Iron deficiency anemia - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Iron deficiency anemia (IDA) is the most common form of anemia. Causes include decreased iron intake, increased iron loss, and increased iron requirements.
Clinical history, presentation, and findings include fatigue, pallor, dyspnea on exertion, and pica.
Blood tests reveal microcytic, hypochromic anemia; low reticulocyte count.
Other laboratory findings include low serum iron, increased total iron-binding capacity (TIBC), less than 16% transferrin saturation, and low serum ferritin.
Diagnosis of IDA requires investigation of the underlying cause.

Peripheral blood smear demonstrating some changes often seen with iron deficiency anemia. Note that many of the red cells are microcytic (compare size of red cell with the lymphocyte nucleus) and hypochromic (wide central pallor). There are some pencil forms

From personal collection of Dr Rebecca Fischer Connor; used with permission

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Definition

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Koilonychia
Peripheral blood smear demonstrating some changes often seen with iron deficiency anemia. Note that many of the red cells are microcytic (compare size of red cell with the lymphocyte nucleus) and hypochromic (wide central pallor). There are some pencil forms

Citations

Key Articles

US Preventive Services Task Force. Iron deficiency anemia in pregnant women: screening and supplementation. Sep 2015 [internet publication].[Full Text]
Mitra AK, Khoury AJ. Universal iron supplementation: a simple and effective strategy to reduce anaemia among low-income, postpartum women. Public Health Nutr. 2012 Mar;15(3):546-53.[Abstract][Full Text]
Snook J, Bhala N, Beales ILP, et al. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut. 2021 Nov;70(11):2030-51.[Abstract][Full Text]
US Preventive Services Task Force. Iron deficiency anemia in young children: screening. Sep 2015 [internet publication].[Full Text]
Pavord S, Daru J, Prasannan N, et al. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol. 2020 Mar;188(6):819-30.[Abstract][Full Text]
Anker SD, Kirwan BA, van Veldhuisen DJ, et al. Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis. Eur J Heart Fail. 2018 Jan;20(1):125-33.[Abstract][Full Text]
Snook J, Bhala N, Beales ILP, et al. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut. 2021 Sep 8 [Epub ahead of print].[Abstract][Full Text]

Referenced Articles

1. World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. 2011 [internet publication].[Full Text]
2. World Health Organization. The global prevalence of anaemia in 2011. 2015 [internet publication].[Full Text]
3. Kassebaum NJ, Jasrasaria R, Naghavi M, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014 Jan 30;123(5):615-24.[Abstract][Full Text]
4. Andrews, NC. Iron deficiency and related disorders. In: Lee GR, Foerster J, Lukens J, et al., eds. Wintrobe's clinical hematology. Baltimore, MD: Lippincott, Williams & Wilkins; 1999:979-1010.
5. Pasricha SR, Drakesmith H, Black J, et al. Control of iron deficiency anemia in low- and middle-income countries. Blood. 2013 Apr 4;121(14):2607-17.[Abstract][Full Text]
6. Looker AC, Dallman PR, Carroll MD, et al. Prevalence of iron deficiency in the United States. JAMA. 1997 Mar 26;277(12):973-6.[Abstract]
7. Levi M, Rosselli M, Simonetti M, et al. Epidemiology of iron deficiency anaemia in four European countries: a population-based study in primary care. Eur J Haematol. 2016 Dec;97(6):583-93.[Abstract]
8. Centers for Disease Control and Prevention. Recommendations to prevent and control iron deficiency in the United States. MMWR Recomm Rep. 1998 Apr 3;47(RR-3):1-29.[Abstract]
9. Gupta PM, Hamner HC, Suchdev PS, et al. Iron status of toddlers, nonpregnant females, and pregnant females in the United States. Am J Clin Nutr. 2017 Dec;106(suppl 6):1640S-6S.[Abstract][Full Text]
10. van der Merwe LF, Eussen SR. Iron status of young children in Europe. Am J Clin Nutr. 2017 Dec;106(suppl 6):1663S-71S.[Abstract][Full Text]
11. Beutler E. Disorders of iron metabolism. In: Lichtman MA, Beutler E, Kipps TJ, et al. Williams hematology. 7th ed. New York: McGraw-Hill Medical; 2006: 511-59,803-22.
