Iron deficiency anemia and indications of intravenous iron
Written by:Iron deficiency anemia is the most prevalent, affecting 5% of the adult world population. Intravenous iron is administered in patients with digestive diseases that prevent digestive absorption. The indication of intravenous iron should always make a hematologist, which will also determine the frequency and number of doses.
Prevalence of iron deficiency anemia
Of all the types of anemia, iron deficiency is the most prevalent, affecting 5% of the adult world population. This prevalence increases with age, so that in the case of men, stood at 2% for the age range between 18 and 50 years, increasing to almost 30% for those over 85 years. In the case of women, the prevalence is around 20% for the age range from 18 to 50 years, increasing to 80% for over 85 years. Among the most common causes are physiological menstrual losses in young women and chronic gastrointestinal bleeding source in patients older than 55 years.
Importance of iron for the body and how it metabolizes
Iron is crucial for aerobic cell metabolism, growth and proliferation of the same, the development of the immune system or defense, as well as transport and storage of oxygen. Approximately 65% of iron in the body is found in hemoglobin, a protein that turns red red blood cells and is responsible for transport of oxygen to the various tissues. Another 10% is bound to other proteins such as myoglobin located in the muscles and the rest, as deposit in the liver as ferritin.
Where the iron absorbed from the diet?
Keep in mind that iron from the diet is absorbed in the duodenum or distal jejunum first and said absorption is very low, between 1-2 mg / day, which is at most 10 -15% of all iron that can be eaten during the day by diet. This means that the integrity of the mucosa of the small intestine portion should be optimal for iron uptake is supplied.
If iron absorption is digestive, what sense does the use of intravenous iron?
The main route of treatment of iron deficiency anemia is administration orally, in its various formulations: tablets, granules, liquid, etc.. However, sometimes it is more effective and useful for the direct use of intravenous iron. This occurs in patients with diseases affecting the digestive tract, especially inflammatory or infectious origin as gastritis, duodenitis or chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis). Also other autoimmune processes that may affect the mucosa of the digestive or surgery resective lowering Catchment iron and other nutrients make treatments with conventional oral iron without a profile suitable bioavailability, default precisely absorption, It is more direct intravenous iron.
Other times it's own patient intolerance to oral iron components producing constipation, stomach pain or diarrhea which forces us to use the formulation of intravenous iron.
On the other hand, intravenous iron is very useful as an adjunct to other treatments in cancer patients anemia or chronic renal failure, where erythropoietin is administered recombinant.
Administration and risks of intravenous iron
The administration of intravenous iron should be done in day hospital or consultation, under the supervision of specialist. By peripheral venous access it is administered over a period of time ranging, depending on its formulation, between 30 minutes and one hour. After administration, and after making basic constants to the patient, such as blood pressure, temperature and heart rate, the patient can go home.
Dose adjustment is performed by the hematologist or responsible specialist, depending on the response achieved, pudendal performed 1, 2 or 3 times a week for a period of 1 or 2 months.
This type of treatment is generally very well tolerated. The current provisions minimized to maximize the occurrence of side effects. However, like any medicine, it is not without producing any adverse phenomenon of allergic origin or anaphylactoid as can be: skin rash, fever, small hematoma at the puncture site or very strangely, crisis franca bronchospasm, as anaphylactic reaction established.
As anecdotal fact we can say that up to 35-40 years ago, intravenous or parenteral iron is administered intramuscularly and this produced a tattoo in place of permanent and unsightly puncture, why let this form of administration used.
