- so let's talk about the treatment of iron-deficiency anemia. and i'm really just goingto abbreviate that ida. so, you'd imagine thatwith iron deficiency it could be treated withsupplementation of iron, and you'd be completely correct. you can treat iron-deficiency anemia by giving a patient iron supplements, and there are a couple of different ways
in which you can supplement iron. the first is by givingoral iron supplements. and a few things to keep inmind about oral iron supplements is, firstly, as we brieflytalked about before, stomach acid plays a really important role in converting dietary iron into a form that's more readilyabsorbed by the duodenum. so, a patient couldhelp out the absorption of this oral iron if they were to take it
alongside some acidic drink,for example, orange juice. that would help the absorptionof the iron supplement. secondly, oral iron can stain teeth black, and, more importantly, itcan cause black stools. it can cause black stools,and this is really important because upper gastrointestinal bleeding can also present with black stools. so, if a patient has black stools, it's really important togo through their history
and see if, even remotely,they've been taking any iron supplementsthat could account for the black stools, becauseupper gastrointestinal bleeding is a medical emergency. so, that's the first way in which you can replete someone's iron. the second way isthrough intravenous iron, and really iv iron is reservedfor patients who either can't take anything by mouth,
patients who can't tolerate oral iron, because really oral iron is not a very pleasant thing to take, and also for those patientswho require a dose of iron that would be too large totake through oral means. so, really iv iron is reserved for those classes of patients. and then the third way in which you can treat iron-deficiency anemiais with a blood transfusion,
and blood transfusions arereally saved for patients who have very severe anemia, because blood transfusions are not without their own life-threatening consequences. so, just briefly i wantto go over this chart that we use to describe some of the most common causesof iron-deficiency anemia. and you can imagine thatby giving a patient iron, you could, in a lot of instances,
treat their iron deficiency. for example, if thepatient is suffering from decreased intake, well giving them iron would certainly solve that problem. or if they have an increased demand, such as a pregnant lady orsomebody growing at a rapid rate, giving someone an ironsupplement in those conditions could treat the iron-deficiencyanemia for good. however, if a patient hasa condition that leads to
an impairment in the absorption of iron, firstly, you couldn't givethem oral iron at all, but also in these patients giving iv iron would only be a very temporary measure. it wouldn't solve the underlying problem. they would still continue tohave iron-deficiency anemia. also, patients who are suffering from increased loss of bloodfor whatever reason, giving them iron supplementswould solve the acute problem,
but they would continueto have the anemia, unless you solved the underlying problem. so really, for these groups of patients, iron supplementation is not enough. now with that being said, let's move on to the treatment of anemiaof chronic disease. actually, i want to putthat in a different color, so it's less confusing. i'll put that in purple.
anemia of chronic disease, okay? i'm going to abbreviate that too. so, anemia of chronic diseaseis an interesting disease because you can't reallytreat it with iron. so, even though when you lookat these patients' blood, you see that there's a deficiencyof iron in their serum, and that's what's causing the anemia, giving these patients ironwouldn't lead to any benefit, because remember the body is firstly
limiting its absorption of iron. so, any iron that you giveorally wouldn't be absorbed, and secondly, whateveriron does enter the body is being sequestered awayand hidden away in storage, and it's not being used for the production of red blood cells. so, giving iron wouldn't help, and not only would it not help, but all of the iron that's given
and then subsequently stored in the liver eventually leads to damagingreactions in the liver, and it can lead to anindependent disease of the liver. so, anemia of chronic disease is never, is never treated with iron, because not only does it not help, it can actually hurt the patient. also, keep in mind that in situations such as infection and bacterial infection
the anemia of chronic disease is kind of like a protective mechanism. the body is trying to keep theiron away from the bacteria, in a way to sort of decreasethe growth of the bacteria. providing extra iron inthat type of situation might prove to be harmful, in terms of increasing therate of bacterial growth. so that's also anotherreason why we try to avoid giving these patients iron.
so really, the treatment ofanemia of chronic disease rests on treating, i'm justgoing to abbreviate that tx, treating the underlying condition, the underlying, usuallyinflammatory, condition, just as is important withiron-deficiency anemia. and these really are themain mechanisms by which you treat both iron-deficiency anemia and anemia of chronic disease.