Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA.
Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA.
Eur J Haematol. 2023 Feb;110(2):123-130. doi: 10.1111/ejh.13892. Epub 2022 Nov 20.
Iron deficiency is the most common nutrient deficiency in the world, affecting over 20% of premenopausal women worldwide. Oral iron supplementation is often the first-line treatment for the acute and chronic management of iron deficiency due to its ease and accessibility. However, there is no consensus on the optimal formulation or dosing strategy, or which patients should be preferentially treated with intravenous iron. Management of iron deficiency is complicated by the hepcidin-ferroportin iron regulatory pathway, which has evolved to prevent iron overload and thereby creates an inherent limit on gastrointestinal iron uptake and efficacy of oral iron. Unabsorbed iron propagates many of the side effects that complicate oral iron use including dyspepsia and constipation, all of which can thus be exacerbated by excessive oral iron doses. Daily low dose and every other day dosing protocols have attempted to bypass this physiologic bottleneck to allow for effective absorption and limit side effects; however, this approach has still resulted in low fractional iron absorption. In the following manuscript, we review the pathophysiology of iron absorption and current evidence for various preparations of oral iron. Lastly, we highlight opportunities for further study to advance the care of individuals affected by iron deficiency.
缺铁是世界上最常见的营养缺乏症，影响着全球超过 20%的育龄前妇女。由于口服补铁的简便易用，它通常是治疗缺铁的急性和慢性管理的一线治疗方法。然而，对于最佳配方或剂量策略，或者应该优先给予静脉铁治疗的患者，目前仍没有共识。铁调素-亚铁转运蛋白铁调节通路的存在使缺铁的管理变得复杂，该通路的进化旨在防止铁过载，从而对胃肠道铁吸收和口服铁的疗效造成固有限制。未被吸收的铁会引发许多使口服铁治疗复杂化的副作用，包括消化不良和便秘，所有这些副作用都可能因过量口服铁剂而加重。每日低剂量和每两天一次的给药方案试图绕过这种生理瓶颈，以实现有效的吸收并限制副作用；然而，这种方法仍导致铁的分数吸收较低。在接下来的手稿中，我们回顾了铁吸收的病理生理学和各种口服铁制剂的现有证据。最后，我们强调了进一步研究的机会，以推进受缺铁影响的个体的护理。
