Editing Iron deficiency (section)

==Treatment==
Before commencing treatment, there should be a definitive diagnosis of the underlying cause of iron deficiency.  This is particularly the case in older patients, who are most susceptible to [[colorectal cancer]] and the gastrointestinal bleeding it often causes. In adults, 60% of patients with iron-deficiency anemia may have underlying gastrointestinal disorders leading to chronic blood loss.<ref name="pmid8179652">{{cite journal | vauthors = Rockey DC, Cello JP | title = Evaluation of the gastrointestinal tract in patients with iron-deficiency anemia | journal = The New England Journal of Medicine | volume = 329 | issue = 23 | pages = 1691–5 | date = December 1993 | pmid = 8179652 | doi = 10.1056/NEJM199312023292303 | doi-access = free }}</ref>
It is likely that the cause of the iron deficiency will need treatment as well.

Upon diagnosis, the condition can be treated with [[iron supplements]]. The choice of the supplement will depend upon both the severity of the condition, the required speed of improvement (e.g. if awaiting elective surgery), and the likelihood of treatment being effective (e.g. if the patient has underlying [[Inflammatory bowel disease|IBD]], is undergoing [[Kidney dialysis|dialysis]], or is having [[erythropoiesis-stimulating agent|ESA]] therapy).

Examples of oral iron that are often used are [[ferrous sulfate]], [[ferrous gluconate]], or amino acid chelate tablets. Recent research suggests the replacement dose of iron, at least in the elderly with iron deficiency, may be as little as 15&nbsp;mg per day of elemental iron.<ref name="pmid16194646">{{cite journal | vauthors = Rimon E, Kagansky N, Kagansky M, Mechnick L, Mashiah T, Namir M, Levy S | title = Are we giving too much iron? Low-dose iron therapy is effective in octogenarians | journal = The American Journal of Medicine | volume = 118 | issue = 10 | pages = 1142–7 | date = October 2005 | pmid = 16194646 | doi = 10.1016/j.amjmed.2005.01.065 }}</ref>

Low-certainty evidence suggests that IBD-related anemia treatment with [[Intravenous iron infusion|Intravenous (IV) iron infusion]] may be more effective than [[Oral iron|oral iron therapy]], with fewer people needing to stop treatment early due to adverse effects.<ref name=":02">{{Cite journal |last1=Gordon |first1=Morris |last2=Sinopoulou |first2=Vassiliki |last3=Iheozor-Ejiofor |first3=Zipporah |last4=Iqbal |first4=Tariq |last5=Allen |first5=Patrick |last6=Hoque |first6=Sami |last7=Engineer |first7=Jaina |last8=Akobeng |first8=Anthony K |date=2021 |title=Interventions for treating iron deficiency anaemia in inflammatory bowel disease |journal=Cochrane Database of Systematic Reviews |volume=1 |issue=1 |pages=CD013529 |doi=10.1002/14651858.CD013529.pub2 |pmc=8092475 |pmid=33471939}}</ref> The type of iron preparation may be an important determinant of clinical benefit. Moderate-certainty evidence suggests response to treatment may be higher when IV [[ferric carboxymaltose]], rather than IV [[iron sucrose]] preparation is used, despite very-low certainty evidence of increased adverse effects, including bleeding, in those receiving ferric carboxymaltose treatment.<ref name=":02"/>

[[Ferric maltol]], marketed as ''Accrufer'' and ''Ferracru,'' is available in oral and IV preparations. When used as a treatment for IBD-related anemia, very low certainty evidence suggests a marked benefit with oral ferric maltol compared with placebo. However, it was unclear whether the IV preparation was more effective than oral ferric maltol.<ref name=":02"/>

