Listen to 5 Pearls segment of Iron Deficiency Anemia!

Time Stamps

• 1:40 Should patients be screened for iron deficiency? If so, who and how often?
• 3:23 What are the indications for diagnostic endoscopy in iron deficient patients?
• 5:53 How should you advice patients to take oral iron? What is optimal dosing?
• 11:41 In which patients would you consider IV iron? What are the risks?
• 14:44 Throwback Question: What is a medication overuse HA?

Show Notes

Pearl 1:

• Asymptomatic patients at high risk of IDA should probably be screened, but this recommendation is not evidence based and is based on outdated professional society guidelines.
• The interval of repeat screening is also not clear.

Pearl 2:

• Men and post-menopausal women with IDA without any history of overt bleeding should be referred to scope from both upper and lower endoscopy.
• In these populations, there is an increased chance of malignancy, and an even greater chance of other GI pathology that can be intervened on.

Pearl 3:

• The exact optimal dose of oral iron is not known and likely depends on the individual patient.
• When choosing a dose, one should consider the pharmacology of hepcidin-induced malabsorption and balance this with the patient’s side effect burden.
• Patients should be instructed to NOT take it with food and if possible with vitamin C or citrus food.

Pearl 4:

• Newer formulations of IV iron are safer and without increased risk for significant adverse reaction or infection.
• It is quicker and more effective than oral iron in repleting stores.
• IV iron should be considered in patients who are poorly tolerating oral Fe SE, have malabsorption disease, ESRD or with ongoing blood loss that oral iron cannot keep up with.

Pearl 5:

• If you notice your patient’s headache changes from intermittent to a chronic, daily headache while using lots of abortive therapy medications, consider medication overuse headache.
• To avoid medical overuse headache, encourage your patient to limit triptans and NSAIDs to less than 2 times per week on average.
• Don’t confuse medication overuse headache with a medication induced headache, which is most common drugs seen with drugs like  nitrates, phosphodiesterase inhibitors, and hormones

References:

• Stoltzfus, Rebecca J., and Michele L. Dreyfuss. Guidelines for the use of iron supplements to prevent and treat iron deficiency anemia. Vol. 2. Washington^ eDC DC: Ilsi Press, 1998.
• Iron Deficiency Anemia Prevention. “Recommendations to prevent and control iron deficiency in the United States.” MMWR: Morbidity & Mortality Weekly Report. 47 (1998): 1-29.
• “Guidelines for the Management of Iron Deficiency Anemia,” British society of gastroenterology, BMJ, 2011.
•  Yates JM, Logan EC, Stewart RM. Iron deficiency anaemia in general practice: clinical outcomes over three years and factors influencing diagnostic investigations. Postgrad Med J. 2004;80(945):405–410.
• Ioannou GN, Rockey DC, Bryson CL, Weiss NS. Iron deficiency and gastrointestinal malignancy: a population-based cohort study.Am J Med. 2002;113(4):276.
• Brise H, Hallberg L. Absorbability of different iron compounds. Acta Med Scand Suppl 1962;376: 23-37.
• Rimon E, Kagansky N, Kagansky M, et al. Are we giving too much iron? Low-dose iron therapy is effective in octogenarians. Am J of Med 2005;118(10): 1142-1147
• Auerbach M, Adamson JW. How we diagnose and treat iron deficiency anemia. Am J Hematol. 2016;91(1):31.
• Avni T, Bieber A, Grossman A, Green H, Leibovici L, Gafter-Gvili A. The safety of intravenous iron preparations: systematic review and meta-analysis. Mayo Clin Proc2015;90:12-23. 10.1016/j.mayocp.2014.10.007
• Munksgaard SB, Jensen RH. “Medication overuse headache.” Headache. 2014: 807-22.