Iron deficiency and anemia of chronic disease treatment

- So let's talk about the treatment of iron-deficiency anemia. And I'm really just going to abbreviate that IDA. So, you'd imagine that with iron deficiency it could be treated with supplementation of iron, and you'd be completely correct. You can treat iron-deficiency anemia by giving a patient iron supplements, and there are a couple of different ways in which you can supplement iron. The first is by giving oral iron supplements. And a few things to keep in mind about oral iron supplements is, firstly, as we briefly talked about before, stomach acid plays a really important role in converting dietary iron into a form that's more readily absorbed by the duodenum. So, a patient could help out the absorption of this oral iron if they were to take it alongside some acidic drink, for example, orange juice. That would help the absorption of the iron supplement. Secondly, oral iron can stain teeth black, and, more importantly, it can cause black stools. It can cause black stools, and this is really important because upper gastrointestinal bleeding can also present with black stools. So, if a patient has black stools, it's really important to go through their history and see if, even remotely, they've been taking any iron supplements that could account for the black stools, because upper gastrointestinal bleeding is a medical emergency. So, that's the first way in which you can replete someone's iron. The second way is through intravenous iron, and really IV iron is reserved for patients who either can't take anything by mouth, patients who can't tolerate oral iron, because really oral iron is not a very pleasant thing to take, and also for those patients who require a dose of iron that would be too large to take through oral means. So, really IV iron is reserved for those classes of patients. And then the third way in which you can treat iron-deficiency anemia is with a blood transfusion, and blood transfusions are really saved for patients who have very severe anemia, because blood transfusions are not without their own life-threatening consequences. So, just briefly I want to go over this chart that we use to describe some of the most common causes of iron-deficiency anemia. And you can imagine that by giving a patient iron, you could, in a lot of instances, treat their iron deficiency. For example, if the patient is suffering from decreased intake, well giving them iron would certainly solve that problem. Or if they have an increased demand, such as a pregnant lady or somebody growing at a rapid rate, giving someone an iron supplement in those conditions could treat the iron-deficiency anemia for good. However, if a patient has a condition that leads to an impairment in the absorption of iron, firstly, you couldn't give them oral iron at all, but also in these patients giving IV iron would only be a very temporary measure. It wouldn't solve the underlying problem. They would still continue to have iron-deficiency anemia. Also, patients who are suffering from increased loss of blood for whatever reason, giving them iron supplements would solve the acute problem, but they would continue to have the anemia, unless you solved the underlying problem. So really, for these groups of patients, iron supplementation is not enough. Now with that being said, let's move on to the treatment of anemia of chronic disease. Actually, I want to put that in a different color, so it's less confusing. I'll put that in purple. Anemia of chronic disease, okay? I'm going to abbreviate that too. So, anemia of chronic disease is an interesting disease because you can't really treat it with iron. So, even though when you look at these patients' blood, you see that there's a deficiency of iron in their serum, and that's what's causing the anemia, giving these patients iron wouldn't lead to any benefit, because remember the body is firstly limiting its absorption of iron. So, any iron that you give orally wouldn't be absorbed, and secondly, whatever iron does enter the body is being sequestered away and hidden away in storage, and it's not being used for the production of red blood cells. So, giving iron wouldn't help, and not only would it not help, but all of the iron that's given and then subsequently stored in the liver eventually leads to damaging reactions in the liver, and it can lead to an independent disease of the liver. So, anemia of chronic disease is never, is never treated with iron, because not only does it not help, it can actually hurt the patient. Also, keep in mind that in situations such as infection and bacterial infection the anemia of chronic disease is kind of like a protective mechanism. The body is trying to keep the iron away from the bacteria, in a way to sort of decrease the growth of the bacteria. Providing extra iron in that type of situation might prove to be harmful, in terms of increasing the rate of bacterial growth. So that's also another reason why we try to avoid giving these patients iron. So really, the treatment of anemia of chronic disease rests on treating, I'm just going to abbreviate that TX, treating the underlying condition, the underlying, usually inflammatory, condition, just as is important with iron-deficiency anemia. And these really are the main mechanisms by which you treat both iron-deficiency anemia and anemia of chronic disease.