12. Musallam KM, Taher AT. Iron deficiency beyond erythropoiesis: should we be concerned? Curr Med Res Opin. 2018 Jan;34(1):81-93.[Abstract]
13. Lopez A, Cacoub P, Macdougall IC, et al. Iron deficiency anaemia. Lancet. 2016 Feb 27;387(10021):907-16.[Abstract]
14. Hunt JR, Zito CA, Johnson LK. Body iron excretion by healthy men and women. Am J Clin Nutr. 2009 Jun;89(6):1792-8.[Abstract]
15. Bothwell TH. Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr. 2000 Jul;72(1 suppl):257S-64S.[Abstract]
16. FIGO Working Group on Good Clinical Practice in Maternal-Fetal Medicine. Good clinical practice advice: iron deficiency anemia in pregnancy. Int J Gynaecol Obstet. 2019 Mar;144(3):322-4.[Abstract]
17. Frewin R, Henson A, Provan D. ABC of clinical haematology. Iron deficiency anaemia. BMJ. 1997 Feb 1;314(7077):360-3.[Abstract][Full Text]
18. Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015 May 7;372(19):1832-43.[Abstract]
19. Gafter-Gvili A, Schechter A, Rozen-Zvi B. Iron deficiency anemia in chronic kidney disease. Acta Haematol. 2019;142(1):44-50.[Abstract][Full Text]
20. Waldmann A, Koschizke JW, Leitzmann C, et al. German vegan study: diet, life-style factors, and cardiovascular risk profile. Ann Nutr Metab. 2005 Nov-Dec;49(6):366-72.[Abstract]
21. Haider LM, Schwingshackl L, Hoffmann G, et al. The effect of vegetarian diets on iron status in adults: a systematic review and meta-analysis. Crit Rev Food Sci Nutr. 2018 May 24;58(8):1359-74.[Abstract]
22. Hurrell R, Egli I. Iron bioavailability and dietary reference values. Am J Clin Nutr. 2010 May;91(5):1461S-7S.[Abstract]
23. Harvey LJ, Armah CN, Dainty JR, et al. Impact of menstrual blood loss and diet on iron deficiency among women in the UK. Br J Nutr. 2005 Oct;94(4):557-64.[Abstract]
24. Aikawa R, Khan NC, Sasaki S, et al. Risk factors for iron-deficiency anaemia among pregnant women living in rural Vietnam. Public Health Nutr. 2006 Jun;9(4):443-8.[Abstract]
25. Halfdanarson TR, Litzow MR, Murray JA. Hematologic manifestations of celiac disease. Blood. 2007 Jan 15;109(2):412-21.[Abstract]
26. Betesh AL, Santa Ana CA, Cole JA, et al. Is achlorhydria a cause of iron deficiency anemia? Am J Clin Nutr. 2015 Jul;102(1):9-19.[Abstract]
27. Tovey FI, Hobsley M. Post-gastrectomy patients need to be followed up for 20-30 years. World J Gastroenterol. 2000 Feb;6(1):45-8.[Abstract]
28. Allison MC, Howatson AG, Torrance CJ, et al. Gastrointestinal damage associated with the use of nonsteroidal antiinflammatory drugs. N Engl J Med. 1992 Sep 10;327(11):749-54.[Abstract]
29. Lupoli R, Lembo E, Saldalamacchia G, et al. Bariatric surgery and long-term nutritional issues. World J Diabetes. 2017 Nov 15;8(11):464-74.[Abstract][Full Text]
30. Cohen-Solal A, Damy T, Terbah M, et al. High prevalence of iron deficiency in patients with acute decompensated heart failure. Eur J Heart Fail. 2014 Sep;16(9):984-91.[Abstract][Full Text]
31. Baker RD, Greer FR, Committee on Nutrition American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics. 2010 Nov;126(5):1040-50.[Abstract][Full Text]
32. Domellöf M. Meeting the iron needs of low and very low birth weight infants. Ann Nutr Metab. 2017;71 Suppl 3:16-23.[Abstract][Full Text]
33. Male C, Persson LA, Freeman V, et al. Prevalence of iron deficiency in 12-mo-old infants from 11 European areas and influence of dietary factors on iron status (Euro-Growth study). Acta Paediatr. 2001 May;90(5):492-8.[Abstract]
34. Bodnar LM, Cogswell ME, McDonald T. Have we forgotten the significance of postpartum iron deficiency? Am J Obstet Gynecol. 2005 Jul;193(1):36-44.[Abstract]
35. Bodnar LM, Cogswell ME, Scanlon KS. Low income postpartum women are at risk of iron deficiency. J Nutr. 2002 Aug;132(8):2298-302.[Abstract]
36. Hutchinson C. A review of iron studies in overweight and obese children and adolescents: a double burden in the young? Eur J Nutr. 2016 Oct;55(7):2179-97.[Abstract]
37. Nead KG, Halterman JS, Kaczorowski JM, et al. Overweight children and adolescents: a risk group for iron deficiency. Pediatrics. 2004 Jul;114(1):104-8.[Abstract]
38. Qu XH, Huang XL, Xiong P, et al. Does Helicobacter pylori infection play a role in iron deficiency anemia? A meta-analysis. World J Gastroenterol. 2010 Feb 21;16(7):886-96.[Abstract][Full Text]
39. Cardenas VM, Mulla ZD, Ortiz M, et al. Iron deficiency and Helicobacter pylori infection in the United States. Am J Epidemiol. 2006 Jan 15;163(2):127-34.[Abstract]
40. DuBois S, Kearney DJ. Iron-deficiency anemia and Helicobacter pylori infection: a review of the evidence. Am J Gastroenterol. 2005 Feb;100(2):453-9.[Abstract]
41. Yuan W, Li Y, Yang K, et al. Iron deficiency anemia in Helicobacter pylori infection: meta-analysis of randomized controlled trials. Scand J Gastroenterol. 2010 Jun;45(6):665-76.[Abstract]
42. World Health Organization. Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes. 2014 [internet publication].[Full Text]
