual feelings of weakness and tiredness. Iron deficiency is one cause of anemia which most commonly results from blood loss or absorption problems. Blood loss may be visible (menstruation, injury) or may be difficult to detect by both the patient or doctor (gastrointestinal bleeding), while the inability to absorb iron usually is due to a gastrointestinal disease like celiac disease or surgeries like gastric bypass surgery. Aside from iron deficiency, there are multiple other reasons why a person might have Anemia. Some of the major causes include:

- Nutritional deficiency (vitamin B12, folate)

- Inherited defects in hemoglobin or the red blood cell itself

- Kidney disease

- Bone marrow suppression or disease

This article will focus specifically on the treatment of iron deficiency anemia.

Nonpharmacologic Choices

If your iron deficiency anemia is mild, or if it is due to dietary choices that you can change, you and your doctor may choose to treat it by increasing your dietary intake of iron alone. Iron is most readily available in foods like red meat, poultry, and seafood like clams and mussels. It is also available to a lesser extent in plant foods like beans, dark leafy vegetables, dried fruits, and fortified bread and cereals. Vitamin C enhances the absorption of iron, and in one study, the addition of 100mg vitamin C to a standard meal increased iron absorption by 67%. If you are looking to increase your iron absorption, consider having a serving of food high in vitamin C, like a glass of orange juice, broccoli, or bell peppers with your next meal. In contrast, compounds found in tea and coffee can reduce the absorption of iron from food, and therefore should be consumed between meals instead of at mealtimes.

Pharmacologic Choices

The main medical treatment for iron deficiency anemia is iron supplementation. The three major kinds of iron supplements are simple iron salts, heme iron polypeptide supplements, and parenteral iron.

1. Simple iron salts (ferrous fumarate, ferrous gluconate and ferrous sulfate): These are the most common supplements used to treat iron deficiency. The different iron salts contain varying amounts of elemental iron, so speak with your doctor or pharmacist to determine the right dose for you. They can cause some bothersome side effects like nausea, constipation or diarrhea, which can be minimized by slowly increasing your dose when you first start taking the supplement. When taken with food, these side effects are minimized; however, absorption is also reduced compared to when they are taken on an empty stomach. Speak with your pharmacist to determine which strategy would work best for you.

2. Iron polypeptide supplement (FeraMAX): The iron polypeptide supplement may cause less gastrointestinal upset than iron salt supplements. This medication is vegan friendly. This is important as most vegans are deficient in iron. Downside of Feramax is that it is more expensive than iron salt supplements, so please weigh the difference between cost and side effects.

3. Parenteral iron: This is iron that is given directly into the bloodstream, thereby bypassing the gastrointestinal system. Parenteral iron is only given in the hospital setting and is typically reserved for people who have had severe blood loss that cannot be replenished quickly enough by oral iron supplementation. There is an increased risk of infection with this method so it is not the first choice for iron supplementation for most people.

Large excesses of iron in the body can be dangerous and may lead to poisoning. You should start taking iron supplements only after speaking with your doctor and doing the appropriate tests to check if you have iron deficiency. Iron supplements could be dangerous to children if the wrong dose is given or if it is accidently consumed at higher amounts. As always, if you have any additional questions about iron deficiency anemia, reach out to your family doctor for additional information.