Considerations for Practice

Professor Michael Auerbach is a haematologist and oncologist at Auerbach Hematology and Oncology Associates, Inc. (Baltimore, USA) and a Clinical Professor of Medicine at Georgetown University School of Medicine (Washington DC). He is also a member of the Lombardi Cancer Center (Washington DC). He serves on the scientific board of the Network for Advancement of Transfusion Alternatives, and advises the Society for the Advancement of Blood Management.

A significant association has been found between iron status and psychological distress in young Japanese women, according to a new article. The results highlight an increased risk of anger, fatigue and tension in women with iron deficiency without anaemia (IDNA). The authors suggest that IDNA may be a risk factor for mental health problems in this patient group.

Iron deficiency without anaemia (IDNA) frequently affects women of reproductive age. This study aimed to determine the relationship between IDNA and mental health and somatic symptoms.

Commonalities in the typical symptoms of iron deficiency and heart failure mean clinical presentation is of low diagnostic value in these patients. A thorough screening of blood iron status – including measures of storage, circulating and functional iron – are required to accurately diagnose iron deficiency and should be routine practice in this patient population.

Table 2. The commonalities between symptoms of heart failure (HF) and iron deficiency (ID) and iron deficiency anaemia (IDA)1,2

Blood transfusion avoidance is an important goal in the management of patients with end-stage renal disease (ESRD). However, despite the increased use of agents to treat anaemia and iron deficiency over the last 15 years, the proportion of these patients receiving blood transfusions has doubled. 

New evidence has revealed that iron deficiency is associated with unfavourable haemodynamics and worsening of New York Heart Assocation (NYHA) functional class in patients with idiopathic pulmonary arterial hypertension (IPAH), indicating that treatment of iron deficiency should be considered in these patients.

There is a significant association between prior iron deficiency anaemia and ischaemic stroke, data indicate. Researchers recommend that patients found to have iron deficiency anaemia be surveyed and managed for the possible underlying bleeding source and/or iron deficiency status in order to reduce the risk of subsequent ischaemic stroke. The authors recommend that the casual relationship between iron deficiency anaemia and ischaemic stroke be further investigated.

A new article has indicated that both iron deficiency and anaemia are prevalent in patients with Crohn’s disease and ulcerative colitis, with a higher prevalence in the former. The authors also demonstrate that more than half of anaemic patients with inflammatory bowel disease have iron deficiency.


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