In a recent small study where taking iron every other day was given versus once daily iron, they demonstrated an improved absorption.  How should we apply this in real world practice?

In my practice, iron is used quite often and occasionally I will see iron dosed multiple (2-3) times per day.  This study does help me question if that is always the right thing to do in patients who are still struggling to get adequate intake.  Here’s a few thoughts…

• In geriatrics, it is very important to assess ferritin to see if we are actually doing something.  The iron stores can tell us if we are improving the iron deficiency situation or not.
• Tracking hemoglobin can get lost in the mix sometimes with our polypharmacy patient.  If hemoglobin is within normal limits and ferritin looks fine as well, I will definitely have more confidence asking for at least a reduction to every other day with goal to potentially discontinue.
• Understand why the iron was started.  I see so many patients started on iron post-op and get continued on it indefinitely when they didn’t need it prior to the surgery.
• Constipation and GI upset.  This recent study does make me feel better about recommending every other day iron in the setting of mild to moderate GI complaints from iron.
• It is always difficult to make a blanket statement from a small study like this, but I would like to see more evidence in the setting of bariatric surgery.  Many of these patients are on chronic iron therapy, but I wonder if many of these patients could get by with every other day.
• Don’t forget about anemia of CKD.  In CKD, the kidney, which produces erythropoietin is damaged and sometimes supplementing with iron is done in vain.  Be sure to monitor for the response by monitoring hemoglobin and ferritin.  If iron stores are adequate in this setting, this may give us more ammunition to discontinue iron or at least reduce to every other day and reassess.

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