Individualized Treatment for Iron-deficiency Anemia in Adults

  • Michael Alleyne
    The National Cancer Institute, National Institutes of Health, Bethesda, Md

    The National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Md
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  • McDonald K. Horne
    Hematology Service and Department of Laboratory Medicine, WG Magnuson Clinical Center, National Institutes of Health, Bethesda, Md
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  • Jeffery L. Miller
    Reprint requests should be addressed to Jeffery L. Miller, MD, Chief, Section on Molecular Genomics and Therapeutics, Molecular Medicine Branch, NIDDK, National Institutes of Health, Building 10, Room 9N311, 10 Center Drive, Bethesda, MD 20892-1801
    The National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Md
    Search for articles by this author


      Iron deficiency is one of the most common disorders affecting humans, and iron-deficiency anemia continues to represent a major public health problem worldwide. It is especially common among women of childbearing age because of pregnancy and menstrual blood loss. Additional patient groups include those with other sources of blood loss, malnutrition, or gut malabsorption. Iron-deficiency anemia remains prevalent despite the widespread ability to diagnose the disease and availability of medicinal iron preparations. Therefore, new approaches are needed to effectively manage these patient populations. In this review, the diagnosis and treatment of iron-deficiency anemia are discussed with emphasis placed on consideration of patient-specific features. It is proposed that all patients participate in their own care by helping their physician to identify a tolerable daily iron dose, formulation, and schedule. Dosing cycles are recommended for iron replacement based on the tolerated daily dose and the total iron deficit. Each cycle consists of 5000 mg of oral elemental iron ingested over at least 1 month with appropriate follow-up. This approach should assist physicians and their patients with the implementation of individualized treatment strategies for patients with iron-deficiency anemia.


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        • Nissenson A.R.
        • Goodnough L.T.
        • Dubois R.W.
        Anemia: or just an innocent bystander?.
        Arch Intern Med. 2003; 163: 1400-1404
        • United Nations Sub-Committee on Nutrition (ACC/SCN)
        “Fourth report on the world nutrition situation.”.
        (United Nations)2000
        • Centers for Disease Control and Prevention
        “Recommendations to prevent and control iron deficiency in the United States.”.
        MMWR Morb Mortal Wkly Rep. 1998; 47: 1-29
        • Looker A.C.
        • Dallman P.R.
        • Carroll M.D.
        • et al.
        Prevalence of iron deficiency in the United States.
        JAMA. 1997; 277: 973-976
        • Heeney M.M.
        • Andrews N.C.
        Iron homeostasis and inherited iron overload disorders: an overview.
        Hematol Oncol Clin North Am. 2004; 18: 1379-1403
        • Kemna E.H.
        • Tjalsma H.
        • Willems H.L.
        • Swinkels D.W.
        Hepcidin: from discovery to differential diagnosis.
        Haematologica. 2008; 93: 90-97
        • Farley P.C.
        • Foland J.
        Iron deficiency anemia.
        Postgrad Med. 1990; 87: 89-101
        • Cook J.D.
        Diagnosis and management of iron-deficiency anaemia.
        Best Pract Res Clin Haematol. 2005; 18: 319-332
        • Institute of Medicine
        Food and Nutrition Board.
        Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc. National Academy Press, Washington, DC2001
        • Love A.L.
        • Billett H.H.
        Obesity, bariatric surgery, and iron deficiency: True, true, true and related.
        Am J Hematol. 2008; 83: 403-409
        • Crosby W.H.
        The rationale for treating iron deficiency anemia.
        Arch Intern Med. 1984; 144: 471-472
      1. Beutler E. Disorders of iron metabolism. In: Williams Hematology. Chapter 40. Seventh Edition. McGraw-Hill; :511-553.

        • Provan D.
        Mechanisms and management of iron deficiency anemia.
        Br J Haematol. 1999; 105: 19-26
      2. Stang J. Story M. Guidelines for Adolescent Nutrition Services. 2005
        • Cook J.D.
        Iron-deficiency anemia.
        Baillieres Clin Haematol. 1994; 7: 787-804
        • Massey A.
        Microcytic anemia.
        Med Clin North Am. 1992; 76: 549-565
        • Rimon E.
        • Kagansky N.
        • Kagansky M.
        • et al.
        Are we giving too much iron?.
        Am J Med. 2005; 118: 1142-1147
        • Bonnar J.
        • Goldberg A.
        • Smith J.A.
        Do pregnant women take their iron?.
        Lancet. 1969; 1: 457-458
        • Beutler E.
        • Hoffbrand A.V.
        • Cook J.D.
        Iron deficiency and overload.
        Hematology Am Soc Hematol Educ Program. 2003; 40-61
        • Wiltink W.F.
        • Ybema H.J.
        • Leijnse B.
        • Gerbrandy J.
        The iron tolerance test.
        Clin Chim Acta. 1966; 13: 701-707
        • Hershko C.
        • Hoffbrand A.V.
        • Keret D.
        • et al.
        A Role of autoimmune gastritis, Helicobacter pylori and celiac disease in refractory or unexplained iron deficiency anemia.
        Haematologica. 2005; 90: 585-595
      3. Goroll AH, Mulley AG. Office evaluation and management of the adult patient. Prim Care. 82:607-608.

        • Cook J.D.
        • Flowers C.H.
        • Skikne B.S.
        The quantitative assessment of body iron.
        Blood. 2003; 101: 3359-3364