Iron deficiency anemia affects >1.2 billions individuals worldwide, and
iron deficiency in the absence of
anemia is even more frequent. Total-body (absolute)
iron deficiency is caused by physiologically increased
iron requirements in children, adolescents, young and pregnant women, by reduced
iron intake, or by pathological defective absorption or chronic blood loss. Adaptation to
iron deficiency at the tissue level is controlled by
iron regulatory proteins to increase
iron uptake and retention; at the systemic level, suppression of the
iron hormone hepcidin increases
iron release to plasma by absorptive enterocytes and recycling macrophages. The diagnosis of absolute
iron deficiency is easy unless the condition is masked by inflammatory conditions. All cases of
iron deficiency should be assessed for treatment and underlying cause. Special attention is needed in areas endemic for
malaria and other
infections to avoid worsening of
infection by
iron treatment. Ongoing efforts aim at optimizing
iron salts-based
therapy by protocols of administration based on the physiology of
hepcidin control and reducing the common adverse effects of oral
iron. IV
iron, especially last-generation compounds administered at high doses in single infusions, is becoming an effective alternative in an increasing number of conditions because of a more rapid and persistent hematological response and acceptable safety profile. Risks/benefits of the different treatments should be weighed in a personalized therapeutic approach to
iron deficiency.