Core IM | Internal Medicine Podcast #148 Iron Deficiency Treatment: 5 Pearls Segment
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Mar 27, 2024 Exploring the nuances of iron deficiency treatment, including oral vs. IV options. Insights on choosing IV iron formulations and using the Ganzoni formula. Understanding Fishbane reaction vs. anaphylaxis during infusion. Discusses dosing regimens for optimal iron supplementation efficacy and safety concerns.
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Interpreting Iron Labs
- Ferritin, an acute phase reactant, increases with inflammation, requiring adjusted cutoffs in conditions like heart failure or CKD.
- Current recommendations suggest using a ferritin cutoff below 100 in these patients or below 300 with a T-SAT below 20%.
IV Iron Indications
- Prescribe IV iron for patients who cannot tolerate oral iron, have severe or symptomatic anemia, or experience ongoing blood loss.
- Also consider IV iron for those with absorption issues (e.g., gastric bypass, celiac disease), or those for whom oral iron may be harmful (e.g., IBD).
Transfusion Iron Misconception
- Patients with GI bleeds often receive transfusions to raise hemoglobin, but the iron in transfusions isn't readily usable for new RBC production.
- This can lead to persistent anemia even after transfusion, highlighting the importance of IV iron supplementation.