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Iron deficiency

Clara Camaschella

Abstract

Iron deficiency anemia affects >1.2 billions individuals worldwide and iron deficiency in the absence of anemia is even more frequent. Total body (absolute) iron deficiency is caused by physiologically increased iron requirements in children, adolescents, young and pregnant women, by reduced iron intake or by pathological defective absorption or chronic blood loss. Adaptation to iron deficiency at tissue level is controlled by Iron Regulatory Proteins to increase iron uptake and retention; at systemic level suppression of the iron hormone hepcidin increases iron release to plasma by absorptive enterocytes and recycling macrophages. The diagnosis of absolute iron deficiency is easy unless masked by inflammatory conditions. All cases of iron deficiency should be assessed for treatment and for the underlying cause. Special attention is needed in areas endemic for malaria and other infections to avoid infection worsening by iron treatment. Ongoing efforts aim at optimizing the iron salts-based therapy by protocols of administration based on the physiology of hepcidin control and at reducing the common side effects of oral iron. Intravenous iron, especially last generation compounds administered at high dose in single infusions, is becoming an effective alternative in an increasing number of conditions, because of a more rapid and persistent hematological response, and an acceptable safety profile. Risks/benefits of the different treatments should be weighted in a personalized therapeutic approach to iron deficiency.

  • Submitted May 30, 2018.
  • Accepted July 16, 2018.