[Chronic hemorrhagic iron deficiency. Sources of hemorrhage, blood loss and systematic iron substitution]

In only 121/436 (28 per cent) patients with chronic haemorrhagic iron deficiency bleeding sources could be removed by appropriate management or healed spontaneously. In 61 per cent of all cases the disease lasted from 1 year to greater than 20 years. The fall of haemoglobin per month correlated closely with blood losses per month as calculated by determinations of 59Fe whole body iron loss. Over prolonged periods estimations of the magnitude of blood loss (range 1- greater than 721 per year) based on changes of the iron status under normal diets and under systematic iron substitution. Oral iron administration with appraisable bioavailability was able to compensate blood losses up to 151 and with increasing doses up to 361 per year with maintenance of normal or borderline haemoglobin values. However, side reactions increased considerably after years and with rising doses. Under such circumstances combinations of i.v. iron, oral iron and blood transfusions were successful over prolonged periods.