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World J Gastroenterol. Jun 14, 2010; 16(22): 2720-2725
Published online Jun 14, 2010. doi: 10.3748/wjg.v16.i22.2720
Treatment of iron deficiency anemia associated with gastrointestinal tract diseases
Ulas D Bayraktar, Soley Bayraktar
Ulas D Bayraktar, Soley Bayraktar, Division of Hematology and Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, United States
Author contributions: Bayraktar UD and Bayraktar S performed the literature search and wrote the paper.
Correspondence to: Ulas D Bayraktar, MD, Division of Hematology and Oncology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, St 3300, Miami, FL 33136, United States.
Telephone: +1-305-4580998 Fax: +1-305-5850037
Received: January 6, 2010
Revised: February 2, 2010
Accepted: February 9, 2010
Published online: June 14, 2010

The gastrointestinal (GI) tract is a common site of bleeding that may lead to iron deficiency anemia (IDA). Treatment of IDA depends on severity and acuity of patients’ signs and symptoms. While red blood cell transfusions may be required in hemodynamically unstable patients, transfusions should be avoided in chronically anemic patients due to their potential side effects and cost. Iron studies need to be performed after episodes of GI bleeding and stores need to be replenished before anemia develops. Oral iron preparations are efficacious but poorly tolerated due to non-absorbed iron-mediated GI side effects. However, oral iron dose may be reduced with no effect on its efficacy while decreasing side effects and patient discontinuation rates. Parenteral iron therapy replenishes iron stores quicker and is better tolerated than oral therapy. Serious hypersensitive reactions are very rare with new intravenous preparations. While data on worsening of inflammatory bowel disease (IBD) activity by oral iron therapy are not conclusive, parenteral iron therapy still seems to be advantageous in the treatment of IDA in patients with IBD, because oral iron may not be sufficient to overcome the chronic blood loss and GI side effects of oral iron which may mimic IBD exacerbation. Finally, we believe the choice of oral vs parenteral iron therapy in patients with IBD should primarily depend on acuity and severity of patients’ signs and symptoms.

Keywords: Anemia, Inflammatory bowel disease, Intravenous iron, Iron deficiency, Oral iron