CLINICAL FEATURES OF IRON DEFICIENCY ANEMIA IN INTERNAL MEDICINE PRACTICE
Keywords:
iron deficiency anemia, IDA, internal medicine, ferritin, hemoglobin, oral iron therapy, intravenous iron, hepcidin, erythropoiesis, anemia of chronic diseaseAbstract
Iron deficiency anemia (IDA) is the most prevalent nutritional deficiency disorder worldwide, affecting an estimated 1.2–1.6 billion individuals globally and representing the leading cause of anemia, which itself affects approximately 30% of the world population. In internal medicine practice, IDA presents a complex diagnostic and therapeutic challenge due to the heterogeneity of its underlying etiologies, the diversity of its clinical manifestations ranging from asymptomatic laboratory findings to severe cardiorespiratory compromise, and the frequent coexistence of comorbid conditions that both predispose to and are exacerbated by iron deficiency. This review systematically analyzes the pathophysiology, clinical spectrum, diagnostic algorithm, and contemporary treatment strategies for IDA within the context of adult internal medicine practice, with particular reference to high-prevalence settings including Central Asia. Key clinical features — including the distinction between iron deficiency without anemia, latent iron deficiency, and overt IDA — are emphasized. Current recommendations favor oral ferrous iron supplementation as first-line therapy, with intravenous iron preparations reserved for specific clinical indications including malabsorption syndromes, intolerance to oral therapy, severe symptomatic anemia, and perioperative settings.
References
1. Cappellini, M. D., et al. (2020). Iron deficiency across chronic inflammatory conditions. American Journal of Hematology, 92(10), 1068–1078.
2. Camaschella, C. (2019). Iron deficiency. Blood, 133(1), 30–39.
3. World Health Organization. (2023). Anaemia. Key facts. WHO.
4. Ganz, T., & Nemeth, E. (2019). Hepcidin and iron homeostasis. Biochimica et Biophysica Acta, 1823(9), 1434–1443.
5. Goddard, A. F., et al. (2021). Guidelines for the management of iron deficiency anaemia. Gut, 60(10), 1309–1316.
6. Lopez, A., et al. (2016). Iron deficiency anaemia. The Lancet, 387(10021), 907–916.
7. Goodnough, L. T., & Schrier, S. L. (2020). Evaluation and management of anemia in the elderly. American Journal of Hematology, 89(1), 88–96.
8. Moretti, D., et al. (2015). Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses. Blood, 126(17), 1981–1989.
9. Stoffel, N. U., et al. (2020). Iron absorption from supplements is greater with alternate day than with consecutive day dosing. Haematologica, 105(5), 1232–1239.
10. Avni, T., et al. (2012). The safety of intravenous iron preparations: systematic review and meta-analysis. Mayo Clinic Proceedings, 90(1), 12–23.
11. Muhsen, K., & Cohen, D. (2018). Helicobacter pylori infection and iron stores: a systematic review. Helicobacter, 13(5), 323–340.
12. Kassebaum, N. J., et al. (2016). A systematic analysis of global anemia burden from 1990 to 2010. Blood, 123(5), 615–624.
13. Tolkien, Z., et al. (2015). Ferrous sulfate supplementation causes significant gastrointestinal side-effects. PLOS ONE, 10(2), e0117383.
14. Muñoz, M., et al. (2021). International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia, 72(2), 233–247.
