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Review
. 2023 Feb;110(2):123-130.
doi: 10.1111/ejh.13892. Epub 2022 Nov 20.

The role of oral iron in the treatment of adults with iron deficiency

Jamie O Lo  1 , Ashley E Benson  1 , Kylee L Martens  2 , Madeline A Hedges  1 , Hannah Stowe McMurry  2 , Thomas DeLoughery  2 , Joseph E Aslan  2 , Joseph J Shatzel  2   3
Affiliations
Review

The role of oral iron in the treatment of adults with iron deficiency

Jamie O Lo et al. Eur J Haematol. 2023 Feb.

Abstract

Iron deficiency is the most common nutrient deficiency in the world, affecting over 20% of premenopausal women worldwide. Oral iron supplementation is often the first-line treatment for the acute and chronic management of iron deficiency due to its ease and accessibility. However, there is no consensus on the optimal formulation or dosing strategy, or which patients should be preferentially treated with intravenous iron. Management of iron deficiency is complicated by the hepcidin-ferroportin iron regulatory pathway, which has evolved to prevent iron overload and thereby creates an inherent limit on gastrointestinal iron uptake and efficacy of oral iron. Unabsorbed iron propagates many of the side effects that complicate oral iron use including dyspepsia and constipation, all of which can thus be exacerbated by excessive oral iron doses. Daily low dose and every other day dosing protocols have attempted to bypass this physiologic bottleneck to allow for effective absorption and limit side effects; however, this approach has still resulted in low fractional iron absorption. In the following manuscript, we review the pathophysiology of iron absorption and current evidence for various preparations of oral iron. Lastly, we highlight opportunities for further study to advance the care of individuals affected by iron deficiency.

Keywords: anemia; blood loss; iron deficiency; oral iron.

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Figures

Figure 1.
Figure 1.. Hepcidin (HAMP) regulation of systemic iron absorption.
Following oral iron intake, reflexive upregulation of hepcidin expression leads to inhibition and degradation of the iron export channel ferroportin and loss of absorption supporting iron deficiency.
Figure 2.
Figure 2.
Proposed algorithm for treating iron deficiency.
See this image and copyright information in PMC

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