Iron deficiency: Conclusions. Treatment

✅ Let’s summarize the diagnosis:
✔️ To identify iron deficiency, you need to pass the following tests: iron, ferritin, OZhSS, OAK. It is also necessary to calculate the percentage of transferrin saturation with iron and, for this we divide the iron by the OZhSS and multiply by 100%.
✔️ The following deviations indicate iron deficiency:
✔️ Ferritin below 30-40

3d render Blood cells (depth of field)

✔️ The percentage of transferrin saturation with iron is below 19% (this is especially significant for people with an inflammatory process, in whom ferritin may be falsely elevated)
✔️ A decrease in hemoglobin in a blood test along with a decrease in MCV and MCHC (or just one of these parameters)
✔️ Decreased hemoglobin (anemia), which rises after taking iron supplements
✅When diagnosing, it is still important to find the causes, which we wrote about above. It is often sufficient to simply take a thorough history from the patient (eg, heavy menstruation in a woman, marathon jogging in men, vegetarianism, celiac disease, earlier gastrointestinal bleeding).
✅If there are doubts about the source of bleeding, EGD and colonoscopy may be prescribed to exclude bleeding from different parts of the gastrointestinal tract.
✅Do not forget that:
✔️ Not only iron deficiency can lead to increased fatigue, but also some other diseases of the endocrine system, depression, neurological diseases, diseases of the heart, lungs, therefore sometimes iron deficiency is not enough to eliminate and identify
✔️ Zinc deficiency can also lead to a peak (craving for inedible foods), for example, autism, schizophrenia, pregnancy
✔️ Pregnancy, some neurological conditions, leg cramps (against the background of various conditions, for example, dehydration, hypothyroidism, excessive sweating, taking certain medications), sleep disturbances can also lead to restless legs syndrome.
Who Should Screen for Iron Deficiency (When No Symptoms)?
-Those who have had bleeding after injury
-Those who have heavy periods
-After childbirth
-Blood donors
-For athletes with intense training
especially for runners
-In case of chronic diseases of the gastrointestinal tract and malabsorption
-After detecting helminthic invasion
-People with celiac disease
-All women of childbearing age every 5 years (if there are risk factors, then every year)
There is no point in screening men and women during menopause.
Now for the treatment.
First, the question that torments everyone. Which is better – to drink several iron tablets
months or intravenous injection? Previously, the question was unambiguous – if possible, only drink in tablets, because those iron preparations that were injected
intravenously or intramuscularly, often caused anaphylactic shock, sometimes with
Modern drugs no longer give such reactions, although allergic reactions are still quite common, and anaphylaxis can also be, albeit rarely.
In total, iron tablets are preferable,
-It is expensive to inject iron intravenously (and it is really expensive, there are much
-I don’t want to be in a medical facility and do droppers, I just want to take iron at home
-We are afraid of the development of severe allergic reactions, including anaphylaxis
-Introduced to children and adolescents (they are almost always prescribed drugs in tablets /
syrups / drops).
Intravenous iron is given when:
-Iron is poorly tolerated in tablets and there are side effects from ZHIT
-There was severe blood loss
– Have had stomach surgery
-There is malabsorption syndrome and iron is poorly absorbed
-In the second trimester of pregnancy with severe deficiency and always, in the third trimester, when it is urgent to fill the deficit
-No effect at all, from iron, in tablets
Which iron supplements are preferable?
-There is no evidence that new forms of iron (such as chelated iron) really have an advantage, although in some patients they may cause side effects less often, but not always, and in all they do not raise iron levels sufficiently. But you can use them, in principle.
– As before, the optimal drug is ferrous sulfate. – especially in children (in children in our country it is Aktiferrin, in adults Tardiferon, Sorbifer, Fenyuls, Ferroplex, Ferro-Folgamma,)
-Clear evidence has emerged. the fact that taking iron supplements every other day (for example, Monday-Wednesday-Friday) contributes to the best
iron absorption and fewer side effects.
-There is no clear evidence that iron intake, along with vitamin C, significantly improves its absorption, although it is important to get food rich in vitamin C during this period
-High doses are absorbed no better than low ones, sometimes even worse, and the dosage is selected individually, based on many factors:
How to take iron correctly?
It is better not to take with meals (30-60 minutes before meals, for example), and should not be taken with coffee, tea, calcium-containing food, milk, eggs, dietary fiber, calcium supplements, zinc.