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Course: Health and medicine > Unit 6
Lesson 6: Iron deficiency anemia and anemia of chronic diseaseIron deficiency and anemia of chronic disease treatment
Created by Nauroz Syed.
Want to join the conversation?
- How do we distinguish melena from iron-colored black stool?(4 votes)
- There's a lab test called Occult Blood Stool that tests for actual presence of blood in the stool.(2 votes)
- Whats oral iron?And whats a gastrointestinal?(2 votes)
- Gastro means 'stomach'. Intestinal means 'of the intestine'. Oral iron means taking iron by mouth, in other words taking iron pills.(3 votes)
Video transcript
- So let's talk about the treatment of iron-deficiency anemia. And I'm really just going
to abbreviate that IDA. So, you'd imagine that
with iron deficiency it could be treated with
supplementation of iron, and you'd be completely correct. You can treat iron-deficiency anemia by giving a patient iron supplements, and there are a couple of different ways in which you can supplement iron. The first is by giving
oral iron supplements. And a few things to keep in
mind about oral iron supplements is, firstly, as we briefly
talked about before, stomach acid plays a really important role in converting dietary iron into a form that's more readily
absorbed by the duodenum. So, a patient could
help out the absorption of this oral iron if they were to take it alongside some acidic drink,
for example, orange juice. That would help the absorption
of the iron supplement. Secondly, oral iron can stain teeth black, and, more importantly, it
can cause black stools. It can cause black stools,
and this is really important because upper gastrointestinal bleeding can also present with black stools. So, if a patient has black stools, it's really important to
go through their history and see if, even remotely,
they've been taking any iron supplements
that could account for the black stools, because
upper gastrointestinal bleeding is a medical emergency. So, that's the first way in which you can replete someone's iron. The second way is
through intravenous iron, and really IV iron is reserved
for patients who either can't take anything by mouth, patients who can't tolerate oral iron, because really oral iron is not a very pleasant thing to take, and also for those patients
who require a dose of iron that would be too large to
take through oral means. So, really IV iron is reserved for those classes of patients. And then the third way in which you can treat iron-deficiency anemia
is with a blood transfusion, and blood transfusions are
really saved for patients who have very severe anemia, because blood transfusions are not without their own life-threatening consequences. So, just briefly I want
to go over this chart that we use to describe some of the most common causes
of iron-deficiency anemia. And you can imagine that
by giving a patient iron, you could, in a lot of instances, treat their iron deficiency. For example, if the
patient is suffering from decreased intake, well giving them iron would certainly solve that problem. Or if they have an increased demand, such as a pregnant lady or
somebody growing at a rapid rate, giving someone an iron
supplement in those conditions could treat the iron-deficiency
anemia for good. However, if a patient has
a condition that leads to an impairment in the absorption of iron, firstly, you couldn't give
them oral iron at all, but also in these patients giving IV iron would only be a very temporary measure. It wouldn't solve the underlying problem. They would still continue to
have iron-deficiency anemia. Also, patients who are suffering from increased loss of blood
for whatever reason, giving them iron supplements
would solve the acute problem, but they would continue
to have the anemia, unless you solved the underlying problem. So really, for these groups of patients, iron supplementation is not enough. Now with that being said, let's move on to the treatment of anemia
of chronic disease. Actually, I want to put
that in a different color, so it's less confusing. I'll put that in purple. Anemia of chronic disease, okay? I'm going to abbreviate that too. So, anemia of chronic disease
is an interesting disease because you can't really
treat it with iron. So, even though when you look
at these patients' blood, you see that there's a deficiency
of iron in their serum, and that's what's causing the anemia, giving these patients iron
wouldn't lead to any benefit, because remember the body is firstly limiting its absorption of iron. So, any iron that you give
orally wouldn't be absorbed, and secondly, whatever
iron does enter the body is being sequestered away
and hidden away in storage, and it's not being used for the production of red blood cells. So, giving iron wouldn't help, and not only would it not help, but all of the iron that's given and then subsequently stored in the liver eventually leads to damaging
reactions in the liver, and it can lead to an
independent disease of the liver. So, anemia of chronic disease is never, is never treated with iron, because not only does it not help, it can actually hurt the patient. Also, keep in mind that in situations such as infection and bacterial infection the anemia of chronic disease is kind of like a protective mechanism. The body is trying to keep the
iron away from the bacteria, in a way to sort of decrease
the growth of the bacteria. Providing extra iron in
that type of situation might prove to be harmful, in terms of increasing the
rate of bacterial growth. So that's also another
reason why we try to avoid giving these patients iron. So really, the treatment of
anemia of chronic disease rests on treating, I'm just
going to abbreviate that TX, treating the underlying condition, the underlying, usually
inflammatory, condition, just as is important with
iron-deficiency anemia. And these really are the
main mechanisms by which you treat both iron-deficiency anemia and anemia of chronic disease.