Wiesenthal M, Dignass A, Hartmann F, Iqbal T, Stein J. Serum hepcidin levels predict intestinal iron absorption in IBD patients. CRP and IL-6 values were slightly higher in CD versus UC patients, but the differences were statistically not significant (Table1). Sharma N, Begum J, Eksteen B, Elagib A, et al. Bethesda, MD 20894, Web Policies Gasche C, Berstad A, Befrits R, Beglinger C, et al. A 56-year-old woman was referred for evaluation of anemia. Because the anemia is mild and the history and laboratory values are consistent with iron. Iron depletion occurs commonly and is related to associations among blood loss, low dietary iron intake, and malabsorption. Elevated C-Reactive Protein (CRP) | Inflammation | Andrew Weil, M.D. MATTHEW W. SHORT, LTC, MC, USA, AND JASON E. DOMAGALSKI, MAJ, MC, USA. Group comparisons in Hb change from baseline and Hb standardized area under the curve (AUC) analysis were assessed using an analysis of covariance (ANCOVA) model with CRP or IL-6 group (high vs. low) as a factor and baseline Hb and gender as covariates. The https:// ensures that you are connecting to the Haematologica 2011; 96:1761. Elevated hepcidin in inflammation is . A systematic review19 examined 38 studies of BM iron in nonhealthy adults with rheumatoid arthritis, liver disease, hematologic disorders, and other CICs. 3-4 tablets every other day (>100 mg Fe per dose), Polysaccharide iron complex (EZFE, Ferrex, NovaFerrum), 2 tablets every other day (>100 mg Fe per dose). Study record managers: refer to the Data Element Definitions if submitting registration or results information.. Search for terms 1df). High intracellular iron also downregulates transferrin production, lowering TIBC. This prospective statistical approach resulted in a cutoff at 4mg/L (high CRP: >4mg/L; low CRP: 4mg/L) and ensured an equal number of patients in both groups. The history should focus on potential etiologies and may include questions about diet, gastrointestinal (GI) symptoms, history of pica or pagophagia (i.e., compulsive consumption of ice), signs of blood loss (e.g., epistaxis, menorrhagia, melena, hematuria, hematemesis), surgical history (e.g., gastric bypass), and family history of GI malignancy. This test is a second-line technique for evaluating the small bowel because it is complicated by the level of sedation and duration of procedure.13 Magnetic resonance imaging enteroclysis, computed tomographic enterography, or barium studies may also be considered, but have a limited ability to identify most small bowel lesions, which are mucosal and flat.7. Statistical presentation includes least-squares means (LS means), standard errors (SE) split by baseline CRP or IL-6 (high vs. low) group, and associated level of significance. Iron Deficiency Anemia - Hematology and Oncology - Merck Manuals Notably, the median baseline CRP indicates that almost half of the patients had elevated levels of acute-phase proteins. Initial Hb response to oral iron was significantly lower in IBD patients with a high baseline CRP level (>4mg/L), compared to those with low baseline CRPat least for the first 2months of treatment. Women should be screened during pregnancy, and children screened at one year of age. Ferritin and TSAT ranges reported by studies that evaluated BM iron in patients with CICs. Patients with iron deficiency anemia are often asymptomatic and have limited findings on examination. 2df). Differences were less pronounced with stratification according to baseline IL-6. Received 2014 Oct 9; Accepted 2014 Nov 21. iron to improve their IDA. Phosphate binder, approved for use in ID in ndCKD. CRP . Causes include inadequate iron intake, decreased iron absorption, increased iron demand, and increased iron loss (Table 2).5,7,18,19, Premenopausal women with a negative evaluation for abnormal uterine bleeding can be given a trial of iron therapy. The median baseline CRP value of the study population was applied as the cutoff value. Iron Deficiency Anemia: Evaluation and Management | AAFP 001) and IL-6 levels (mean difference in change: 1.33 ng/L, 95%CI 0.87-1.79, P < . Assessment of iron stores using ferritin and TSAT in CICs. The American Academy of Pediatrics recommends universal hemoglobin screening and evaluation of risk factors for iron deficiency anemia in all children at one year of age.16 Risk factors include low birth weight, history of prematurity, exposure to lead, exclusive breastfeeding beyond four months of life, and weaning to whole milk and complementary foods without iron-fortified foods.16 The Centers for Disease Control and Prevention recommends screening children from low-income or newly immigrated families at nine to 12 months of age, and consideration