This document summarizes treatment options for iron deficiency anemia associated with gastrointestinal diseases. Oral iron therapy is commonly used but has side effects and low compliance due to gastrointestinal issues. Parenteral iron therapy provides advantages as iron is absorbed directly into the bloodstream, avoiding gastrointestinal absorption. A novel parenteral iron complex, ferric carboxymaltose, has a favorable safety profile and may be more effective than oral iron or older parenteral therapies for treating iron deficiency anemia linked to gastrointestinal conditions.
2. Introduction
o The GI tract is a common site of bleeding that may lead to iron deficiency
anemia (IDA).
o Treatment varies based on patient¡¯s signs & symptoms:
Red blood cell transfusion & Oral iron preparations have side effects
The bone marrow examination is not accurate
o Raise awareness of parenteral iron therapies in the treatment of IDA linked
with GI diseases, particularly inflammatory bowel diseases (IBDs).
4. Methods
Oral Iron Replacement Parenteral Iron Replacement
o Asymptomatic and mildly symptomatic patients o Cannot be treated adequately with oral iron
with IDA supplements due to severe GI side effects, etc.
o Same efficacy & side effects between ferrous o Many clinicians have been reluctant due to the
sulfate, ferrous gluconate, and ferrous fumarate rarely lethal hypersensitive reactions to high
in a randomized, double blind study molecular weight iron dextran infusions
o To avoid GI side effects and consequent non- o Ferric Carboxymaltose (FeCarb) is a novel
compliance, oral iron should be started at a low parenteral iron complex with a favorable side
dose once daily after meals effect profile
5. Results
Parenteral therapy Oral iron therapy
o May be more advantageous due to low iron absorption o High incidence of GI side effects (epigastric pain and
from the GI tract & lower compliance to the oral diarrhea) that lead to discontinuation of therapy in up
therapy. to 21% of patients
o Useful in patients with moderate-severe active IBD o may worsen IBD as a result of non-absorbed iron-
mediated toxic reactive oxygen species.
o Quicker response
o Does not have life-threatening side effects
o More convenient for some patients
7. Conclusion
o As of Dec. 2009, FeCarb has not been evaluated by the Food and Drug
Administration.
o Novel parenteral iron preparations are safer than high molecular weight iron
dextran & are more useful due to GI side effects of oral iron therapy.
Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2883127/?tool=pubmed