Diagnosis and Treatment of Ferropenic Anemia in Primary Care in Spain
Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v2i4.2939
Abstract
Background and objective: Iron deficiency anemia is a frequent cause of consultation in routine medical practice. Knowing how it is diagnosed and treated in Primary Care can allow us to detect if there is any area for improvement. Method: Descriptive multicenter survey-type study with 12 questions to find out the aspects of greater variability in the management of iron deficiency anemia. The population under study are physicians from Primary Care Centers nationwide who treat these patients. Results: 732 physicians answered the form and 51.8% consider iron deficiency anemia a serious disease. To make the diagnosis, 80.7% check the ferritin and only 27.2% check the transferrin saturation index (TSI). 71.6% perform control tests every three months, 57.9% prescribe iron only for three months, and 47% end treatment when Hb normalizes. When the patient is referred, the majority do so to the digestive service, followed by hematology, internal medicine, and gynecology. Conclusions: Despite the fact that almost 52% of those surveyed consider iron deficiency anemia a serious disease and that ferritin is the most useful biochemical determination for its diagnosis, around 20% do not use it. On the hand, the TSI, which can often help distinguish iron deficiency anemia from inflammatory anemia, is only requested by slightly more than 27%, which can lead to diagnostic errors. On the other hand, on some occasions, the treatment is insufficient, since the majority treat the patients for only 3 months and 47% finish the treatment when the Hb normalizes without taking into account the ferritin result. Although the diagnosis and treatment of iron deficiency anemia in Primary Care has improved, it is likely that many patients would benefit from greater use of ferritin and TSI and from longer-lasting treatments.
Keywords
iron deficiency anemia; iron deficiency; ferritin; primary care
Funding
The survey was carried out thanks to the collaboration of Laboratorio Bial SA, which was responsible for the web design of the survey and the sending of invitations to participate.
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[3] Petry N. Olofin I. Hurrell RF. Boy E. Wirth JP. Moursi M. et al. The proportion of anemia associated with iron deficiency in low, medium, and high human development index countries: a systematic analysis of national surveys. Nutrients. 2016;8:E693. https:// doi.org/10.3390/nu8110693.
[4] Capellini MD. Musallam KM. Taher AT. Iron deficiency anemia revisited. J Intern Med. 2020;287:153-70.
[5] Ning S. Zeller MP. Management of iron deficiency. ASH. 2019;1:315-22.
[6] Bayraktar UD. Treatment of iron deficiency anemia associated with gastrointestinal tract diseases. World J Gastroenterol. 2010(16):2720-5.
[7] Jimenez K. Kulnigg-Dabsch K. Gasche C. Management of iron deficiency anemia. Gastroenterol Hepatol. 2015;11:241-9.
[8] De Loughery TG. Microcytic anemia. N Engl J Med. 2014;371:1324-31.
[9] Juncà J. Un algoritmo diagnóstico para la ferropenia. Med Clin. 2001;116:146-9.
[10] Parisha SR. Tye-Din J. Muckenthaler MU. Swinkels DW. Iron deficiency. Lancet. 2021;397:233-48.
[11] Rockey DC. Cello JP. Evaluation of the gastrointestinal tract in patients with iron deficiency anemia. N Engl J Med. 1993;329:1691-5.
[12] Ioannou GN. Rockey DC. Bryson CL. Weiss NS. Iron deficiency and gastrointestinal malignancy: a population-based cohort study. Am J Med. 2002;113:276-80.
[13] Chen YC. Chao TY. Cheng SN. Hu SH. Liu JY. Prevalence of von Willebrand disease in women with iron deficiency anaemia and menorrhagia in Taiwan. Haemophilia. 2008;14:768-74.
[14] Grau J. ¿Es siempre el tratamiento con hierro oral la mejor opción terapéutica? Rev Clin Esp. 2020;220:27-8.
[15] Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;373:485-6.
[16] Goodnough LT. Nemeth E. Ganz T. Detection, evaluation, and management of iron restricted erythropoiesis. Blood. 2010;116:4754-61.
[17] Mansour D. Hofmann A. Gemzell-Danielsson K. A review of clinical guidelines on the management of iron deficiency and iron-deficiency anemia in women with heavy menstrual bleeding. Adv Ther. 2020;38:201-25.
[18] Weiss G. Ganz T. Goodnough LT. Anemia of inflammation. Blood. 2019;133:40-50.
[19] Juncà J. Fernández-Avilés F. Oriol A. Navarro JT. Millá F. Sancho JM. Feliu E. et al. The usefulness of the serum transferrin receptor in detecting iron deficiency in the anemia of chronic disorders. Haematologica. 1998;83:676-80.
[20] Weiss G. Anemia of chronic disorders: new diagnostic tools and new treatment strategies. Semin Hematol. 2015;52:313-20.
[21] Bruno M. De Falco L. Iolascon A. How I diagnose non-thalassemic microcytic anemias. Semin Hematol. 2015;52:270-8.
[22] Cappellini MD. Comin-Colet J. de Francisco A. Dignass A. Doehner W. Lam CS. et al. Iron deficiency across chronic inflammatory conditions: International expert opinion on definition. diagnosis. and management. Am J Hematol. 2017;92:1068-78.
[23] Garcia Erce JA. Altes A. Lopez Rubio M. Remacha AF. Manejo del déficit de hierro en distintas situaciones clínicas y papel del hierro intravenoso: recomendaciones del Grupo Español de Eritropatología de la SEHH. Rev Clin Esp. 2020;220:31-42.
[24] Fairbanks VF. Laboratory testing for iron status. Hosp Pract. 1991;26:17-24.
[25] Cancelo-Hidalgo MJ. Castelo-Branco C. Palacios S. Haya-Palazuelos J. Ciria-Recasens M. Manasanch J. et al. Tolerability of different oral iron supplements: a systematic review. Curr Med Res Opin. 2013;29:291-303.
[26] Moretti D. Goede JS. Zeder C. Jiskra M. Chatzinakou V. Tjalsma H. et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. Blood. 2015;126:1981-9.
[27] Stoffel NU. Zeder C. Brittenham GM. Moretti D. Zimmermann MB. Iron absorption from supplements is greater with alternate day than with consecutive day dosing in iron deficient anemic women. Haematologica. 2020;105:1232-9.
[28] Kaundal R. Bhatia P. Jain A. Jain A. Nampoothiri RV. Mishra K. et al. Randomized controlled trial of twice-daily versus alternate-day oral iron therapy in the treatment of iron-deficiency anemia. Ann Hematol. 2020;99:57-63.
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