Diagnosis and management of iron deficiency anemia in the 21st century.
Diagnosis and management of iron deficiency anemia in the 21st century.
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DOI：
10.1177/1756283x11398736
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发表时间：
2011-05-01
影响因子：
4.2
通讯作者：
Graham, David Y
中科院分区：
文献类型：
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作者：
Johnson-Wimbley, Terri D;Graham, David Y
缺铁是全世界最普遍的营养缺乏症。它在5%的美国女性和2%的美国男性中造成了贫血。这篇综述文章的目的是帮助从业者了解铁代谢的生理学，并帮助准确诊断缺铁性贫血。目前对缺铁性贫血患者的一线治疗是口服补铁。口服补充剂在纠正缺铁性贫血方面是廉价、安全和有效的；然而，一些患者不能耐受，部分患者的口服补充剂不足。胃肠道失血超过肠道铁吸收能力的患者(如肠道血管发育不良)可发展为缺铁性贫血，口服补铁难以奏效。事实证明，这一人群的管理是最具挑战性的。从历史上看，这些患者需要大量和频繁的输血，并因其顽固性贫血而遭受终末器官损害。静脉补铁不再受欢迎，继而出现罕见但严重的副作用。更新、更安全的静脉注射铁制剂现已问世，目前可能未得到充分利用。本文讨论了静脉补铁治疗重度缺铁性贫血和口服补铁失败患者的可能性。
Iron deficiency is the single most prevalent nutritional deficiency worldwide. It accounts for anemia in 5% of American women and 2% of American men. The goal of this review article is to assist practitioners in understanding the physiology of iron metabolism and to aid in accurately diagnosing iron deficiency anemia. The current first line of therapy for patients with iron deficiency anemia is oral iron supplementation. Oral supplementation is cheap, safe, and effective at correcting iron deficiency anemia; however, it is not tolerated by some patients and in a subset of patients it is insufficient. Patients in whom the gastrointestinal blood loss exceeds the intestinal ability to absorb iron (e.g. intestinal angiodysplasia) may develop iron deficiency anemia refractory to oral iron supplementation. This population of patients proves to be the most challenging to manage. Historically, these patients have required numerous and frequent blood transfusions and suffer end-organ damage resultant from their refractory anemia. Intravenous iron supplementation fell out of favor secondary to the presence of infrequent but serious side effects. Newer and safer intravenous iron preparations are now available and are likely currently underutilized. This article discusses the possible use of intravenous iron supplementation in the management of patients with severe iron deficiency anemia and those who have failed oral iron supplementation.