43. Kc A, Rana N, Målqvist M, et al. Effects of delayed umbilical cord clamping vs early clamping on anemia in infants at 8 and 12 months: a randomized clinical trial. JAMA Pediatr. 2017 Mar 1;171(3):264-70.[Abstract][Full Text]
44. World Health Organization. Daily iron supplementation in infants and children. 2016 [internet publication].[Full Text]
45. McCarthy EK, Dempsey EM, Kiely ME. Iron supplementation in preterm and low-birth-weight infants: a systematic review of intervention studies. Nutr Rev. 2019 Dec 1;77(12):865-77.[Abstract][Full Text]
46. De-Regil LM, Jefferds MED, Peña-Rosas JP. Point-of-use fortification of foods with micronutrient powders containing iron in children of preschool and school-age. Cochrane Database Syst Rev. 2017 Nov 23;(11):CD009666.[Abstract][Full Text]
47. Das JK, Salam RA, Mahmood SB, et al. Food fortification with multiple micronutrients: impact on health outcomes in general population. Cochrane Database Syst Rev. 2019 Dec 18;(12):CD011400.[Abstract][Full Text]
48. Suchdev PS, Jefferds MED, Ota E, et al. Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age. Cochrane Database Syst Rev. 2020 Feb 28;(2):CD008959.[Abstract][Full Text]
49. Field MS, Mithra P, Peña-Rosas JP. Wheat flour fortification with iron and other micronutrients for reducing anaemia and improving iron status in populations. Cochrane Database Syst Rev. 2021 Jan 18;(1):CD011302.[Abstract][Full Text]
50. Baxter JB, Carducci B, Kamali M, et al. Fortification of salt with iron and iodine versus fortification of salt with iodine alone for improving iron and iodine status. Cochrane Database Syst Rev. 2022 Apr 21;(4):CD013463.[Abstract][Full Text]
51. da Silva Lopes K, Yamaji N, Rahman MO, et al. Nutrition-specific interventions for preventing and controlling anaemia throughout the life cycle: an overview of systematic reviews. Cochrane Database Syst Rev. 2021 Sep 26;(9):CD013092.[Abstract][Full Text]
52. Sazawal S, Black RE, Ramsan M, et al. Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial. Lancet. 2006 Jan 14;367(9505):133-43.[Abstract]
53. Neuberger A, Okebe J, Yahav D, et al. Oral iron supplements for children in malaria-endemic areas. Cochrane Database Syst Rev. 2016 Feb 27;(2):CD006589.[Abstract][Full Text]
54. Cusick SE, Opoka RO, Abrams SA, et al. Delaying iron therapy until 28 days after antimalarial treatment is associated with greater iron incorporation and equivalent hematologic recovery after 56 days in children: a randomized controlled trial. J Nutr. 2016 Sep;146(9):1769-74.[Abstract][Full Text]
55. Moya-Alvarez V, Bodeau-Livinec F, Cot M. Iron and malaria: a dangerous liaison? Nutr Rev. 2016 Oct;74(10):612-23.[Abstract]
56. World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. 2016 [internet publication].[Full Text]
57. World Health Organization. Daily iron supplementation in adult women and adolescent girls. 2016 [internet publication].[Full Text]
58. World Health Organization. Daily iron supplementation in postpartum women. 2016 [internet publication].[Full Text]
59. US Preventive Services Task Force. Iron deficiency anemia in pregnant women: screening and supplementation. Sep 2015 [internet publication].[Full Text]
60. Imdad A, Bhutta ZA. Routine iron/folate supplementation during pregnancy: effect on maternal anaemia and birth outcomes. Paediatr Perinat Epidemiol. 2012 Jul;26(suppl 1):168-77.[Abstract][Full Text]
61. Haider BA, Olofin I, Wang M, et al; Nutrition Impact Model Study Group (anaemia). Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ. 2013 Jun 21;346:f3443.[Abstract][Full Text]
62. Low MS, Speedy J, Styles CE, et al. Daily iron supplementation for improving anaemia, iron status and health in menstruating women. Cochrane Database Syst Rev. 2016 Apr 18;(4):CD009747.[Abstract][Full Text]
63. Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, et al. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2015 Jul 22;(7):CD004736.[Abstract][Full Text]
64. Mwangi MN, Prentice AM, Verhoef H. Safety and benefits of antenatal oral iron supplementation in low-income countries: a review. Br J Haematol. 2017 Jun;177(6):884-95.[Abstract][Full Text]
65. Peña-Rosas JP, De-Regil LM, Malave HG, et al. Intermittent oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2015 Oct 19;(10):CD009997.[Abstract][Full Text]
66. Fernández-Gaxiola AC, De-Regil LM. Intermittent iron supplementation for reducing anaemia and its associated impairments in adolescent and adult menstruating women. Cochrane Database Syst Rev. 2019 Jan 31;(1):CD009218.[Abstract][Full Text]
67. Keats EC, Haider BA, Tam E, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2019 Mar 14;(3):CD004905.[Abstract][Full Text]
68. Mitra AK, Khoury AJ. Universal iron supplementation: a simple and effective strategy to reduce anaemia among low-income, postpartum women. Public Health Nutr. 2012 Mar;15(3):546-53.[Abstract][Full Text]
69. Muñoz M, Acheson AG, Auerbach M, et al. International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia. 2017 Feb;72(2):233-47.[Abstract][Full Text]
