Iron deficiency, its identification and optimal management is more complex than many doctors realise. There are many exceptions to the interpretation of iron studies and patient co-morbidities become an important consideration. Dr Patrick Coleman leads us through this topic with practical examples, summaries of the guidelines and a discussion about relevant product information. This is part one of a two-part article.

This is part one of this series. Read Part 2 >>

Practice points

• Iron infusions rapidly replace iron stores over days to weeks.
• To get the haemoglobin from 73g/L up to 99 g/L via blood transfusion requires at least two units of blood at enormous cost. One to three months later the patient would have become anaemic again, they would be still iron deficient, and their quality of life would not have been improved if iron is not replaced.
• Severe microcytosis due to iron deficiency in a reasonably well patient suggests the anaemia has been occurring over a very, very long period of time.
• Patients who have stage 4 kidney failure should have their ferritin level maintained at greater than 100 ug/L and the transferrin saturation greater than 20% at all times, prior to erythrocyte stimulating agents.
• Anything that stimulates haematopoiesis (e.g. polycythaemia, erythrocyte stimulating agents) will make the bone marrow use up vast quantities of iron and this then needs to be replaced.
• Repeated transfusions may cause iron overload and an iron-chelating agent may be indicated.
• A thalassemia trait may present with a hypochromic, microcytic picture, although the iron stores are completely normal.
• The serum iron has a diurnal variation and is it is affected by so many other parameters that we can discard it completely.
• The four most helpful iron studies parameters are the haemoglobin, the serum ferritin, the transferrin saturation and the CRP.