Essentials

Iron deficiency is a clinically significant nutritional disorder that disproportionately affects women compared with men, and is particularly common in women of reproductive age1. Iron deficiency is also frequently associated with pregnancy where it can have implications for the health of both the mother and child1,2.

At present, few studies have examined the effect of iron therapy in iron deficient cancer patients without anaemia. However, studies in iron deficient patients with anaemia show that iron therapy can may be effective against both absolute and functional iron deficiency anaemia in association with a wide range of tumour types1.

International and national groups for cancer care professionals have issued guidance on iron deficiency diagnosis including thresholds for iron level markers that should trigger consideration of iron therapy (see table below)1-4. The European Society for Medical Oncology recommends iron levels and inflammation are evaluated by transferrin saturation (TSAT), ferritin and C-reactive protein (CRP) measurement at presentation and then periodically throughout the course of treatment for iron deficiency1.

Non-invasive, endoscopic and radiologic investigations and treatment of the underlying cause of iron deficiency in patients with gastrointestinal disorders are important to prevent further iron loss1. Iron stores can be replenished with iron supplementation and current guidelines recommend that the decision to treat iron deficiency in the absence of anaemia be taken in the context of the clinical significance of symptoms, the patient’s history and individual preference2-4.

Patients with gastrointestinal disorders frequently present with iron deficiency1. In patients with inflammatory bowel disease, the prevalence of iron deficiency has been reported to range from 36 to 90%2.

The duodenum and upper jejunum are the primary routes of dietary iron absorption and dysfunction of these structures can result in malabsorption of iron and iron deficiency. The gastrointestinal tract is also a common site of chronic blood loss, which can deplete the body’s iron stores.

Treating iron deficiency and iron deficiency anaemia in patients with CKD

In patients with CKD-associated iron deficiency anaemia, the aim of iron therapy is to ensure adequate iron stores for erythropoiesis, to correct iron deficiency, and, in patients receiving ESA treatment, to prevent iron deficiency from developing. Iron therapy, particularly with IV iron, can enhance erythropoiesis and raise haemoglobin levels in CKD patients with anaemia even when TSAT and ferritin levels do not indicate absolute iron deficiency1.

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