70. Daru J, Allotey J, Peña-Rosas JP, et al. Serum ferritin thresholds for the diagnosis of iron deficiency in pregnancy: a systematic review. Transfus Med. 2017 Jun;27(3):167-74.[Abstract][Full Text]
71. World Health Organization. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. 2020 [internet publication].[Full Text]
72. Fletcher A, Forbes A, Svenson N, et al. Guideline for the laboratory diagnosis of iron deficiency in adults (excluding pregnancy) and children. Br J Haematol. 2022 Feb;196(3):523-9.[Abstract][Full Text]
73. Ko CW, Siddique SM, Patel A, et al. AGA clinical practice guidelines on the gastrointestinal evaluation of iron deficiency anemia. Gastroenterology. 2020 Sep;159(3):1085-1094.[Abstract][Full Text]
74. Koulaouzidis A, Said E, Cottier R, et al. Soluble transferrin receptors and iron deficiency, a step beyond ferritin. A systematic review. J Gastrointestin Liver Dis. 2009 Sep;18(3):345-52.[Abstract]
75. Punnonen K, Irjala K, Rajamaki A. Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood. 1997 Feb 1;89(3):1052-7.[Abstract][Full Text]
76. Snook J, Bhala N, Beales ILP, et al. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut. 2021 Nov;70(11):2030-51.[Abstract][Full Text]
77. Chey WD, Leontiadis GI, Howden CW, et al. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017 Feb;112(2):212-39.[Abstract][Full Text]
78. American Society for Clinical Pathology. Thirty five things physicians and patients should question. Choosing Wisely, an initiative of the ABIM Foundation. 2021 [internet publication].[Full Text]
79. Chey W, Howden C, Moss S, et al. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2024;119(9):1730-53.[Full Text]
80. Peytremann-Bridevaux I, Arditi C, Froehlich F, et al; EPAGE II Study Group. Appropriateness of colonoscopy in Europe (EPAGE II). Iron-deficiency anemia and hematochezia. Endoscopy. 2009 Mar;41(3):227-33.[Abstract][Full Text]
81. Hershko C, Camaschella C. How I treat unexplained refractory iron deficiency anemia. Blood. 2014 Jan 16;123(3):326-33.[Abstract][Full Text]
82. Banerjee AK, Celentano V, Khan J, et al. Practical gastrointestinal investigation of iron deficiency anaemia. Expert Rev Gastroenterol Hepatol. 2018 Mar;12(3):249-56.[Abstract]
83. Girelli D, Nemeth E, Swinkels DW. Hepcidin in the diagnosis of iron disorders. Blood. 2016 Jun 9;127(23):2809-13.[Abstract][Full Text]
84. Löfving A, Domellöf M, Hellström-Westas L, et al. Reference intervals for reticulocyte hemoglobin content in healthy infants. Pediatr Res. 2018 Nov;84(5):657-61.[Abstract][Full Text]
85. Nalado AM, Mahlangu JN, Duarte R, et al. Utility of reticulocyte haemoglobin content and percentage hypochromic red cells as markers of iron deficiency anaemia among black CKD patients in South Africa. PLoS One. 2018 Oct 3;13(10):e0204899.[Abstract][Full Text]
86. Mei Z, Flores-Ayala RC, Grummer-Strawn LM, et al. Is erythrocyte protoporphyrin a better single screening test for iron deficiency compared to hemoglobin or mean cell volume in children and women? Nutrients. 2017 May 31;9(6):557.[Abstract][Full Text]
87. Simundic AM, Bölenius K, Cadamuro J, et al. Joint EFLM-COLABIOCLI recommendation for venous blood sampling. Clin Chem Lab Med. 2018;56(12):2015-38.[Abstract]
88. Kettaneh A, Eclache V, Fain O, et al. Pica and food craving in patients with iron-deficiency anemia: a case-control study in France. Am J Med. 2005 Feb;118(2):185-8.[Abstract]
89. Silber MH, Becker PM, Earley C, et al. Willis-Ekbom Disease Foundation revised consensus statement on the management of restless legs syndrome. Mayo Clin Proc. 2013 Sep;88(9):977-86.[Abstract][Full Text]
90. Goel A, Bakshi SS, Soni N, et al. Iron deficiency anemia and Plummer-Vinson syndrome: current insights. J Blood Med. 2017 Oct 19;8:175-84.[Abstract][Full Text]
91. Hershko C, Hoffbrand AV, Keret D, et al. Role of autoimmune gastritis, Helicobacter pylori and celiac disease in refractory or unexplained iron deficiency anemia. Haematologica. 2005 May;90(5):585-95.[Abstract]
92. Sheth TN, Choudhry NK, Bowes M, et al. The relation of conjunctival pallor to the presence of anemia. J Gen Intern Med. 1997 Feb;12(2):102-6.[Abstract][Full Text]
93. Trost LB, Bergfeld WF, Calogeras E. The diagnosis and treatment of iron deficiency and its potential relationship to hair loss. J Am Acad Dermatol. 2006 May;54(5):824-44.[Abstract]
94. Deloche C, Bastien P, Chadoutaud S, et al. Low iron stores: a risk factor for excessive hair loss in non-menopausal women. Eur J Dermatol. 2007 Nov-Dec;17(6):507-12.[Abstract]
95. McCann JC, Ames BN. An overview of evidence for a causal relation between iron deficiency during development and deficits in cognitive or behavioral function. Am J Clin Nutr. 2007 Apr;85(4):931-45.[Abstract][Full Text]
96. Falkingham M, Abdelhamid A, Curtis P, et al. The effects of oral iron supplementation on cognition in older children and adults: a systematic review and meta-analysis. Nutr J. 2010 Jan 25;9:4.[Abstract][Full Text]
97. Larson LM, Phiri KS, Pasricha SR. Iron and cognitive development: what is the evidence? Ann Nutr Metab. 2017;71 Suppl 3:25-38.[Abstract][Full Text]