A Cochrane review of controlled trials comparing [[Intravenous iron infusion|intravenous (IV) iron therapy]] with [[Iron supplement|oral iron]] supplements in people with [[chronic kidney disease]], found low-certainty evidence that people receiving IV-iron treatment were 1.71 times as likely to reach their target [[hemoglobin]] levels.<ref name=":1">{{Cite journal |last1=O'Lone |first1=Emma L |last2=Hodson |first2=Elisabeth M |last3=Nistor |first3=Ionut |last4=Bolignano |first4=Davide |last5=Webster |first5=Angela C |author-link5=Angela Webster |last6=Craig |first6=Jonathan C |date=2019 |editor-last=Cochrane Kidney and Transplant Group |title=Parenteral versus oral iron therapy for adults and children with chronic kidney disease |journal=Cochrane Database of Systematic Reviews |language=en |volume=2019 |issue=2 |pages=CD007857 |doi=10.1002/14651858.CD007857.pub3 |pmc=6384096 |pmid=30790278}}</ref> Overall, hemoglobin was 0.71g/dl higher than those treated with oral iron supplements. Iron stores in the liver, estimated by serum [[ferritin]], were also 224.84&nbsp;μg/L higher in those receiving IV-iron.<ref name=":1" /> However there was also low-certainty evidence that allergic reactions were more likely following IV-iron therapy. It was unclear whether the type of iron therapy administration affects the risk of death from any cause, including cardiovascular, nor whether it may alter the number of people who may require a blood transfusion or dialysis.<ref name=":1" />

===Food sources===
Mild iron deficiency can be prevented or corrected by eating iron-rich foods and cooking in an iron skillet. Because iron is a requirement for most plants and animals, a wide range of foods provide iron. Good sources of dietary iron have [[heme]] iron, as this is most easily absorbed and is not inhibited by medication or other dietary components. Two examples are [[red meat]] and [[poultry]].<ref>{{cite journal | vauthors = Defoliart G | year = 1992 | title = Insects as Human Food | journal = Crop Protection | volume = 11 | issue = 5| pages = 395–99 | doi=10.1016/0261-2194(92)90020-6}}</ref><ref>{{cite journal | vauthors = Bukkens SG | year = 1997 | title = The Nutritional Value of Edible Insects | journal = Ecol. Food. Nutr. | volume = 36 | issue = 2–4| pages = 287–319 | doi=10.1080/03670244.1997.9991521| bibcode = 1997EcoFN..36..287B }}</ref> Non-heme sources contain iron, though the iron is less bioavailable. Examples are [[lentil]]s, [[bean]]s, [[leafy vegetable]]s, [[pistachio]]s, [[tofu]], fortified bread, and fortified breakfast cereals.

Iron from different foods is absorbed and processed differently by the body; for instance, iron in meat (heme iron source) is more easily absorbed than iron in grains and vegetables ("non-heme" iron sources).<ref>{{cite web | url = http://www.eatwell.gov.uk/healthissues/irondeficiency/ | title = Iron deficiency | archive-url = https://web.archive.org/web/20060808184739/http://www.eatwell.gov.uk/healthissues/irondeficiency/ | archive-date=8 August 2006 | work = UK Food Standards Agency }}</ref> Minerals and chemicals in one type of food may also inhibit absorption of iron from another type of food eaten at the same time.<ref>{{cite web | url = https://www.nlm.nih.gov/medlineplus/ency/article/002422.htm | title = Iron in diet | work = MedlinePlus | publisher = U.S. National Library of Medicine }}</ref> For example, [[oxalate]]s and [[phytic acid]] form insoluble complexes which bind iron in the gut before it can be absorbed.