of screening for preterm and low-birth-weight infants before six months of age if they are not given iron-fortified formula.14 The U.S. Preventive Services Task Force found insufficient evidence for screening in asymptomatic children six to 12 months of age and does not make recommendations for other ages.4 A meta-analysis showed that infants in whom cord clamping was delayed for up to two minutes after birth had a reduced risk of low iron stores for up to six months.17 Larger randomized studies that include maternal outcomes are needed before delayed cord clamping can be recommended for general practice. Lastly, a recently presented investigation from our group has shown that IBD patients with ACD respond differently to oral iron treatment compared to those with IDA [12]. Schroder O, Mickisch O, Seidler U, de WA, et al. Iron Status in Infants in Ethiopia. - Full Text View - ClinicalTrials.gov HHS Vulnerability Disclosure, Help Patients were randomized in a 2:1 ratio to receive either i.v. When you have anemia, you don't have enough hemoglobin, and so your cells aren't getting enough oxygen to function well. 2, 94-96 In pregnancy, iron deficiency anemia is associated with increased maternal morbidity and mortality, possibly due to not being able to . In ID, iron stores are progressively exhausted before red cell morphology of hemoglobin levels are affected, and patients may experience early symptoms such as fatigue, reduced cognitive performance, and exercise intolerance. This should also be considered in the selection of diagnostic markers for assessment of iron status. intravenous, UC ulcerative colitis. Hematuria and epistaxis should be included in the inquiry because patients frequently fail to mention them. Although the observed differences to the i.v. Iron deficiency anemia (IDA) is a common complication of inflammatory bowel disease (IBD). She asked whether she could take iron tablets or should receive iron injections, which she had heard carry a risk for allergic reactions. BMID is found in patients with a ferritin range between 30 and 200 g/dL and TSAT between 10% and 20%. Significantly impaired oral iron absorption was reported in pediatric patients (n=19) with active (defined by IL-6>5pg/mL) versus inactive CD [11]. the contents by NLM or the National Institutes of Health. Patients in the yellow region may be considered for iron supplementation if TSAT is 20% to 25% in CKD, or if TSAT is <20% and ferritin is up to 500 g/L in HF, if they are receiving dialysis, and/or if they are using ESAs. Hyams JS, Fitzgerald JE, Treem WR, Wyzga N, Kreutzer DL. Chest pain. . C-reactive protein (CRP) is widely used as a routine marker of chronic or acute inflammation [7]. A complete iron panel showed low serum iron (54 mg/dL), normal TIBC (300 mg/dL), and low TSAT (18%). Acute-phase reactions lead to substantial changes in iron metabolism and are characterized by high levels of ferritin and hepcidin and low levels of iron and transferrin. ID is defined as a health-related condition in which iron availability is insufficient to meet the bodys needs and which can be present with or without anemia,3(p1069) and it is fundamentally recognized that IDA is simply the most advanced stage of ID. Measurement of the serum ferritin level is the most accurate test to diagnose iron deficiency anemia. This is the largest study showing an impact of systemic inflammation on iron absorption in anemic IBD patients. It is the most common nutritional disorder worldwide and accounts for approximately one-half of anemia cases.1,2 Iron deficiency anemia can result from inadequate iron intake, decreased iron absorption, increased iron demand, and increased iron loss.3 Identifying the underlying etiology and administering the appropriate therapy are keys to the evaluation and management of this condition. iron treatment appears to be independent of inflammatory status in IBD patients. Differential ferritin expression is associated with iron deficiency in coeliac disease. A linear relationship between serum high-sensitive C-reactive protein fection, CRP >5.0 mg/L . Patients were stratified by baseline CRP levels into a high-CRP (>4mg/L; n=96) and a low-CRP (4mg/L; n=100) group, and responsiveness to iron supplementation (Hb change from baseline) was compared. Serum iron levels inversely correlated with baseline CRP. Ferritin <30 g/L in the presence of TSAT <45% is indicative of absolute low iron stores (black). Iron deficiency across chronic inflammatory conditions: International I have iron-deficiency anemia, and recently my lymphocyte along with Following an inflammatory stimulus, causing, for example, IL6 expression which can directly induce CRP expression in the liver, CRP levels rise rapidly to peak levels of 350400mg/L. In addition, both markers proved to be independent of baseline TSAT (CRP: R=0.0337, p=0.657; IL-6: R=0.0708, p=0.358) and serum ferritin (CRP: R=0.1313, p=0.074; IL-6: R=0.0443, p=0.554). Lack of iron available to the BM eventually manifests as hypochromic, microcytic anemia. In patients in whom endoscopy may be contraindicated because of procedural risk, radiographic imaging may offer sufficient screening. Can anemia cause high CRP and ESR? Christoph Gasche, Email: ta.ca.neiwinudem@ehcsag.hpotsirhc. . 