98. Hegde N, Rich MW, Gayomali C. The cardiomyopathy of iron deficiency. Tex Heart Inst J. 2006;33(3):340-4.[Abstract]
99. Hassan TH, Badr MA, Karam NA, et al. Impact of iron deficiency anemia on the function of the immune system in children. Medicine (Baltimore). 2016 Nov;95(47):e5395.[Abstract][Full Text]
100. The relation of iron to blood platelets. Nutr Rev. 1976 Jan;34(1):25-7.[Abstract]
101. Ioannou GN, Spector J, Scott K, et al. Prospective evaluation of a clinical guideline for the diagnosis and management of IDA. Am J Med. 2002 Sep;113(4):281-7.[Abstract]
102. Beutler E, Hoffbrand A, Cook JD. Iron deficiency and overload. Hematology Am Soc Hematol Educ Program. 2003;40-61.[Abstract][Full Text]
103. Bovy C, Gothot A, Delanaye P, et al. Mature erythrocyte parameters as new markers of functional iron deficiency in hemodialysis: sensitivity and specificity. Nephrol Dial Transplant. 2007 Apr;22(4):1156-62.[Abstract]
104. Wang M. Iron deficiency and other types of anemia in infants and children. Am Fam Physician. 2016 Feb 15;93(4):270-8.[Abstract][Full Text]
105. Means RT Jr. Hepcidin and anaemia. Blood Rev. 2004 Dec;18(4):219-25.[Abstract]
106. Cappellini MD, Musallam KM, Taher AT. Iron deficiency anaemia revisited. J Intern Med. 2020 Feb;287(2):153-70.[Abstract]
107. Labbe RF, Vreman HJ, Stevenson DK. Zinc protoporphyrin: a metabolite with a mission. Clin Chem. 1999 Dec;45(12):2060-72.[Abstract]
108. Larrick JW, Hyman ES. Acquired iron-deficiency anemia caused by an antibody against the transferrin receptor. N Engl J Med. 1984 Jul 26;311(4):214-8.[Abstract]
109. Nittis T, Gitlin JD. The copper-iron connection: hereditary aceruloplasminemia. Semin Hematol. 2002 Oct;39(4):282-9.[Abstract]
110. Chitambar CR, Zivkovic Z. Inhibition of hemoglobin production by transferrin-gallium. Blood. 1987 Jan;69(1):144-9.[Abstract][Full Text]
111. US Preventive Services Task Force. Iron deficiency anemia in young children: screening. Sep 2015 [internet publication].[Full Text]
112. Cantor AG, Bougatsos C, Dana T, et al. Routine iron supplementation and screening for iron deficiency anemia in pregnancy: a systematic review for the US Preventive Services Task Force. Ann Intern Med. 2015 Apr 21;162(8):566-76.[Abstract][Full Text]
113. American Academy of Family Physicians. Summary of recommendations for clinical preventive services. Jul 2017 [internet publication].[Full Text]
114. Guidelines and Protocols Advisory Committee in British Columbia. Iron deficiency - diagnosis and management. Apr 2019 [internet publication].[Full Text]
115. Kidney Disease: Improving Global Outcomes (KDIGO). KDOQI clinical practice guideline for anemia in chronic kidney disease. Kidney Int Suppl. 2012;2(4):279-35.[Full Text]
116. Pavord S, Daru J, Prasannan N, et al. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol. 2020 Mar;188(6):819-30.[Abstract][Full Text]
117. Thomas DW, Hinchliffe RF, Briggs C, et al. Guideline for the laboratory diagnosis of functional iron deficiency. Br J Haematol. 2013 Jun;161(5):639-48.[Abstract]
118. Breymann C, Honegger C, Hösli I, et al. Diagnosis and treatment of iron-deficiency anaemia in pregnancy and postpartum. Arch Gynecol Obstet. 2017 Dec;296(6):1229-34.[Abstract]
119. Dignass AU, Gasche C, Bettenworth D, et al; European Crohn's and Colitis Organisation. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohns Colitis. 2015 Mar;9(3):211-22.[Abstract][Full Text]
120. Api O, Breyman C, Çetiner M, et al. Diagnosis and treatment of iron deficiency anemia during pregnancy and the postpartum period: iron deficiency anemia working group consensus report. Turk J Obstet Gynecol. 2015 Sep;12(3):173-81.[Abstract][Full Text]
121. Davidsson L, Kastenmayer P, Szajewska H, et al. Iron bioavailability in infants from an infant cereal fortified with ferric pyrophosphate or ferrous fumarate. Am J Clin Nutr. 2000 Jun;71(6):1597-602.[Abstract][Full Text]
122. Schrier SL. So you know how to treat iron deficiency anemia. Blood. 2015 Oct 22;126(17):1971.[Abstract][Full Text]
123. Stoffel NU, Cercamondi CI, Brittenham G, et al. Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials. Lancet Haematol. 2017 Nov;4(11):e524-e33.[Abstract]
124. Stoffel NU, Zeder C, Brittenham GM, et al. Iron absorption from supplements is greater with alternate day than with consecutive day dosing in iron-deficient anemic women. Haematologica. 2020 May;105(5):1232-39.[Abstract][Full Text]
125. O'Neil-Cutting MA, Crosby WH. The effect of antacids on the absorption of simultaneously ingested iron. JAMA. 1986 Mar 21;255(11):1468-70.[Abstract]
126. Okam MM, Koch TA, Tran MH. Iron supplementation, response in iron-deficiency anemia: analysis of five trials. Am J Med. 2017 Aug;130(8):991.e1-991.e8.[Abstract]
127. Aapro M, Österborg A, Gascón P, et al. Prevalence and management of cancer-related anaemia, iron deficiency and the specific role of i.v. iron. Ann Oncol. 2012 Aug;23(8):1954-62.[Abstract][Full Text]
