David Kahn, MD 

Ironing Out Deficiency: Anemia Management in Hematology and Oncology 

This presentation discusses the management of iron deficiency in a general hematology practice, covering causes, diagnosis, treatment options, and patient education, particularly regarding iron infusions.

Common Causes of Iron Deficiency in Hematology Practice:


Iron deficiency often results from conditions such as menorrhagia (heavy menstrual bleeding), gastric bypass surgery, chronic kidney disease, and certain cancer treatments, which may require iron supplementation to manage the deficiency.


Diagnosis relies on a combination of patient history and lab results. Clinicians must differentiate between iron deficiency and anemia. It’s important to understand the body’s need for iron and consider treatment options, such as oral or IV iron, with a trial period before retesting for improvements.


Oral iron is often the first treatment choice for many patients. However, not all patients are suitable candidates for oral iron, particularly if they have gastrointestinal issues or other complicating factors. IV iron may be necessary for those who do not respond to oral supplementation.


IV iron treatment involves dosing strategies that aim to minimize the number of infusions, reducing patient burden. Fewer doses are preferable when managing iron deficiency through IV iron therapy.


Adverse reactions to IV iron are rare but can occur. Common symptoms include nausea, typically the next day. Test doses may not predict the development of these reactions. It’s important to be prepared to manage these rare adverse events effectively.


Patient education is crucial to addressing concerns about the risks and benefits of IV iron infusions. For pregnant patients, it’s important to emphasize the benefits of iron supplementation for both the patient and the fetus. Follow-up after IV infusion may be necessary, and some patients will require regular check-ins.


If iron deficiency is suspected to be related to gastrointestinal issues, such as those related to colon cancer, referring patients to a gastroenterologist is key. Understanding the criteria for referral helps ensure appropriate management of underlying conditions.

Future Directions in Iron Deficiency Management:


Looking ahead, there is an increasing focus on early screening for iron deficiency, including more rigorous iron and ferritin testing, particularly in childhood. The goal is to reduce iron deficiency-related deaths globally and improve management practices.

In summary, the management of iron deficiency in hematology requires a comprehensive approach involving accurate diagnosis, appropriate treatment choices, patient education, and collaboration with specialists when necessary. Ongoing advancements in treatment and screening hold promise for improving outcomes and reducing the global burden of iron deficiency.

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Panelists discuss how accurately diagnosing iron deficiency, selecting appropriate treatments like oral or intravenous iron, educating patients, and collaborating with specialists are essential for effective management and improving outcomes in hematology practice.

David Kahn, MD

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