British Society of Gastroenterology guides management for iron deficiency anemia
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The British Society of Gastroenterology published guidelines for the management of iron deficiency anemia among an adult population.
“Iron deficiency anemia (IDA) may present in primary care or across a range of specialties in secondary care and because of this, and the insidious nature of the condition, it has not always been optimally managed despite the considerable burden of disease — with investigation sometimes being inappropriate, incorrectly timed or incomplete and the role of iron replacement therapy (IRT) for symptom relief neglected,” Jonathon Snook, MA, DPhil, FRCP, University Hospitals Dorset NHS Trust, and colleagues wrote in Gut. “It is therefore important that contemporary guidelines for the management of IDA are available to all clinicians.”
The executive summary of recommendations and practice statements included clinical assessment steps, evaluation of the small bowel, treatment strategies, special considerations and more. Highlights from the 40 established guidelines for the management of IDA follow.
Researchers noted that IDA can be caused by an array of GI pathologies; thorough and urgent investigation should be considered among adults with a new diagnosis lacking obvious explanation. Further, diagnosis should be confirmed via iron studies (ie, serum ferritin or other blood tests like transferrin saturation) prior to investigation.
Independent predictors such as age, sex, hemoglobin concentration and mean cell volume should be evaluated in the risk for GI cancer in IDA; the risk for cancer in iron deficiency alone is low.
For examining the small bowel, they recommended capsule endoscopy as the preferred screening method due to its sensitivity to mucosal lesions. CT or MR enterography may also be considered.
Initial IDA treatment should include one tablet per day of either ferrous sulfate, fumarate or gluconate with a reduced dose of one tablet every other day if not tolerated. Follow-up monitoring of Hb response to treatment is imperative in the first 4 weeks with treatment continued for approximately 3 months after Hb level normalization to ensure adequate replenishment of iron.
Occasionally, limited transfusion of packed red cells may be required to treat symptomatic IDA.
Among older patients with IDA, major comorbidities and/or limited performance status, the risks vs. benefits of invasive endoscopic investigations must be carefully considered.
In the treatment of inflammatory bowel disease-associated IDA, intolerance and malabsorption of oral therapy may occur; parenteral IRT may be required for this subset of patients.
Special service considerations include a clear understanding of IDA management strategies delivered by a designated team that is led by a senior clinician. Further, it was recommended that service providers aim to establish an ambulatory care base for the administration of parenteral iron.
“For a dedicated IDA service to deliver highly effective care, the four essential components are confirmation of IDA, timely access to appropriate investigation (if not already investigated), ensuring appropriate IRT (with long-term therapy when needed) and strong clinical leadership,” Snook and colleagues concluded. “IDA services can also provide an alternative pathway for patients found to have more severe anemia and who otherwise might have been referred for emergency hospital admission.”
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