How I treat unexplained refractory iron deficiency anemia.
Blood. 2013 Nov 8;
Authors: Hershko C, Camaschella C
Endoscopic gastrointestinal workup fails to establish the cause of iron deficiency anemia (IDA) in a substantial proportion of patients. In patients referred for hematologic evaluation with unexplained or refractory IDA, screening for celiac disease, autoimmune gastritis, H pylori and hereditary forms of IDA is recommended. About 4 to 6% of patients with obscure refractory IDA have celiac disease and autoimmune gastritis is encountered in 20 to 27% of patients . Stratification by age cohorts in autoimmune gastritis implies a disease presenting as IDA many years before the establishment of clinical cobalamin deficiency. Over 50% of patients with unexplained refractory IDA have active H pylori infection and, after excluding all other causes of IDA, 64 to 75% of such patients are permanently cured by H pylori eradication. In young patients with a history suggestive of hereditary iron deficiency with serum ferritin higher than expected for IDA, mutations involving iron trafficking and regulation should be considered. Recognition of the respective roles of H pylori, autoimmune gastritis, celiac disease, and genetic defects in the pathogenesis of iron deficiency should have a strong impact on the current diagnostic workup and management of unexplained, or refractory iron deficiency anemia.
PMID: 24215034 [PubMed - as supplied by publisher]