Management of IDA involves identifying and treating the underlying cause(s) of the iron deficiency as well as treating the deficiency itself. Treatment of iron deficiency is most commonly done with oral iron replacement. Oral iron is inexpensive, over-the counter, and effective when taken as prescribed and is generally considered frontline therapy. In some settings, oral iron is either poorly tolerated (due to excessive GI side effects such as constipation or cramping) or ineffective (due to reduced iron absorption from uncommon GI disorders). When oral iron is poorly tolerated, alternative oral iron formulations are usually tried prior to initiating intravenous iron treatments.
In cases in which oral iron is ineffective or poorly tolerated, or when rapid iron repletion is needed due to serious symptomatic anemia, new and safer intravenous iron preparations such as iron sucrose have been developed that are effective for replenishing low iron stores. When patients are medically unstable due to continued heavy bleeding or severe symptomatic anemia, blood transfusion may be necessary.
The presence of iron deficiency is common in women of child-bearing years due to monthly iron loss with each period. If accompanied by inadequate dietary iron intake, this can progress over time to moderate to severe anemia. Excessive blood loss with menstruation can occur for a variety of reasons, including uterine fibroids (benign tumors of the muscle layer of the uterus).
Causes of anemia medical expert witness specialties include hematology, internal medicine, hospitalist medicine, pediatric hospitalist medicine, gynecoloy, and reproductive endocrinology.