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Iron Chef: Serving up high quality care in the setting of iron deficiency and iron overload PowerPoint Presentation

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Description : Check out this medical presentation on Bypass Surgery, which is titled "Iron Chef: Serving up high quality care in the setting of iron deficiency and iron overload", to know about the the burden of iron deficiency, investigations to diagnose iron deficiency, the investigations required to identify cause of iron deficiency, and strategies to manage iron deficiency.

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Published on : Jun 02, 2021 | Views : 2417 | Downloads : 6

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Iron Chef: Serving up high quality care in the setting of iron deficiency and iron overload Donald Houston MD PhD FRCPC Emily Rimmer MD MSc. FRCPC May 1, 2020
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Iron deficiency anemia (IDA): It’s easy as 1,2,3 Emily Rimmer MD MSc. FRCPC May 1, 2020
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Presenter Disclosure Faculty / Speaker’s name: Emily Rimmer Relationships with commercial interests: Grants/Research Support: none Speakers Bureau/Honoraria: none Consulting Fees: none Other: none
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Mitigating Potential Bias Not Applicable
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Learning Objectives Recognize the burden of iron deficiency Understand investigations to diagnose iron deficiency List the investigations required to identify cause of iron deficiency Apply strategies to manage iron deficiency
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I-D-A, its easy as 1-2-3… Step 1 – Identify iron deficiency Step 2 – Investigate cause of iron deficiency Step 3 – Iron repletion Come on, come on, come on, let me tell you what it’s all about….
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Epidemiology of iron deficiency ~30% of the global population have anemia1 Iron deficiency is the predominant cause of anemia2 Women and children are most at risk Regardless of geography or SES Green represents iron deficiency anemia (IDA) Ning and Zeller. Management of iron deficiency. Hematology 2019. Kassebaum et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood 2014
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Iron deficiency (ID) Iron deficiency is highly prevalent: ~2 billion individuals Symptoms: Fatigue, pica, depression, headache, restless legs syndrome Anemia: dyspnea with exertion, lightheadedness, palpitations Many patients with ID are not anemic. Do they require treatment? Will treatment improve their fatigue or quality of life? Will it enhance physical performance?
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The iron deficient but non-anemic patient… Meta-analysis of 18 randomized controlled trials Total n = 1162 individuals; mostly young healthy females Follow up duration: 90 days to 4 months Oral iron preparations studied in 14 trials Mean daily dose was 87 mg (elemental) Bottom line: Iron supplementation reduced self reported fatigue, but didn’t really change measures of work capacity 1. Efficacy of iron replacement therapy on fatigue and work capacity in non-anemic adults with iron depletion: a systematic review of randomized trials. Houston et al BMJ Open. 2018
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Step 1: Identify iron deficiency (ID) ID can occur in presence or absence of anemia (A) IDA is typically associated with microcytosis All microcytic anemia are due to impairment of hemoglobin synthesis Serum ferritin is the single best test to identify ID/IDA Drawback is ferritin is acute phase reactant
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Ning and Zeller. Management of iron deficiency. Hematology 2019.
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Tests consistent with ID/IDA
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Step 2: Investigate cause of IDA NB: IDA is a symptom NOT a diagnosis To effectively manage IDA, the etiology MUST be identified and, if possible, corrected
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Conditions associated with ID Decreased iron availability Malabsorption Gastric bypass, celiac, etc Inflammatory diseases CHF CKD (Diet) Increased iron need Pregnancy, and breastfeeding Childhood Blood loss GI, GU, vaginal, blood donation, epistaxis
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Insert algorithm
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Menstrual blood loss Most common cause in women of reproductive age Detailed bleeding history is recommended Use of a validated bleeding score recommended1 Strategies to reduce menstrual blood loss Hormonal contraception (OCP, progesterone secreting IUD) Anti-fibrinolytic agents (tranexamic acid) 1. www.letstalkperiod.ca
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Insert algorithm
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GI investigations Endoscopy referral for upper/lower scope FOBT is NOT recommended when ID/IDA present GI malignancies can occur at any age! https://wrha.mb.ca/endoscopy/central-intake/
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Insert algorithm
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Step 3: Iron replacement When to treat: When ID confirmed AND causes considered With anemia, but likely without anemia Oral iron supplementation Preferred Intravenous iron Avoid RBC transfusion in IDA unless hemodynamic instability
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algorithm
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Oral iron preparations (Full Replacement doses) Recommended first line Unproven claims of increased GI tolerability
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Which oral supplement is preferred? Which one is most efficacious? The one with the most iron Which one is best tolerated? The one with the least iron There is no evidence that one preparation is more effective than another or has fewer side effects than another1 Cancelo-Hildalgo MJ et al. 2013. Tolerability of different oral iron supplements: a systematic review. Curr Med Res Opin. 2013;29(4):291.
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Oral vs. Parenteral Iron
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When to consider IV iron? Intolerance to more than 1 oral regimen, even when ramping up slowly and taking with food and management of constipation - Try iron sulphate elixer EOD Malabsorption syndromes Inflammatory bowel disease Post gastric bypass surgery Chronic kidney disease – on dialysis (standard of care) **In almost all instances, try oral replacement first
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Barriers to Practice Change Access to IV iron is challenging in Winnipeg Community hematology (Dr. Harris) can provide some of this service to patients in Winnipeg If patient followed by gastroenterologist, they should be able to provide this as well Rural MD are encouraged to provide in local hospital
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Take home message(s) Iron deficiency anemia is common Oral iron supplementation is preferred Forewarn patients about GI side effects Start low, go slow
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Thank you erimmer@cancercare.mb.ca