Treatment for iron deficiency anemia involves finding and eliminating, or ruling out, sources of blood loss and cause of the deficiency, that is, whether it is the result of insufficient intake or malabsorption. Without this first step, any pharmacologic therapy will only relieve symptoms (palliative) or add to an existing problem.
Iron deficiency and blood loss are the most common causes. Iron replacement is very effective in the treatment of iron deficiency anemia and can be administered orally, intramuscularly (IM), or intravenously (IV).
The most common form of iron supplementation is from oral preparations, or a combination of oral iron and vitamin C, to enhance iron absorption. Usually, these are administered in the form of ferrous sulfate, a simple and inexpensive supplement. Although the pharmaceutical industry has a myriad of iron preparations, all of which are more expensive and much harder to absorb than ferrous sulfate and usually not necessary, it has been found that the simple form works best.
Sometimes the oral form causes stomach upsets. This is especially true of pharmaceutical forms. Other forms are easier to absorb and easier on the digestive tract. In either case, taking a supplement with meals in divided doses, along with vitamin C, works best.
In some cases, iron may have to be administered parenterally (by other means than oral). This may be because the patient is noncompliant with taking oral forms or if he needs more iron than can be taken orally, if malabsorption prevents adequate iron absorption, or if a maximum rate of hemoglobin regeneration is desired. Because total dose IV (intravenous) infusion of supplemental iron is painless and requires fewer injections, it is usually preferred to IM (intramuscular) administration.
IV iron supplementation is usually reserved for pregnant or geriatric patients with severe anemia. They should receive a total infusion of iron dextran in normal saline over eight hours. IM injections are often given when there is a malabsorptive problem since this form will bypass the digestive system.
For deep IM injections, the Z-track technique should be used to avoid subcutaneous irritation and discoloration from leaking medication. The only areas of injection are the upper outer quadrant of the buttocks (the ventro-gluteal muscles). The area should not be massaged after the injection and the patient should not do any vigorous exercise for at least thirty minutes.
Oral administration of ferrous sulfate, gluconate, or fumarate that provides about 200 mg of elemental iron is effective in reversing iron deficiency anemia. After iron therapy has begun, individuals often show a rapid decrease in fatigue, lethargy, and other symptoms.
Two-thirds of the hemoglobin deficit is generally corrected within the first month of therapy, regardless of the severity of the anemia. Therapy is usually continued for six to twelve months after bleeding has been contained.
For menstruating women, daily therapy may be needed until menopause. An increase in reticulocyte count is a good measure of response to iron therapy.
Side effects of pharmaceutical oral iron preparations include the following:
- a change in stool color to green or black;
- constipation or loose stools;
- stained teeth (so good oral care after administration is important).
- Death can result from iron poisoning, which occurs when there is a rapid ingestion of massive amounts of iron. The most common cause of accidental poisoning in small children involves the ingestion of iron supplements or vitamins with iron. As few as 6-12 tablets have caused death. Any child suspected of ingesting these tablets is considered an immediate medical emergency. Thirty minutes can make a crucial difference.
- Taking a self-prescribed supplement may mask such dangerous conditions as a gastrointestinal bleed from ulcers, cancer, or parasites. Therefore, it is wiser to seek a professional diagnosis.
Since too much iron can be just as devastating to the body as too little; and, since it cannot be excreted easily, chelation therapy is recommended. Patients who require repeated blood transfusions, as those with sickle cell anemia, thalassemia major, and some forms of cancer, can develop transfusional iron overload.
The type of chelation therapy used to remove iron from patients with an overload should not be confused with EDTA (ethylenediaminetetra acetic acid), a method used by some alternative medicine practitioners. EDTA is a broad-spectrum chelator that binds with, and removes, a number of minerals, including iron.
By contrast, new oral chelators may prove to be more specific for iron. Since the 1970s, some type of chelation therapy has been available for use, but it has not been ideal for the patient as it requires intravenous solutions a few nights a week. This is why an oral solution is sought.