128. Gascón, P. Iron therapy in cancer-induced anemia. Transfus Altern Transfus Med. 2012;12:130-4.
129. Lee TW, Kolber MR, Fedorak RN, et al. Iron replacement therapy in inflammatory bowel disease patients with iron deficiency anemia: a systematic review and meta-analysis. J Crohns Colitis. 2012 Apr;6(3):267-75.[Abstract][Full Text]
130. Reinisch W, Staun M, Tandon RK, et al. A randomized, open-label, non-inferiority study of intravenous iron isomaltoside 1,000 (Monofer) compared with oral iron for treatment of anemia in IBD (PROCEED). Am J Gastroenterol. 2013 Dec;108(12):1877-88.[Abstract][Full Text]
131. Comin-Colet J, Lainscak M, Dickstein K, et al. The effect of intravenous ferric carboxymaltose on health-related quality of life in patients with chronic heart failure and iron deficiency: a subanalysis of the FAIR-HF study. Eur Heart J. 2013 Jan;34(1):30-8.[Abstract][Full Text]
132. Kansagara D, Dyer E, Englander H, et al. Treatment of anemia in patients with heart disease: a systematic review. Ann Intern Med. 2013 Dec 3;159(11):746-57.[Abstract][Full Text]
133. Beck-da-Silva L, Piardi D, Soder S, et al. IRON-HF study: a randomized trial to assess the effects of iron in heart failure patients with anemia. Int J Cardiol. 2013 Oct 9;168(4):3439-42.[Abstract]
134. Aapro M, Beguin Y, Bokemeyer C, et al. Management of anaemia and iron deficiency in patients with cancer: ESMO clinical practice guidelines. Ann Oncol. 2018 Oct 1;29(suppl 4):iv96-iv110.[Abstract][Full Text]
135. Pieracci FM, Stovall RT, Jaouen B, et al. A multicenter, randomized clinical trial of IV iron supplementation for anemia of traumatic critical illness. Crit Care Med. 2014 Sep;42(9):2048-57.[Abstract]
136. Schiesser D, Binet I, Tsinalis D, et al. Weekly low-dose treatment with intravenous iron sucrose maintains iron status and decreases epoetin requirement in iron-replete haemodialysis patients. Nephrol Dial Transplant. 2006 Oct;21(10):2841-5.[Abstract]
137. O'Lone EL, Hodson EM, Nistor I, et al. Parenteral versus oral iron therapy for adults and children with chronic kidney disease. Cochrane Database Syst Rev. 2019 Feb 21;(2):CD007857.[Abstract][Full Text]
138. De Franceschi L, Iolascon A, Taher A, et al. Clinical management of iron deficiency anemia in adults: Systemic review on advances in diagnosis and treatment. Eur J Intern Med. 2017 Jul;42:16-23.[Abstract]
139. Avni T, Bieber A, Grossman A, et al. The safety of intravenous iron preparations: systematic review and meta-analysis. Mayo Clin Proc. 2015 Jan;90(1):12-23.[Abstract]
140. Macdougall IC, Strauss WE, McLaughlin J, et al. A randomized comparison of ferumoxytol and iron sucrose for treating iron deficiency anemia in patients with CKD. Clin J Am Soc Nephrol. 2014 Apr;9(4):705-12.[Abstract][Full Text]
141. Hetzel D, Strauss W, Bernard K, et al. A phase III, randomized, open-label trial of ferumoxytol compared with iron sucrose for the treatment of iron deficiency anemia in patients with a history of unsatisfactory oral iron therapy. Am J Hematol. 2014 Jun;89(6):646-50.[Abstract][Full Text]
142. Onken JE, Bregman DB, Harrington RA, et al. A multicenter, randomized, active-controlled study to investigate the efficacy and safety of intravenous ferric carboxymaltose in patients with iron deficiency anemia. Transfusion. 2014 Feb;54(2):306-15.[Abstract]
143. Auerbach M, Adamson J, Bircher A, et al. On the safety of intravenous iron, evidence trumps conjecture. Haematologica. 2015 May;100(5):e214-5.[Abstract][Full Text]
144. Auerbach M, Witt D, Toler W. Clinical use of the total dose intravenous infusion of iron dextran. J Lab Clin Med. 1988 May;111(5):566-70.[Abstract]
145. Auerbach M, Chaudhry M, Goldman H. Value of methylprednisolone in prevention of the arthralgia-myalgia syndrome associated with the total dose infusion of iron dextran: a double blind randomized trial. J Lab Clin Med. 1998 Mar;131(3):257-60.[Abstract]
146. Dave CV, Brittenham GM, Carson JL, et al. Risks for anaphylaxis with intravenous iron formulations: retrospective cohort study. Ann Intern Med. 2022 May;175(5):656-64.[Abstract][Full Text]
147. Khalafallah A, Dennis A, Bates J, et al. A prospective randomized, controlled trial of intravenous versus oral iron for moderate iron deficiency anaemia of pregnancy. J Intern Med. 2010 Sep;268(3):286-95.[Abstract]
