Diagnosis and Treatment of Iron-Deficiency Anemia in Gastrointestinal Bleeding: A Systematic Review

The attached above article is a systematic review that discusses the finding that iron-deficiency anemia often results from blood loss due to lesions in the GI tract in men [as well as in postmenopausal women]. This is the reason I had chosen this article, as the male patient presented in my H&P presents with a history of AV malformations [along his GI tract], which are suspected to be the cause of his iron deficiency anemia. However, the article states that there is no standard management of iron-deficiency anemia in GI bleeding patients. Nevertheless, treatment options include oral or IV iron therapy and transfusion. While oral iron is often first-line, seeing as it is safe, inexpensive, and convenient, many patients poorly respond to its administration due to GI side effects, malabsorption, or further need for supplemental iron doses. Therefore, IV iron may be a better alternative with greater effectiveness and tolerance. The systematic review completed a MEDLINE (PubMed) search for studies published between January 2003 to April 2019. Included search terms were gastrointestinal bleeding, iron deficiency anemia, diagnosis, treatment, management, prognosis, prevalence, safety, iron, transfusion, and quality of life. Inclusion criteria consisted of adults 18 years and older, patients with GI bleeding [all etiologies], patients with IDA, systematic reviews with or without meta-analyses, clinical trials, registry-based studies, cohort studies, population-based studies, and clinical practice guidelines. Ultimately, the article determined that the decision to initiate iron treatment should be based on the patient’s history and symptoms with respect to the patient’s co-morbidities, hemodynamic stability, hemoglobin level, and additional treatments. As the patient in my H&P presented with iron-deficiency anemia resistant to oral iron supplementation with ferrous sulfate, IV iron was appropriately indicated in the next step of his management, as consistent with the findings of the article.  Moreover, the article found that IV iron, which is generally well-tolerated and safe, has been shown to be more effective in restoring ferritin levels and iron stores in patients with non-variceal acute upper GI bleeding compared to oral iron, further reinforcing the management plan for the patient.