Iron deficiency is the single most prevalent
nutritional deficiency worldwide. It accounts for
anemia in 5% of American women and 2% of American men. The goal of this review article is to assist practitioners in understanding the physiology of
iron metabolism and to aid in accurately diagnosing
iron deficiency anemia. The current first line of
therapy for patients with
iron deficiency anemia is oral
iron supplementation. Oral supplementation is cheap, safe, and effective at correcting
iron deficiency anemia; however, it is not tolerated by some patients and in a subset of patients it is insufficient. Patients in whom the gastrointestinal blood loss exceeds the intestinal ability to absorb
iron (e.g. intestinal
angiodysplasia) may develop
iron deficiency anemia refractory to oral
iron supplementation. This population of patients proves to be the most challenging to manage. Historically, these patients have required numerous and frequent
blood transfusions and suffer end-organ damage resultant from their
refractory anemia. Intravenous
iron supplementation fell out of favor secondary to the presence of infrequent but serious side effects. Newer and safer intravenous
iron preparations are now available and are likely currently underutilized. This article discusses the possible use of intravenous
iron supplementation in the management of patients with severe
iron deficiency anemia and those who have failed oral
iron supplementation.