Diagnosis and management of iron deficiency anemia in the 21st century
Jimenez K, et al • Gastroenterology & Hepatology
Key Finding
Oral iron absorption maxes at 20-25% of 100mg doses; hemoglobin should increase 2 g/dL within 4-8 weeks with adequate therapy
Key Findings
- 1Oral iron absorption maxes at 20-25% of 100mg doses
- 2Hemoglobin should increase 2 g/dL within 4-8 weeks
- 3IV iron preferred when gut absorption impaired
- 4Iron normalization requires up to 3 months
Original title: “Management of Iron Deficiency Anemia”
Plain English Summary
Anemia affects one-fourth of the world's population, and iron deficiency is the predominant cause. This clinical review provides a management algorithm for iron deficiency anemia, comparing oral versus intravenous iron therapy and identifying when gastrointestinal investigation is warranted.
In-Depth Analysis
Abstract
"Anemia affects one-fourth of the world's population, and iron deficiency is the predominant cause."
Key Findings
Oral Iron Therapy
- •Absorption maxes at 20-25% of 100mg doses
- •Effective for mild anemia (Hb 11.0-11.9 g/dL in women)
- •Slow repletion; iron normalization requires up to 3 months
Intravenous Iron Therapy
- •Achieves faster repletion and higher ferritin levels
- •Preferred when "uptake through the gut is impaired" in conditions like celiac disease
Response Monitoring
- •Hemoglobin should increase 2 g/dL within 4-8 weeks
- •Iron normalization requires up to 3 months
Clinical Implications
The authors advocate that gastroenterologists become "experts in iron replacement therapy" and recommend their streamlined diagnostic algorithm.
Paradigm Relevance
How this study applies to different clinical perspectives:
Standard Medical
RelevantConventional clinical guidelines used by most doctors
Why it matters:
Provides standard clinical algorithms for iron deficiency diagnosis and management
Research Consensus
RelevantCurrent scientific understanding, often ahead of guidelines
Why it matters:
Emphasizes importance of adjusted ferritin cutoffs in inflammatory conditions—key for research interpretation
Metabolic Optimization
RelevantProactive targets for optimal health, not just disease absence
Why it matters:
Guides optimal treatment selection between oral and IV iron based on individual patient factors
Study Details
- Type
- Review Article
- Methodology
- Clinical review with proposed management algorithm for diagnosis and treatment of iron deficiency anemia
Evidence Quality
Grade B - Clinical review with evidence-based algorithm. Source: PMC4836595
Related Biomarkers
Calculate & Evaluate on Metabolicum
Original Source
Related Studies
The effect of low versus high fractional iron absorption on iron absorption and utilization
Stoffel NU, et al • American Journal of Clinical Nutrition • 2020
Alternate-day iron absorption 40-50% higher than consecutive day (p<0.001); 200mg alternate-day yields ~2x total absorption vs 100mg consecutive-day
Iron Status of Vegetarian Adults: A Review of Literature
Pawlak R, et al • American Journal of Lifestyle Medicine • 2016
Female vegetarians: ferritin <12 µg/L prevalence 12-79%; inadequate hemoglobin 6-30.3%. Male vegetarians: ferritin <12 µg/L prevalence 1.7-29%
Understanding Elevated Ferritin: Beyond Simple Iron Overload
Koperdanova M, Cullis JO • BMJ • 2015
Standard ferritin reference ranges miss 57% of women with functional iron deficiency - symptoms often appear at 30-50 ng/mL, well within "normal" ranges.