How I treat unexplained refractory iron deficiency anemia

Area of Science:

• Gastroenterology
• Hematology
• Internal Medicine

Background:

• Endoscopic evaluation often fails to identify the cause of iron deficiency anemia (IDA).
• Unexplained or refractory IDA necessitates further investigation beyond standard gastrointestinal workup.

Purpose of the Study:

• To review the prevalence and impact of specific conditions in patients with unexplained or refractory IDA.
• To highlight the importance of screening for celiac disease, autoimmune gastritis, Helicobacter pylori, and hereditary factors.

Main Methods:

• Literature review and synthesis of existing data on IDA etiology.
• Analysis of diagnostic yield for various conditions in refractory IDA cases.

Main Results:

• Celiac disease is found in 4-6% of patients with obscure refractory IDA.
• Autoimmune gastritis affects 20-27% of patients, potentially preceding cobalamin deficiency.
• Helicobacter pylori infection is present in over 50% of unexplained refractory IDA cases, with eradication curing 64-75% of them.
• Hereditary iron deficiency should be considered in young patients with specific ferritin levels.

Conclusions:

• Recognizing the roles of H. pylori, autoimmune gastritis, celiac disease, and genetic defects is crucial for diagnosing and managing refractory IDA.
• Targeted screening can significantly improve diagnostic yield and patient outcomes for unexplained IDA.