Today we will be discussing the best way to treat iron deficiency anemia which affects at least one billion people worldwide. Based on the Donor Iron Status Evaluation study which evaluated over 2,400 donors, iron deficiency anemia is problematic in frequent blood donors and affects at least two thirds of the women and half of the men. The true prevalence of iron deficiency anemia is even higher because many more donors are deferred for low hemoglobin.
Daily oral iron supplements have been the primary treatment for iron deficiency anemia, but many patients have gastrointestinal side effects and stop treatment. Researchers are now questioning whether daily iron supplementation is the best treatment. Hepcidin, which is a key regulator of iron, actually increases with iron supplementation and the increase may impair further iron absorption and may decrease iron bioavailability.
Dr. Schrier, who wrote an editorial on the subject, describes hepcidin:
“Hepcidin is a small polypeptide made in the liver in response to about three different signals. One signal is an inflammatory signal and another signal is an anemia signal. And the third signals the status of iron storage in the body, and it is the major peptide that controls iron absorption and iron utilization.”
To understand exactly how much and how long hepcidin is increased by oral iron supplements, researchers measured total and fractional iron absorption in 54 non-anemic young women with iron deficiency anemia who received iron either once or twice daily. They found that iron supplements of 60 milligrams or higher increased plasma iron and hepcidin for up to 24 hours. Moreover, higher concentrations of hepcidin actually decreases iron absorption for up to 48 hours.
Dr. Moretti, who led the study, explains the results in terms of the best iron supplement regime:
“Our study suggests that daily supplementation and twice daily supplementation should be discouraged but it does suggest that the best approach would be to take iron every second day because hepcidin levels are again back down at the baseline levels, and then the iron dose would be absorbed again at a higher rate.”
Longer-term studies are needed in patients with iron deficiency anemia, and more research is needed to prevent iron reservoir depletion among blood donors.
We’ll be back with another edition of Transfusion News on December 15th. Thanks for joining us.
- Moretti D, Goede JS, Zeder C, Jiskra M, Chatzinakou V, Tjalsma H, Melse-Boonstra A, Brittenham G, Swinkels DW, Zimmerman MB. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. Blood 2015; 126(17): 1981-1989.
- Schrier S. So you know how to treat iron deficiency anemia. Blood 2015; 126(17): 1971.
- Brittenham GM. Iron deficiency in whole blood donors. Transfusion 2011; 51(3): 458-461.