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Iron Deficiency

Victoria Giffi, MD and Paul Simmons, MD
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Iron deficiency is incredibly common and yet also difficult to both manage and treat. Dr. Victoria Giffi, hematologist extraordinaire, drops tons of knowledge bombs on Paul in this helpful and clear primer on iron deficiency. 

 

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Paul S., MD -

Not sure I can comment on my own segment, but here goes!

August 2020 JAMA review on HFpEF management reminds us: We should be getting an iron panel/ferritin both at initial diagnosis and as part of ongoing management of HFpEF. Looks like 20% or so of HFrEF patients have concurrent iron deficiency and should be supplemented with PO or IV iron.

I hadn't remembered that! Hope that helps, listeners!

PDS

Paul S., MD -

Sorry, folks: The above comment should read HF - REDUCED - EF, not HFpEF!

Reference: JAMA August 4, 2020, p 488. Great article overall, but the iron deficiency part is pertinent for this segment.

PDS

Javad K. -

I have a question about non-iron salt formulations for oral use. There are some heme based iron forms (brand name Proferrin) and some other I believe amino acid based forms like Ferrous Bis-glycinate. These seem to work really well with much less GI distress. My son was having trouble with iron deficiency and constipation so we gave Ferrous Bis-glycinate a try and his ferritin improved significantly. One of the surgeons I worked with used Proferrin for his patients and it seemed to work well. It is hard to find good studies on these though. Is there good evidence at this point to try these? Thanks so much for your perspective! Javad

Neda F., MD -

Hi Javad! Thanks for your question. Here's Dr. Giffi's response:

"Yes great question! So there aren’t large scale studies comparing iron salts with heme iron in the general population that I know of (doubt anyone would pay for this), but I do remember a study a couple of years ago in gastric bypass patients where the heme iron wasn’t absorbed at all while the iron salts were. Many times, we use IV in that population anyway, making that study kind of moot.

As for the general population, especially kids (though I don’t do peds, I know from being a mom how awful constipation can be in kids!), it’s totally reasonable to try heme iron if iron salts aren’t well tolerated or aren’t expected to be tolerated (eg kid is already constipated before starting).

The only time I would use heme iron formulations is if I am not in a hurry to bring the iron up - ie not symptomatic from their anemia, early pregnancy (I use IV in late pregnancy), breastfeeding, etc. The iron salts are just absorbed more efficiently per dose."

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Hippo Primary Care RAP August 2020 Summary 886 KB - PDF

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