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Anemia is sometimes treatable, but certain types of anemia may be lifelong. If the cause is a dietary iron deficiency, eating more iron-rich foods, such as beans, lentils or red meat, or taking iron supplements will usually correct the anemia. Alternatively, intravenous iron (or blood transfusions) can be administered.
The difference between iron intake and iron absorption, also known as bioavailability, can be great. 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. The primary benefit over ascorbic acid is durability and shelf life, particularly for products like milk, which undergo heat treatment.
- Microencapsulation with lecithin binds and protects the iron particles from the action of inhibiting substances.
- 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 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.[1][2]
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 (where the dose needs to be reduced or treatment stopped in over 40% of subjects) and blood transfusions.
A follow-up blood test is important 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.
Iron replacement[edit]
When adjusting daily iron supplementation regimens, lowering the daily iron dose requires a longer duration of therapy. The estimated total dose of elemental iron may be used to guide therapy, and replacement may be provided in cycles. Based on this approach, the person should participate in their own care by determining the iron formulation and dose schedule that they are able to tolerate. The amount of elemental iron that is absorbed in the gut is not constant, and can change significantly depending on several factors, including hemoglobin level and body iron stores. The amount of iron absorbed decreases as the iron deficiency is corrected. Therefore, it is not possible to predict the exact amount of iron that will be absorbed, but it is recommended that approximately 10%-20% of an oral iron dose will be absorbed in the beginning of the therapy.
For ferrous sulfate, one cycle consists of 75 pills or three pills daily for 25 days. Among people with moderate levels of anemia, a single cycle of should be enough and partial replacement of iron stores. If the anemia is not severe and there is no complicating feature such as ongoing blood loss or enteropathies, additional iron supplementation cycles are not going to be required for correcting the anemia. Re-evaluation of the anemia after completion of the first cycle should be performed to see if additional iron supplementation is necessary. If a person is predicted to have ongoing iron deficits (e.g. menorrhagia), maintenance dosing of iron supplements can easily be devised. The key feature of the cycled dosing strategy proposed here is that several factors including the cause of iron deficiency Anemia, the total iron deficit, replacement iron formulations, and the predicted duration of replacement therapy are integrated for implementation of an individualized therapeutic plan.[3]
- ^ National Institutes of Health. "Dietary Supplement Fact Sheet: Iron". United States of America, Department of Health and Human Services. Archived from the original on July 21, 2011. Retrieved March 8, 2012.
- ^ Miret, Silvia; Simpson, Robert J.; McKie, Andrew T. (1 July 2003). "Physiology and molecular biology of dietary iron absorption". Annual Review of Nutrition. 23 (1): 283–301. doi:10.1146/annurev.nutr.23.011702.073139.
- ^ Alleyne, Michael; Horne, McDonald K.; Miller, Jeffery L. (1 November 2008). "Individualized treatment for iron-deficiency anemia in adults". The American Journal of Medicine. 121 (11): 943–948. doi:10.1016/j.amjmed.2008.07.012. ISSN 0002-9343. PMC 2582401. PMID 18954837.