Because iron from plant sources is less easily absorbed than the heme-bound iron of animal sources, [[vegetarian]]s and [[vegan]]s should have a somewhat higher total daily iron intake than those who eat meat, fish, or poultry.<ref>{{cite web | vauthors = Reed M | author-link1 = Reed Mangels | url = http://www.vrg.org/nutrition/iron.htm | title = Iron in the vegan diet | work = The Vegetarian Resource Group }}</ref> [[Legume]]s and dark-green leafy vegetables like [[broccoli]], [[kale]] and Asian greens are especially good sources of iron for vegetarians and vegans. However, [[spinach]] and [[Swiss chard]] contain oxalates that bind iron, making them almost entirely unavailable for absorption.{{citation needed|date=July 2017}} Iron from non-heme sources is more readily absorbed if consumed with foods that contain either heme-bound iron or [[vitamin C]]. This is due to a hypothesized "meat factor" which enhances iron absorption.<ref>{{cite web | url = http://www.merckmanuals.com/home/disorders-of-nutrition/minerals/iron-deficiency-and-toxicity | title = Iron | work = The Merck Manuals Online Medical Library | access-date = 27 October 2015 | archive-date = 17 October 2015 | archive-url = https://web.archive.org/web/20151017034423/http://www.merckmanuals.com/home/disorders-of-nutrition/minerals/iron-deficiency-and-toxicity | url-status = dead }}</ref> The benefits of eating seasonings or condiments that have been fortified with iron for people with iron deficiencies are not clear.<ref name=":2">{{Cite journal |last1=Jalal |first1=Chowdhury SB |last2=De-Regil |first2=Luz Maria |last3=Pike |first3=Vanessa |last4=Mithra |first4=Prasanna |date=2023-09-01 |editor-last=Cochrane Public Health Group |title=Fortification of condiments and seasonings with iron for preventing anaemia and improving health |journal=Cochrane Database of Systematic Reviews |language=en |volume=2023 |issue=9 |pages=CD009604 |doi=10.1002/14651858.CD009604.pub2 |pmc=10472972 |pmid=37665781}}</ref> There is some evidence that iron-fortified condiments or seasonings may help reduce an iron deficiency, however, whether this improves a person's health and prevents the person from developing anemia is not clear.<ref name=":2" />