148. Bailie GR, Mason NA, Valaoras TG. Safety and tolerability of intravenous ferric carboxymaltose in patients with iron deficiency anemia. Hemodial Int. 2010 Jan;14(1):47-54.[Abstract]
149. Anker SD, Comin Colet J, Filippatos G, et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009 Dec 17;361(25):2436-48.[Abstract][Full Text]
150. Van Wyck DB, Mangione A, Morrison J, et al. Large-dose intravenous ferric carboxymaltose injection for iron deficiency anemia in heavy uterine bleeding: a randomized, controlled trial. Transfusion. 2009 Dec;49(12):2719-28.[Abstract]
151. Wang C, Graham DJ, Kane RC, et al. Comparative risk of anaphylactic reactions associated with intravenous iron products. JAMA. 2015 Nov 17;314(19):2062-8.[Abstract]
152. Auerbach M, Ballard H, Glaspy J. Clinical update: intravenous iron for anaemia. Lancet. 2007 May 5;369(9572):1502-4.[Abstract]
153. Sav T, Tokgoz B, Sipahioglu MH, et al. Is there a difference between the allergic potencies of the iron sucrose and low molecular weight iron dextran? Ren Fail. 2007;29(4):423-6.[Abstract]
154. Kochhar PK, Kaundal A, Ghosh P. Intravenous iron sucrose versus oral iron in treatment of iron deficiency anemia in pregnancy: a randomized clinical trial. J Obstet Gynaecol Res. 2013 Feb;39(2):504-10.[Abstract]
155. Bhavi SB, Jaju PB. Intravenous iron sucrose v/s oral ferrous fumarate for treatment of anemia in pregnancy. A randomized controlled trial. BMC Pregnancy Childbirth. 2017 May 8;17(1):137.[Abstract][Full Text]
156. El Khouly NI. Comparison of intravenous ferrous sucrose and oral ferrous sulphate in treatment of postpartum iron deficiency anemia. J Matern Fetal Neonatal Med. 2017 Apr;30(8):967-71.[Abstract]
157. Adkinson NF, Strauss WE, Macdougall IC, et al. Comparative safety of intravenous ferumoxytol versus ferric carboxymaltose in iron deficiency anemia: a randomized trial. Am J Hematol. 2018 May;93(5):683-90.[Abstract][Full Text]
158. Singh A, Patel T, Hertel J, et al. Safety of ferumoxytol in patients with anemia and CKD. Am J Kidney Dis. 2008 Nov;52(5):907-15.[Abstract]
159. Breymann C, Milman N, Mezzacasa A, et al. Ferric carboxymaltose vs. oral iron in the treatment of pregnant women with iron deficiency anemia: an international, open-label, randomized controlled trial (FER-ASAP). J Perinat Med. 2017 May 24;45(4):443-53.[Abstract][Full Text]
160. Aksan A, Işık H, Radeke HH, et al. Systematic review with network meta-analysis: comparative efficacy and tolerability of different intravenous iron formulations for the treatment of iron deficiency anaemia in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2017 May;45(10):1303-18.[Abstract][Full Text]
161. Anker SD, Kirwan BA, van Veldhuisen DJ, et al. Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis. Eur J Heart Fail. 2018 Jan;20(1):125-33.[Abstract][Full Text]
162. Martens P, Dupont M, Dauw J, et al. The effect of intravenous ferric carboxymaltose on cardiac reverse remodelling following cardiac resynchronization therapy-the IRON-CRT trial. Eur Heart J. 2021 Dec 21;42(48):4905-14.[Abstract][Full Text]
163. Daniilidis A, Panteleris N, Vlachaki E, et al. Safety and efficacy of intravenous iron administration for uterine bleeding or postpartum anaemia: a narrative review. J Obstet Gynaecol. 2018 May;38(4):443-7.[Abstract]
164. Derman R, Roman E, Modiano MR, et al. A randomized trial of iron isomaltoside versus iron sucrose in patients with iron deficiency anemia. Am J Hematol. 2017 Mar;92(3):286-91.[Abstract][Full Text]
165. Auerbach M, Henry D, Derman RJ, et al. A prospective, multi-center, randomized comparison of iron isomaltoside 1000 versus iron sucrose in patients with iron deficiency anemia; the FERWON-IDA trial. Am J Hematol. 2019 Sep;94(9):1007-14.[Abstract][Full Text]
166. Mulder MB, van den Hoek HL, Birnie E, et al. Comparison of hypersensitivity reactions of intravenous iron: iron isomaltoside-1000 (Monofer® ) versus ferric carboxy-maltose (Ferinject® ). A single center, cohort study. Br J Clin Pharmacol. 2019 Feb;85(2):385-92.[Abstract][Full Text]
167. Rampton D, Folkersen J, Fishbane S, et al. Hypersensitivity reactions to intravenous iron: guidance for risk minimization and management. Haematologica. 2014 Nov;99(11):1671-6.[Abstract][Full Text]
168. European Medicines Agency. New recommendations to manage risk of allergic reactions with intravenous iron-containing medicines. 2013 [internet publication].[Full Text]
