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Anaemia - iron deficiency - Management
Basis for recommendation

  • This recommendation to use an iron supplement to treat iron deficiency anaemia and to replenish iron stores is based on well established clinical practice [British Society of Gastroenterology, 2005; BNF 54, 2007]. Ferrous sulphate is the first-line option as it is the most commonly used ferrous iron salt, is cost-effective, and has a high bioavailability [Zimmerman and Hurrell, 2007].
  • The following are not routinely recommended in primary care:
    • Modified-release iron preparations, which release most of their iron after passing the small bowel absorption site where iron cannot be effectively absorbed [Frewin et al, 1997; Killip et al, 2007]. Modified-release iron preparations are not available on the NHS.
    • Preparations that contain iron combined with folic acid, vitamin B12, and other nutrients, which should only be recommended for people with nutritional anaemias related to very poor diet or malnutrition [Little, 1999; Cox, 2003].
    • Compound iron and ascorbic acid (vitamin C) preparations are not included. They are not available on the NHS and it is not clear what therapeutic advantage they offer [Little, 1999]. Also high-dose ascorbic acid (vitamin C) supplements should not be taken with iron supplements, because the combination may cause epigastric pain [WHO et al, 2001].
    • Parenteral iron preparations, which are only needed in exceptional circumstances, and are usually reserved as a secondary care treatment.
  • The recommendation to follow a balanced diet of iron-rich foods is based on expert opinion [Heath and Fairweather-Tait, 2002; Killip et al, 2007].
    • However, there is no clear relationship between dietary iron intake and iron status, and there is no evidence to suggest that current dietary changes will have a major impact on iron status in the general population [Heath and Fairweather-Tait, 2002].

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