Following are two tables showing the richest foods in heme and non-heme iron.<ref>{{cite web |title=Food Sources of Iron |url=https://www.dietaryguidelines.gov/resources/2020-2025-dietary-guidelines-online-materials/food-sources-select-nutrients/food-1 |url-status=live |archive-url=https://web.archive.org/web/20240326182848/https://www.dietaryguidelines.gov/resources/2020-2025-dietary-guidelines-online-materials/food-sources-select-nutrients/food-1 |archive-date=26 Mar 2024 |work=[[Dietary Guidelines for Americans]] |publisher=[[Center for Nutrition Policy and Promotion|USDA CNPP]]; [[United States Department of Health and Human Services|HHS Office of Disease Prevention and Health Promotion]]}}</ref> The "% RDA" column is based on the [[USDA]] [[Recommended Dietary Allowance]] of 18&nbsp;mg for women aged between 19 and 50, and 8&nbsp;mg for men aged 19 and older as well as women aged 51 and older.<ref>{{cite web | url = http://www.iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/5_Summary%20Table%20Tables%201-4.pdf | title = Dietary Reference Intakes: Recommended Intakes for Individuals | archive-url = https://web.archive.org/web/20130906180147/http://www.iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/5_Summary%20Table%20Tables%201-4.pdf | archive-date = 6 September 2013 | work = National Academy of Sciences. Institute of Medicine. Food and Nutrition Board }}</ref>
{| class="wikitable"
|+Richest foods in ''heme iron''
!
!
!
! colspan="2" |% RDA
|-
!Food
!Serving size
!Iron
!18&nbsp;mg
!8&nbsp;mg
|-
|[[Pork|pork liver]]
|align="right" |3 oz (85 g)
|align="right" |15.2&nbsp;mg
|align="right" |84%
|align="right" |190%
|-
|[[lamb and mutton|lamb kidney]]
|align="right" |3 oz (85 g)
|align="right" |10.2&nbsp;mg
|align="right" |57%
|align="right" |128%
|-
|[[octopus]]
| align="right" |3 oz (85 g)
| align="right" |8.1&nbsp;mg
| align="right" |45%
|align="right" |101%
|-
|[[lamb and mutton|lamb liver]]
| align="right" |3 oz (85 g)
| align="right" |7&nbsp;mg
| align="right" |39%
|align="right" |88%
|-
|[[oyster|cooked oyster]]
| align="right" |3 oz (85 g)
| align="right" |6.6&nbsp;mg
| align="right" |37%
|align="right" |83%
|-
|[[mussel]]
| align="right" |3 oz (85 g)
| align="right" |5.7&nbsp;mg
| align="right" |32%
|align="right" |71%
|-
|[https://fdc.nal.usda.gov/fdc-app.html#/food-details/1098653/nutrients beef liver]
|align="right" |3 oz (85 g)
|align="right" |5.5&nbsp;mg
|align="right" |31%
|align="right" |69%
|-
|[[Duck as food|duck breast]]
|align="right" |3 oz (85 g)
|align="right" |3.8&nbsp;mg
|align="right" |21%
|align="right" |48%
|-
|[[bison]]
|align="right" |3 oz (85 g)
|align="right" |2.9&nbsp;mg
|align="right" |16%
|align="right" |36%
|-
|[[beef]]
|align="right" |3 oz (85 g)
|align="right" |2.5&nbsp;mg
|align="right" |14%
|align="right" |31%
|-
|[[clam]]s{{efn|Iron content in clams can vary considerably between types and modes of preparation, and the presence of aluminum could reduce iron bioavailability.<ref>{{Cite journal | vauthors = Lai JF, Dobbs J, Dunn MA | title = Evaluation of clams as a food source of iron: Total iron, heme iron, aluminum, and in vitro iron bioavailability in live and processed clams. | journal = Journal of Food Composition and Analysis | date = February 2012 | volume = 25 | issue = 1 | pages = 47–55 | doi = 10.1016/j.jfca.2011.07.004 | url = https://pubag.nal.usda.gov/catalog/567004 }}</ref> The bioaccumulation of heavy metals in clams from highly contaminated areas may make regular consumption unsafe in the long term.<ref>{{cite journal | vauthors = Hossen MF, Hamdan S, Rahman MR | title = Review on the Risk Assessment of Heavy Metals in Malaysian Clams | journal = TheScientificWorldJournal | volume = 2015 | pages = 905497 | date = 2015 | pmid = 26060840 | pmc = 4427851 | doi = 10.1155/2015/905497 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Fang ZQ, Cheung RY, Wong MH | title = Heavy metals in oysters, mussels and clams collected from coastal sites along the Pearl River Delta, South China | journal = Journal of Environmental Sciences | volume = 15 | issue = 1 | pages = 9–24 | date = January 2003 | pmid = 12602597 }}</ref>}}
| align="right" |3 oz (85 g)
| align="right" |2.4&nbsp;mg
| align="right" |13%
|align="right" |30%
|-
|[[lamb and mutton|lamb]]
|align="right" |3 oz (85 g)
|align="right" |2&nbsp;mg
|align="right" |11%
|align="right" |25%
|}
{| class="wikitable"
|+Richest foods in ''non-heme iron''
!Food
!Serving size
!Iron
!% guideline<br>''(figs don't agree)''
|-
|[[bean|raw yellow beans]]
|align="right" |100 g
|align="right" |7&nbsp;mg
|align="right" |35%
|-
|[[Spirulina (dietary supplement)|spirulina]]
|align="right" |15 g
|align="right" |4.3&nbsp;mg
|align="right" |24%
|-
|[[falafel]]
|align="right" |140 g
|align="right" |4.8&nbsp;mg
|align="right" |24%
|-
|[[soybean|soybean kernels]]
|align="right" |125 mL (~{{frac|1|2}} cup)
|align="right" |4.6&nbsp;mg
|align="right" |23%
|-
|[[spinach]]
|align="right" |125 g
|align="right" |4.4&nbsp;mg
|align="right" |22%
|-
|[[lentil]]
|align="right" |125 mL (~{{frac|1|2}} cup)
|align="right" |3.5&nbsp;mg
|align="right" |17.5%
|-
|[[treacle|treacle (CSR Australia)]]
|align="right" |20 mL (1 tbsp)
|align="right" |3.4&nbsp;mg
|align="right" |17%
|-
|[[rye bread]]
|align="right" |100 g
|align="right" |2.8&nbsp;mg
|align="right" |14%
|-
|[[buckwheat]]
|align="right" |100 g
|align="right" |2.2&nbsp;mg
|align="right" |11%
|-
|[[molasses|molasses (Bluelabel Australia)]]
|align="right" |20 mL (1 tbsp)
|align="right" |1.8&nbsp;mg
|align="right" |9%
|-
|[[ginger|candied ginger root]]
|align="right" |15 g
|align="right" |1.7&nbsp;mg
|align="right" |8.5%
|-
|[[sesame|toasted sesame seeds]]
|align="right" |10 g
|align="right" |1.4&nbsp;mg
|align="right" |7%
|-
|[[cocoa solids|cocoa (dry powder)]]
|align="right" |5 g
|align="right" |0.8&nbsp;mg
|align="right" |4%
|}