169. Agarwal R. Iron deficiency anemia in chronic kidney disease: uncertainties and cautions. Hemodial Int. 2017 Jun;21(suppl 1):S78-S82.[Abstract][Full Text]
170. Agarwal R, Kusek JW, Pappas MK. A randomized trial of intravenous and oral iron in chronic kidney disease. Kidney Int. 2015 Oct;88(4):905-14.[Abstract][Full Text]
171. Wolf M, Rubin J, Achebe M, et al. Effects of Iron isomaltoside vs ferric carboxymaltose on hypophosphatemia in iron-deficiency anemia: two randomized clinical trials. JAMA. 2020 Feb 4;323(5):432-43.[Abstract][Full Text]
172. Schaefer B, Tobiasch M, Viveiros A, et al. Hypophosphataemia after treatment of iron deficiency with intravenous ferric carboxymaltose or iron isomaltoside-a systematic review and meta-analysis. Br J Clin Pharmacol. 2021 May;87(5):2256-73.[Abstract][Full Text]
173. Vandemergel X, Vandergheynst F. Potentially life-threatening phosphate diabetes induced by ferric carboxymaltose injection: a case report and review of the literature. Case Rep Endocrinol. 2014;2014:843689.[Abstract][Full Text]
174. Sangrós Sahún MJ, Goñi Gironés E, Camarero Salazar A, et al. Symptomatic hypophosphataemic osteomalacia secondary to the treatment with iron carboxymaltose detected in bone scintigraphy [in Spanish]. Rev Esp Med Nucl Imagen Mol. 2016 Nov - Dec;35(6):391-3.[Abstract]
175. Stainsby D, Jones H, Asher D, et al. Serious hazards of transfusion: a decade of hemovigilance in the UK. Transfus Med Rev. 2006 Oct;20(4):273-82.[Abstract]
176. Shinar S, Skornick-Rapaport A, Maslovitz S. Iron supplementation in twin pregnancy - the benefit of doubling the iron dose in iron deficient pregnant women: a randomized controlled trial. Twin Res Hum Genet. 2017 Oct;20(5):419-24.[Abstract]
177. Rogozińska E, Daru J, Nicolaides M, et al. Iron preparations for women of reproductive age with iron deficiency anaemia in pregnancy (FRIDA): a systematic review and network meta-analysis. Lancet Haematol. 2021 Jul;8(7):e503-12.[Abstract][Full Text]
178. Perelló MF, Coloma JL, Masoller N, et al. Intravenous ferrous sucrose versus placebo in addition to oral iron therapy for the treatment of severe postpartum anaemia: a randomised controlled trial. BJOG. 2014 May;121(6):706-13.[Abstract]
179. National Institute for Health and Care Excellence. Blood transfusion. Nov 2015 [internet publication].[Full Text]
180. Richards T, Baikady RR, Clevenger B, et al. Preoperative intravenous iron to treat anaemia before major abdominal surgery (PREVENTT): a randomised, double-blind, controlled trial. Lancet. 2020 Oct 24;396(10259):1353-61.[Abstract][Full Text]
181. Khalafallah AA, Yan C, Al-Badri R, et al. Intravenous ferric carboxymaltose versus standard care in the management of postoperative anaemia: a prospective, open-label, randomised controlled trial. Lancet Haematol. 2016 Sep;3(9):e415-25.[Abstract]
182. Chen N, Hao C, Peng X, et al. Roxadustat for anemia in patients with kidney disease not receiving dialysis. N Engl J Med. 2019 Sep 12;381(11):1001-10.[Abstract]
183. Chen N, Hao C, Liu BC, et al. Roxadustat treatment for anemia in patients undergoing long-term dialysis. N Engl J Med. 2019 Sep 12;381(11):1011-22.[Abstract]
184. Short MW, Domagalski JE. Iron deficiency anemia: evaluation and management. Am Fam Physician. 2013 Jan 15;87(2):98-104.[Abstract][Full Text]
185. Madore F, White CT, Foley RN, et al. Clinical practice guidelines for assessment and management of iron deficiency. Kidney Int Suppl. 2008 Aug;(110):S7-S11.[Abstract][Full Text]
186. World Health Organization. Nutritional anaemias: tools for effective prevention and control. 2017 [internet publication].[Full Text]
187. Chan KK, Chan BC, Lam KF, et al. Iron supplement in pregnancy and development of gestational diabetes: a randomised placebo-controlled trial. BJOG. 2009 May;116(6):789-97.[Abstract]
188. Ainley LI, Hewitt PE. Haematology patients and the risk of transfusion transmitted infection. Br J Haematol. 2018 Feb;180(4):473-83.[Abstract]
189. Zou S, Stramer SL, Dodd RY. Donor testing and risk: current prevalence, incidence, and residual risk of transfusion-transmissible agents in US allogeneic donations. Transfus Med Rev. 2012 Apr;26(2):119-28.[Abstract]
190. Engle PL, Black MM, Behrman JR, et al. Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world. Lancet. 2007 Jan 20;369(9557):229-42.[Abstract]
191. Snook J, Bhala N, Beales ILP, et al. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut. 2021 Sep 8 [Epub ahead of print].[Abstract][Full Text]