2a), apart from early response in the CD subpopulation (p<0.05 at week 2; Fig. Iron Deficiency Anemia in Chronic Kidney Disease - FullText - Acta In patients with CD, the risk of folate deficiency is high, reaching up to 20-30% at CD diagnosis [13,18,19]. 3 Animal models of hyperthyroidism demonstrate decreased circulating plasma iron and increased hepatic iron and ferritin. The study population consisted of patients with Crohns disease or ulcerative colitis and IDA (Hb110g/L and TSAT<20% or serum ferritin<100ng/mL), randomized to either oral (ferrous sulfate) or i.v. The measurement of evaluated variables by local laboratories in this multicenter study may have added some additional variability into the data. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations, Laboratory diagnosis of iron-deficiency anemia: an overview, New diagnostic tools for delineating iron status, Discordance between erythrocyte sedimentation rate and C-reactive protein measurements: clinical significance, Properties of four acute phase proteins: C-reactive protein, serum amyloid A protein, alpha 1-acid glycoprotein, and fibrinogen, Quantitative data on the magnitude of the systemic inflammatory response and its relationship with serum measures of iron status, Assessment of iron status in settings of inflammation: challenges and potential approaches, Adjusting ferritin concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project, Regression correction equation to adjust serum iron and ferritin concentrations based on C-reactive protein and albumin in patients receiving primary and secondary care, Are current serum and plasma ferritin cut-offs for iron deficiency and overload accurate and reflecting iron status? With iron medication, these counts will improve. Very high levels ( above 200 mg/L) result from bacterial infections, burns and severe chronic conditions. Intravenous iron sucrose versus oral iron supplementation for the treatment of iron deficiency anemia in patients with inflammatory bowel diseasea randomized, controlled, open-label, multicenter study. Iron deficiency is the most common nutrient deficiency worldwide. In some instances, lesions may not be detected on initial examination (e.g., missed mucosal erosions in a large hiatal hernia, suboptimal preparation for colonoscopy, inadequate biopsy of a suspected lesion).13 Colonoscopy can fail to diagnose up to 5 percent of colorectal tumors.13, Additional evaluation of the small intestine is not necessary unless there is inadequate response to iron therapy, the patient is transfusion dependent, or fecal occult blood testing suggests that the patient has had obscure GI bleeding with the source undiscovered on initial or repeat endoscopy.30 In these cases, further evaluation with capsule endoscopy should be considered.30 Enteroscopy is an upper endoscopy procedure using a longer scope to visualize the proximal jejunum; it should be reserved to treat or biopsy lesions identified by capsule endoscopy. Kulnigg S, Stoinov S, Simanenkov V, Dudar LV, et al. Ferritin reflects iron stores and is the most accurate test to diagnose iron deficiency anemia.7 Although levels below 15 ng per mL (33.70 pmol per L) are consistent with a diagnosis of iron deficiency anemia, using a cutoff of 30 ng per mL (67.41 pmol per L) improves sensitivity from 25 to 92 percent, and specificity remains high at 98 percent.8,12 Ferritin is also an acute phase reactant and can be elevated in patients with chronic inflammation or infection. This study investigated whether systemic inflammation at initiation of treatment (assessed by C-reactive protein [CRP] and interleukin-6 [IL-6] measurements) predicts response to iron therapy. Liver iron overload has been diagnosed by MRI in up to 84% of patients with dialytic CKD and is associated with the infusion of more than 250 mg of iron per month.32 Kidney Disease Improving Global Outcomes 2012 guidelines33 warn against iron supplementation in patients with CKD with ferritin >500 g/L, but MRIs have shown that patients with ferritin in that range may have significant iron overload. Iron-Deficiency Anemia | Johns Hopkins Medicine Theurl I, Schroll A, Nairz M, et al. Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases. Iron restriction eventually leads to the anemia of inflammation. In hepatocytes and macrophages, iron is also trapped intracellularly and is stored as iron-rich ferritin, whereas macrophages increase iron-poor serum ferritin in circulation. Evstatiev R, Gasche C. Iron sensing and signalling. Causes of iron deficiency in IBD patients include intestinal bleeding, poor absorption of iron by the diseased intestine, and/or self-imposed dietary restrictions relating to gastrointestinal symptoms. In oral iron-treated patients, a considerable trend toward lower Hb response was observed in the high- versus low-IL-6 groups, but differences did not quite reach the statistical significance (p<0.07 at weeks 2 and 8; Fig. Nevertheless, ESR varies with hematocrit and is driven mostly by the production of fibrinogen and immunoglobulins, which last for several days in the circulation, whereas CRP is mainly produced by the liver in response to cytokines, particularly IL-6, and has a much shorter half-life; discrepancies between ESR and CRP are unsurprisingly common.12 CRP >50 mg/L is frequent in bacterial infections, making it an excellent marker of acute inflammation, whereas the less-noted -1-acid glycoprotein (AGP) increases later in the inflammatory process and is more suitable for confirming chronic inflammation.13 Because ferritin increases >5 times in patients with CRP >80 mg/L than in those with CRP <10 mg/L,14 studies have examined the possibility of correcting ferritin for inflammatory activity. Inclusion in an NLM database does not imply endorsement of, or agreement with, Figure 3 shows TSAT and ferritin levels found in patients with different CICs, with and without BMID. Ferritin is a blood protein that contains iron. Other analytical methods utilizing mass spectrometry are not feasible for routine use in a hospital or outpatient setting [23]. These values were rounded down to the next integer. However, the predictive power of IL-6 was weak compared to CRP. Once iron deficiency anemia is identified, the goal is to determine the underlying etiology. Vermeire S, Van AG, Rutgeerts P. Laboratory markers in IBD: useful, magic, or unnecessary toys? Iron deficiency anemia (IDA) is the most common acquired anemia and should be the first consideration in a patient with unexplained anemia. Summary and statistical analyses were performed using SAS version 8 or later and R version 3.0.2. Normal values for CRP range between 0.20 and 6.10 mg/L [8]. Results: High serum hs-CRP (> 5 mg/l) was found in 42 (57.5 %) and anemia in 32 (43.8 %) patients. Iron deficiency anaemia and iron therapy - Health.vic In i.v. Anaemia is defined by the World Health Organization as a Hb level below 120 g/L in non-pregnant females and 130 g/L in males, which is consistent with the definition of anaemia in the National Blood Authority Patient Blood Management Guidelines. Previously recommended, but currently not on label; >20%: hypotension, vomiting, nausea, headache, diarrhea, injection site reaction, muscle cramps; 1-10%: hypotension, edema, chest pain, hypertension, dizziness, headache, pruritus, rash, diarrhea, nausea, constipation, vomiting, abdominal pain, hypersensitivity reaction, cough, dyspnea, fever. The most common indications for intravenous therapy include GI effects, worsening symptoms of inflammatory bowel disease, unresolved bleeding, renal failureinduced anemia treated with erythropoietin, and insufficient absorption in patients with celiac disease.32, Parenteral treatment options are outlined in Table 3.2,16 Serious adverse effects have occurred in up to 0.7 percent of patients receiving iron dextran, with 31 recorded fatalities reported between 1976 and 1996.32,33 Iron sucrose and sodium ferric gluconate (Ferrlecit) have greater bio-availability and a lower incidence of life-threatening anaphylaxis compared with iron dextran.2 Approximately 35 percent of patients receiving iron sucrose have mild adverse effects (e.g., headache, nausea, diarrhea).7 One small study cited similar adverse effect profiles between intravenous iron dextran and sodium ferric gluconate, with only one serious adverse effect reported in the iron dextran group.34 If this finding is duplicated in larger studies, it could support the use of iron dextran over sodium ferric gluconate, because the total dose can be given in one sitting. Also at week 12, Hb increment tended to be smaller in the high- versus low-CRP group, but the difference did not reach statistical significance. Search date: January 10, 2012. Iron deficiency anemia was confirmed by percent transferrin saturation < 20 %. Recognize chronic inflammatory conditions that affect the interpretation of laboratory markers of iron status, Identify patients most likely to benefit from iron supplementation using ferritin and transferrin saturation, Understand risks and benefits of oral and IV iron preparations. The authors acknowledge statistical support from Patrick Johnson (JPharma Solutions GmbH) and medical writing support from Bettina Barton (SFL Regulatory Affairs & Scientific Communication). Iron deficiency is characterized by microcytosis with an elevated RBC distribution width. Because of Ferritin is an acute phase reactant, It may increase disproportionately relative to iron stores.Accordingly in this case, serum . Clinical Significance of C-Reactive Protein Levels in Predicting It affects 3% of adults and is slightly more common in women younger than 50 years. The concentration of C-reactive protein in sera from healthy individuals. Absolute iron deficiency is defined by severely reduced or absent iron stores, while functional iron deficiency is defined by adequate iron stores but insufficient iron availability for incorporatio Iron-deficiency anemia is usually discovered during a medical examination through a blood test that measures . CKD patients suffer from both absolute and functional iron deficiency. Search for other works by this author on: Vitamin and Mineral Nutrition Information System (WHO/NMH/NHD/MNM/11.1). There was no imputation of missing data; analyses are based on the observed data. Our results suggest that CRP may be useful to identify IBD patients who can benefit from first-line treatment with i.v. In patients with HF, TSAT >20% essentially excluded the possibility of BMID, regardless of ferritin levels.23 In patients with nondialysis CKD (ndCKD) who underwent BM evaluation, TSAT below 20% had only 50% sensitivity but 83% specificity to detect BMID, and the specificity for BMID improved to 98% if associated with a ferritin level <100 g/L, with a reduction in sensitivity to 33%. All adult men and postmenopausal women with iron deficiency anemia should be screened for gastrointestinal malignancy. Fe, elemental iron; LR, label recommendation. Naveen Sharma, Email: moc.liamg@1142amrahsvan. 1. Standardized AUC analysis confirmed a statistically significant difference between the CRP groups in oral iron-treated patients (high vs. low CRP, LS means: 21.3 vs. 29.3; p=0.012). Hepcidin-mediated ferroportin blockade traps iron inside cells, such as hepatocytes and macrophages, which in turn produce ferritin to store iron safely. Long-term use of aspirin or other nonsteroidal anti-inflammatory drugs, Cameron ulcer (i.e., ulcer in large hiatal hernia), Based on weight and amount of desired change in hemoglobin, One to three tablets two or three times per day. Men and postmenopausal women should not be screened, but should be evaluated with gastrointestinal endoscopy if diagnosed with iron deficiency anemia. Iron Deficiency Lab Studies | Iron Corner | SABM Diagnosis of hemolytic anemia in adults - UpToDate Low-molecular-weight iron deficiency, iron sucrose, and ferric gluconate may require several shorter infusions, whereas the remainder have become increasingly popular because of the lower number of visits required to administer high-dose infusions, despite the higher cost of the medication. TSAT 20% to 25% is still associated with BMID in CKD, and TSAT <20% may still predict BMID in patients with ferritin up to 500 g/L with HF or CKD treated with ESAs, with or without hemodialysis. Low iron decreases hepcidin (H) production, allowing for ferroportin (F) activity in duodenal enterocytes, to transfer iron (Fe) absorbed from the diet to transferrin (T), and mobilize iron stored in hepatocytes and macrophages. Among i.v. Your feedback has been submitted successfully. Weiss G, Goodnough LT. Kindmark CO. iron (CD: n=40; UC: n=96). 1-10%: hypophosphatemia, skin rash, nausea; Previously iron isomaltoside; verification of phosphate levels is recommended for repeated infusions. Our results suggest that CRP may be useful to identify IBD patients who can benefit from first-line treatment with i.v. A moderate elevation may be due to acute inflammation from an infection or chronic . Persistent Iron Deficiency Anemia in Patients with Celiac Disease 1Department of Gastroenterology, University Hospital Birmingham, Vincent Drive, Birmingham, B15 2TH UK, 2Interdisciplinary Crohn Colitis Centre Rhein-Main, Schifferstrasse 59, 60594 Frankfurt am Main, Germany, 3Department of Gastroenterology, Heartlands Hospital, Birmingham, B9 5SS UK, 4Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Whringer Grtel 18-20, 1090 Vienna, Austria, 5Vifor Pharma