Iron Deficiency Anemia - Treatment

Treatment

Anemia is sometimes treatable, but certain types of anemia may be lifelong. If the cause is dietary iron deficiency, eating more iron-rich foods, such as beans and lentils, or taking iron supplements, usually with iron(II) sulfate, ferrous gluconate, or iron amino acid chelate ferrous bisglycinate, or synthetic chelate NaFerredetate EDTA, will usually correct the anemia. Alternatively, intravenous iron can be administered.

Recent research suggests the replacement dose of iron, at least in the elderly with iron deficiency, may be as little as 15 mg per day of elemental iron. An experiment done in a group of 130 anemia patients showed a 98% increase in iron count when using an iron supplement with an average of 100 mg of iron. Women who develop iron deficiency anemia in midpregnancy can be effectively treated with low doses of iron (20–40 mg per day). The lower dose is effective and produces fewer gastrointestinal complaints. The body apparently adapts to oral iron supplementation, so iron is often effectively started at a comparatively low dose, then slowly increased.

The difference between iron intake and iron absorption, also known as bioavailability, can be great. Scientific studies indicate iron absorption problems are worsened when iron is taken in conjunction with milk, tea, coffee and other substances. A number of methods that can help mitigate this, including:

• Fortification with ascorbic acid increases bioavailability in both presence and absence of inhibiting substances, but is subject to deterioration from moisture or heat. Ascorbic acid fortification is usually limited to sealed, dried foods, but individuals can easily take ascorbic acid with a basic iron supplement for the same benefits.
• Microencapsulation with lecithin binds and protects the iron particles from the action of inhibiting substances. The primary benefit over ascorbic acid is durability and shelf life, particularly for products like milk, which undergo heat treatment.
• Using an iron amino acid chelate, such as NaFeEDTA, similarly binds and protects the iron particles. A study by the hematology unit of the University of Chile indicated chelated iron (ferrous bis-glycine chelate) can work with ascorbic acid to achieve even higher absorption levels.
• Separating intake of iron and inhibiting substances by a few hours
• Using nondairy milk (such as soy, rice, or almond milk) or goats' milk instead of cows' milk
• Gluten-free diets can resolve some instances of iron-deficiency anemia, especially if it is a result of celiac disease.
• Heme iron, found only in animal foods, such as meat, fish and poultry, is more easily absorbed than nonheme iron, found in plant foods and supplements.

Iron bioavailability comparisons require stringent controls, because the largest factor affecting bioavailability is the subject's existing iron level. Informal studies on bioavailability usually do not take this factor into account, so exaggerated claims from health supplement companies based on this sort of evidence should be ignored. Scientific studies are still in progress to determine which approaches yield the best results and the lowest costs.

If anemia does not respond to oral treatments, it may be necessary to administer iron parenterally using a drip or hemodialysis. Parenteral iron involves risks of fever, chills, backache, myalgia, dizziness, syncope, rash, and with some preparations, anaphylactic shock. The total incidence of adverse events is much lower than that with oral tablets.

A follow-up blood test is essential to demonstrate whether the treatment has been effective; it can be undertaken after two to four weeks. With oral iron, this usually requires a delay of three months for tablets to have a significant effect.