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Acquired Refractory Iron Deficiency Anemia.

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Iron deficiency anemia (IDA) is common, but some cases don't respond to oral iron treatment. This review explores causes like gastrointestinal issues and hepcidin problems, guiding diagnosis and treatment for refractory anemia.

Keywords:
BleedingHepcidinIntravenous ironIron deficiencyIron refractory anemiaMalabsorption

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Area of Science:

  • Hematology
  • Gastroenterology
  • Internal Medicine

Background:

  • Anemia affects one-third of the global population, with iron deficiency anemia (IDA) being a leading cause of disability.
  • IDA stems from insufficient iron intake, reduced absorption, or blood loss; oral iron is the standard treatment.
  • Refractory IDA lacks hematologic response to oral iron, often due to gastrointestinal pathologies or rare genetic forms (IRIDA).

Purpose of the Study:

  • To review underlying conditions of iron-refractory anemia.
  • To discuss the role of hepcidin dysregulation in iron refractory anemia.
  • To outline diagnostic and treatment strategies for iron-refractory anemia.

Main Methods:

  • Literature review of studies on iron deficiency anemia and refractory anemia.
  • Analysis of mechanisms causing iron refractory anemia, including gastrointestinal pathologies and hepcidin dysregulation.
  • Synthesis of diagnostic and therapeutic approaches for iron-refractory anemia.

Main Results:

  • High hepcidin levels, from genetic or acquired conditions, impair iron absorption and recycling, leading to refractory anemia.
  • Gastrointestinal pathologies are frequent causes of acquired iron-refractory anemia.
  • Under-recognition of high hepcidin levels contributes to ineffective treatment of refractory IDA.

Conclusions:

  • Iron-refractory anemia requires a thorough investigation into underlying causes beyond simple iron deficiency.
  • Hepcidin dysregulation is a critical factor in many cases of iron-refractory anemia.
  • Tailored diagnostic and treatment strategies are essential for managing iron-refractory anemia effectively.