How to supplement iron with digestive diseases complicated by iron deficiency anemia? This article makes it clear

For medical professionals only

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Iron deficiency anemia (IDA) refers to a lack of stored iron in the body for various reasons, affecting hemoglobin synthesis and causing small cell hypochromic anemia

Persistent anemia, ineffectiveness of oral iron therapy .

After 3-4 days of intravenous iron supplementation, reticulocytes begin to rise, may peak in 7-10 days, and gradually decrease to normal
after 2-3 weeks.

Hemoglobin begins to rise after two weeks of iron supplementation, and in the absence of cryptogenic bleeding, hemoglobin rises by 20 g/L at four weeks [9].

Therefore, when we evaluate the efficacy of intravenous iron supplementation, we generally evaluate the elevated level of reticulocytes after 7 days of medication, and assess the patient's iron metabolism level
after 4 weeks of medication.
The patient's hospital stay time is 7 days, the efficacy of intravenous iron supplementation is not evaluated during the hospitalization, the patient is instructed to review and evaluate the growth of reticulocytes one week after discharge, and one month after discharge, the review and evaluation of whether to supplement the storage of iron, if the criteria for ferritin and transferrin binding are inconsistent, the binding capacity of transferrin generally prevails
.

(Because ferritin is an acute phase reactor, ferritin may be elevated
for a long time even when a patient has a comorbid inflammatory disease.
)
Summary
:
Iron deficiency anemia can seriously affect the quality of life of patients, and even threaten the lives of
patients, so it is necessary to actively improve iron deficiency anemia.

The patient has unexplained persistent small bowel bleeding, and aggressive iron supplementation is one
of the important treatments for small bowel bleeding complicated by anemia.

Compared with oral iron supplementation, intravenous iron supplementation is more efficient and safer, and is the preferred solution
for patients with large iron deficiency to quickly replenish iron storage.
Through this case, we can learn the treatment principles of anemia associated with unexplained small intestinal bleeding, master the specific use of different iron agents, and make it clear that intravenous iron and oral iron cannot be used at the same time, so as to accumulate more experience
for future iron supplementation treatment.
Expert profile
Professor Cao Xiaocang

• Chief Physician and Professor of Gastroenterology, General Hospital of Tianjin Medical University, Master Supervisor of Tianjin Medical University, Ph.
  D.
  of Peking Union Medical College and Tsinghua University School of Medicine, Postdoctoral Fellow of Texas State University School of Medicine, and Postdoctoral Visiting Scholar
  of Lille University School of Medicine, France.
  
  

• Member of the Gastroenterology Committee of the Gastroenterology Branch of the Chinese Medical Association, Vice Chairman of the Youth Committee of the Behavioral Medicine Branch of the Chinese Medical Association, Member of the Clinical Epidemiology Collaborative Group of the Gastroenterology Branch of the Chinese Medical Association, Member of the Inflammatory Enterology Group of the Gastroenterology Branch of the Chinese Medical Equipment Association, Member of the Proctology Committee of the Inflammatory Bowel Disease Professional Committee of the Anorectal Physician Branch of the Chinese Medical Doctor Association, Member of the Inflammatory Bowel Disease Professional Committee of the Chinese Medical Doctor Association, Member of the Inflammatory Bowel Disease Professional Committee of the Chinese Association of Integrative Traditional and Western Medicine, Member of the Inflammatory Bowel Disease Expert Committee of the Gastroenterology Branch of the Chinese Medical Doctor Association, He is a member of the Inflammatory Bowel Disease Expert Committee of Beijing Medical Reward Foundation, a member of the Standing Committee of the Inflammatory Bowel Disease Alliance of Wu Jieping Medical Foundation, a member of the Standing Committee of the Enterologic Microecology Professional Committee of the Inflammatory Bowel Disease Alliance of the Chinese Society of Biomedical Engineering, a member of the Standing Committee of the Stem Cell Engineering Technology Branch of the Chinese Society of Biomedical Engineering, and a vice chairman of the Inflammatory Enterology Group of the Gastroenterology Branch of the Tianjin Medical Association

• Research interests: Inflammatory bowel disease and digestive immune disease biological therapy and cell therapy, especially in the clinical application of mesenchymal stem cell transplantation
  .
  
  His research achievements have won awards from international conferences such as the American Gastroenterology Annual Conference and the European Union Gastroenterology Annual Conference, and have published dozens of papers in SCI journals and Chinese journals
  .
  

Xie Dong is a
clinical pharmacist in the General Hospital of Tianjin Medical University, a clinical pharmacist in the gastroenterology major of the National Clinical Pharmacist Training Base, and an MTM pharmacist certified by the American Pharmacists
Association (APhA).
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Zheng Hang,Li Yafan.
An ineffective report of oral iron supplementation in iron deficiency anemia[J].
Chinese Journal of Practical Internal Medicine,2015,35(1):192.
Zou Yao,Zhu Xiaofan.
Iron deficiency anemia[J].
Chinese Journal of Practical Internal Medicine,2010,25(2):158-160.
Hematology Branch of Chinese Medical Association.
Multidisciplinary expert consensus on the diagnosis, treatment and prevention of iron deficiency and iron deficiency anemia[J].
Chinese Medical Journal,2018,98(28):2233-2237.
[5] Lee T，C1avel T，Smlmlov K，eta1．0ral versus intravenous imnr lacement therapy distincny alters me gut microbiota and metab010me in patiems with IBD[J]． Gut，2017，66(5)：863—871． Hematology Branch of Chinese Medical Association.
Chinese Expert Consensus on the Application of Intravenous Iron (2019)[J].
Chinese Journal of Hematology 2019,40(5):358-362.
[7] Coyne Dw，Adkinson NF，Nissenson AR，eta1．sodium fbrric gluconate complex in hemodiaJysis patients Adverse reactions in iron dexn-an—sensitive and dextran—tolemnt patients[J]Kidney Int， 2003，63(1)：217—224．D[8]Miller HJ，Hu J，Valentine，eta1． Efficacy and tolerability of intravenous ferric gluconate of imn denciency anemia in patients without kidney disease[J]．mch Intem Med 2007，167(12)：1327-1328． [9] Mantadakis E.
Advances in Pediatric Intravenous Iron Therapy[J].
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