Therapies to Increase Iron or Red Blood Cell Levels
Iron levels that get too low and threaten life, must be restored. Doing so is not always straight-forward. A person might be iron deficient with or without anemia and respond well to supplemental iron or diet changes. Or a person may have complicated health issues that pose challenges and barriers to iron or red blood cell restoration.
Before iron or red blood cells can be replenished, a complete evaluation of a person’s iron status is imperative. A healthcare professional can order tests that will confirm iron deficiency with or without anemia. Further investigation will be needed to determine iron balance issues in patients with cancer, kidney disease, nutritional deficiencies, problems of absorption, infection, inherited anemias, or enzyme disorders. Once the physician is confident of a patient’s iron status, several approaches might be used. These include: diet changes; oral, injected or infused iron; or whole blood (or packed red blood cell) transfusion. In situations where both anemia and iron overload preside restoration of red blood cells combined with iron chelation therapy will be used. Drugs that stimulate red blood cell production may also be incorporated into therapy.
Diet for patients who are iron deficient (see iron avidity diet)
Functional iron deficiency (moderately low iron reserves in ferritin with normal hemoglobin) can be corrected with oral iron (pills) when the cause is insufficient daily intake of iron from the diet. Iron pills, even low-dose pills will replenish stores very soon, generally within 3-4 weeks. If functional iron deficiency progresses to anemia, oral iron alone may not be sufficient to replenish stores. A combination oral iron and diets that include lean red meat can be tried for a period of time. Iron deficiency with anemia is a serious threat to health and should be monitored at least monthly. The underlying cause which might be blood loss due to cancer or problems of absorption will determine the best approach to replenish iron stores and red blood cell levels.
Injected or Infused (parenteral) iron
Parenteral iron, which is administered by infusion or injection, is given to patients who have difficulty absorbing iron because of inherited conditions or surgical removal of portions of their stomach or small intestines.
Intramuscular injections are generally administered to the buttocks and can be somewhat painful and result in bleeding into the muscle. Intramuscular neoplasm (cancer) has been found at the injection site in some cases. Patients have also reported an orange discoloration at injection sites, which appear to be permanent. When iron is injected, it is properly done using a “Z technique” to prevent intramuscular bleeding or discoloration. Intravenous infusion is generally preferred by most hematologists over intramuscular injections (IM) because of these complications.
The intravenous iron or IV infusion procedure generally requires a series of doses that may take up to three to four hours to perform. The procedure is usually done at a hospital on an outpatient basis or at hemodialysis centers. Prior to an infusion, a test dose—25 mg of iron dextran—is given over period of five minutes. The patient is closely supervised to assure that he or she can tolerate the iron. If the patient develops no adverse reaction to the test dose, escalating doses are given over the next few days until 2 grams per infusion are tolerated. When IV iron is administered carefully, with close observation, patients usually tolerate the treatments well.
Side effects of iron toxicity can be acute, such as anaphylactic shock, or chronic, such as tissue iron overload. Unless a person takes an excessive amount of oral iron, acute symptoms with iron pills are generally isolated to gastrointestinal problems such as nausea, vomiting, or cramps.
There is a greater potential for acute side effects from injected or intravenous iron; for this reason the test dose and very slow infusion is used to lower the risk of a reaction.
Transfusion (see Transfusion 2009r)
Drugs that stimulate erythropoiesis pull EPO text from existing site