Ltd., Flughofstrasse 61, 8152 Glattbrugg, Switzerland. Jrgen Stein, Email: ed.trufknarf-inu.me@niets.j. C-reactive protein (CRP) is a substance produced by the liver that increases in the presence of inflammation in the body. Patients with high baseline CRP achieved a lower Hb response with oral iron therapy. Current guidelines recommend empiric treatment in children up to two years of age and in pregnant women with iron deficiency anemia; however, if the hemoglobin level does not increase by 1 g per dL (10 g per L) after one month of therapy in children or does not improve in pregnant women, further evaluation may be indicated.4,15,16 In pregnant patients, poor compliance or intolerance should be considered, and parenteral iron may produce a better response.15, The evaluation should begin with a thorough history and physical examination to help identify the cause of iron deficiency. A ferritin test measures the amount of ferritin in your blood. Among iron tablet-treated patients, Hb increase was significantly smaller in the high- versus low-CRP subgroup (1.1 vs. 2.0, 2.3 vs. 3.1, and 3.0 vs. 4.0g/dL at weeks 2, 4, and 8, respectively; all p<0.05). Yellow striped areas represent areas in which iron supplementation may be considered, depending on the CIC; only patients with CKD are likely to benefit from iron supplementation with ferritin <200 g/L and TSAT of 20% to 25%, whereas patients with HF or CKD treated with erythropoiesis-stimulating agents (ESAs) and/or hemodialysis may be considered for iron supplementation if TSAT is <20% and ferritin is up to 500 g/L. Thrombocytosis - Symptoms and causes - Mayo Clinic Refer to Associated Documents for recommended daily intake values, and foods high in iron. Preventing Iron-Deficiency Anemia. Cells of the immune system release pro-inflammatory cytokines, predominantly interleukin-6 (IL-6), which in turn up-regulate the expression of hepcidin, a key regulator of iron homeostasis. Confusion or changes in speech. Copyright 2013 by the American Academy of Family Physicians. Overlap of ID and other disorders, such as chronic liver or kidney disease, may prevent the MCH and MCV from decreasing, and such indices also become unreliable for use in screening for ID in the presence of thalassemia trait, a frequent hereditary anemia. TSAT <25% yielded maximum sensitivity of 71%.24 In another study, BMID was identified in only 50% of patients with both TSAT <20% and ferritin <100 g/L, but TSAT <20% alone had a sensitivity of 85% and specificity of 48%.25 Those data suggest that underlying ID can still be considered in patients with CKD with TSAT of 20% to 25%, whereas for other CICs, TSAT <20% along with judicious evaluation of ferritin to diagnose ID seems appropriate. Federal government websites often end in .gov or .mil. Responsiveness of IBD patients with high versus low baseline IL-6. An increase in the RDW may be an early indicator of a deficiency in iron, B12 or folate, even before anemia appears. Iron deficiency anemia is a common complication of chronic kidney disease (CKD). A systematic review, Failure of serum ferritin levels to predict bone-marrow iron content after intravenous iron-dextran therapy, Serum ferritin level remains a reliable marker of bone marrow iron stores evaluated by histomorphometry in hemodialysis patients, A possible role for hepcidin in the detection of iron deficiency in severely anaemic HIV-infected patients in Malawi, Definition of iron deficiency based on the gold standard of bone marrow iron staining in heart failure patients, Bone marrow iron, iron indices, and the response to intravenous iron in patients with non-dialysis-dependent CKD, Bone marrow iron distribution, hepcidin, and ferroportin expression in renal anemia, Iron absorption from supplements is greater with alternate day than with consecutive day dosing in iron-deficient anemic women, Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials, Novel oral iron therapies for iron deficiency anemia in chronic kidney disease, Hypophosphatemia: an evidence-based approach to its clinical consequences and management, Iatrogenic iron overload in dialysis patients at the beginning of the 21st century, Chapter 2: Use of iron to treat anemia in CKD, Intravenous iron in patients undergoing maintenance hemodialysis [published correction appears in, Safety and efficacy of rapidly administered (one hour) one gram of low molecular weight iron dextran (INFeD) for the treatment of iron deficient anemia, Iron absorption and serum ferritin in chronic inflammatory bowel disease, Serum ferritin and bone marrow iron stores. Iron deficiency anemia - Symptoms and causes - Mayo Clinic
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