====Food recommendations for children====
Children at 6 months should start having solid food that contains enough iron, which could be found in both heme and non-heme iron.<ref>{{Cite web|url=https://www.cdc.gov/nutrition/InfantandToddlerNutrition/vitamins-minerals/iron.html|title=Iron - Infant and Toddler Nutrition|last=CDC|date=2018-12-03|website=Centers for Disease Control and Prevention|access-date=2019-04-26}}</ref>

'''Heme iron:'''
* Red meat (for example, beef, pork, lamb, goat, or venison)
* Fatty fish
* Poultry (for example, chicken or turkey)
* Eggs

'''Non-heme iron:'''
* Iron-fortified infant cereals
* Tofu
* Beans and lentils
* Dark green leafy vegetables

Iron deficiency can have serious health consequences that diet may not be able to quickly correct; hence, an [[iron supplement]] is often necessary if the iron deficiency has become symptomatic.

===Blood transfusion===
[[Blood transfusion]] is sometimes used to treat iron deficiency with hemodynamic instability.<ref name="AABBfive">{{Citation |author1 = American Association of Blood Banks |author1-link = American Association of Blood Banks |date = 24 April 2014 |title = Five Things Physicians and Patients Should Question |publisher = American Association of Blood Banks |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/american-association-of-blood-banks/ |access-date = 25 July 2014 |archive-url = https://web.archive.org/web/20140924075027/http://www.choosingwisely.org/doctor-patient-lists/american-association-of-blood-banks/ |archive-date = 24 September 2014 |url-status = dead }}, which cites
* {{cite book|author1=AABB|title=Guidelines for Patient Blood Management and Blood|date=2011|isbn=978-1-56395-333-0|url=http://marketplace.aabb.org/EbusPPROD/Default.aspx?TabID=55&productId=1845|access-date=28 July 2014|archive-url=https://web.archive.org/web/20141015211139/http://marketplace.aabb.org/EbusPPROD/Default.aspx?TabID=55&productId=1845|archive-date=15 October 2014|url-status=dead}}
* {{cite journal | vauthors = Lin DM, Lin ES, Tran MH | title = Efficacy and safety of erythropoietin and intravenous iron in perioperative blood management: a systematic review | journal = Transfusion Medicine Reviews | volume = 27 | issue = 4 | pages = 221–34 | date = October 2013 | pmid = 24135037 | doi = 10.1016/j.tmrv.2013.09.001 }}</ref> Sometimes transfusions are considered for people who have chronic iron deficiency or who will soon go to surgery, but even if such people have low hemoglobin, they should be given oral treatment or intravenous iron.<ref name="AABBfive"/>

;Intravenous iron therapy for non-anemic, iron-deficient adults
Current evidence is limited to base any recommendations that intravenous iron therapy is beneficial for treating non-anemic, iron-deficient adults.<ref>{{cite journal | vauthors = Miles LF, Litton E, Imberger G, Story D | title = Intravenous iron therapy for non-anaemic, iron-deficient adults | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | pages = CD013084 | date = December 2019 | issue = 12 | pmid = 31860749 | pmc = 6924972 | doi = 10.1002/14651858.cd013084.pub2 }}</ref> Further research in this area is needed as current body of evidence is very low quality.