Table 1
Causes of IDA

Type of Impairment Cause
Increased iron loss • Chronic blood loss
  • Inflammatory bowel disease
  • GI trace ulcers
  • Gastritis
  • Medications (aspirin/NSAIDs, potassium supplements)
  • Colonic/gastric polyps
  • Diverticular bleeding
  • GI malignancy
  • Intestinal parasites
  • Menses

• Acute blood loss


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  • Intra-operative blood loss
  • Trauma
  • Internal bleeding

• Phlebotomy

  • Polycythemia vera
  • Regular blood donation
Decreased iron absorption • Malabsorptive disease
  • IBD
  • Chronic gastritis
  • Gastric lymphoma
  • Achlorhydria
  • Giardiasis
  • Helicobacter pylori colonization
  • Bacterial overgrowth

• Malabsorption from surgery

  • Short bowel syndrome
  • Gastrectomy
  • Gastric bypass surgery

• Iron binders
• Antacids/decreased gastric acidity

Decreased iron intake • Diet
  • Lack of balanced diet
  • Vegans
  • Tea and toast diet

• Alcoholism
• Low socioeconomic status

Increased iron demand • Growing infants/children
• Adolescents
• Menstruation
• Pregnancy
• Lactation
• Erythropoietin therapy

Source: Kaitha et al, 2015 

Table 2
Anemia Workup

Basic Workup If Cause of Anemia Unclear After Basic Workup Further testing to Distinguish IDA from ACD
  • Serum ferritin
  • Transferrin
  • Transferrin saturation
  • CRP levels
  • Vitamin B12
  • Folic acid
  • Haptoglobin
  • Lactate dehydrogenase
  • Creatine
  • Reticulocyte counts
  • Soluble transferrin receptor
  • Soluble transferrin receptor-ferritin index
  • Reticulocyte hemoglobin concentration
  • Zinc protoporphyrin
  • Percentage of hypochromic red cells
  • Hepcidin levels

Source: Kaitha et al, 2015

Table 3
Indications for IV Iron Therapy

  • Severe anemia (hemoglobin <10g/dL)
  • Intolerance to oral iron therapy
  • Failure of oral iron therapy
  • Need for quicker and prolonged response
  • Active disease (CRP >5mg/L)

Source: Kaitha et al, 2015