Here's a point for you
this basic review points out I think what I'm getting at, which is that in this country our diet is so darn full of iron that in a patient that otherwise doesn't have a bunch of other medical problems except they had this GIB, and yes there are certain groups at
higher risk of IDA like lactating mothers, etc, I still think we can skip the expensive IV Fe once they are out of the transfusion zone
https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
if they eat a normal diet, stock up on some beef, and take some extra vitamins, OK maybe not the 65 mg monster pill of doom TID no one wants to eat, they will get over the deficiency. eventually.
part of conclusion of link
http://www.bloodjournal.org/content/126/17/1971
"It may be that our orthodox treatment of iron deficiency anemia is all wrong. It results in an ∼12% to 15% absorption of iron and produces unpleasant side effects. Rather than administering 1 large iron pill 3 times per day, maybe we should treat iron deficiency anemia by giving a single substantial dose of elemental ferrous iron before breakfast on Monday, Wednesday, and Friday.
Recall that we need to absorb only ∼180 mg of iron per week to meet and beat the best current program."
OK guys sorry yeah not chasing down primary lit papers, I love that you are cuz I'm learning from you, but the paper answers the one question I had which is that the PO Fe should be given on an empty stomach
eh, I'm lazy but this mostly for gutonc
http://sickle.bwh.harvard.edu/iron_absorption.html
quotes that (yes not a primary citation, this is an SDN google-based post)
Heme is absorbed by machinery completely different to that of inorganic iron. The process is more efficient and is independent of duodenal pH .
Consequently meats are excellent nutrient sources of iron. In fact, blockade of heme catabolism in the intestine by a heme oxygenase inhibitor can produce iron deficiency (Kappas et al., 1993).
Whatever the mechanism of iron uptake,
normally only about 10% of the elemental iron entering the duodenum is absorbed. However, this value increases markedly with iron deficiency (Finch, 1994).
Let's say it goes up to 15% for the math I'm going to do.
So away from that, google books
https://books.google.com/books?id=m1xuAgAAQBAJ&pg=PA51&lpg=PA51&dq=percentage+of+heme+iron+absorbed&source=bl&ots=AWcN_J3QFo&sig=YBO8zPipCRqxWmT2TVsU-reeXGc&hl=en&sa=X&ved=0ahUKEwjTnIewr5LKAhVB5GMKHdy6As04ChDoAQguMAQ#v=onepage&q=percentage of heme iron absorbed&f=false
pulls up that in
iron deficient state absorption of iron from meat can be up to 47% and from plants 21%
Menstration increases the average daily iron loss to about 2 mg per day in premenopausal female adults (Bothwell and Charlton, 1982)
so extended cycling while treating iron deficiency in a woman at least (sorry guys) could let me make up about 14 mg/wk
Given the numbers above, the numbers gutonc taunted me with, it still suggests that encouraging dietary sources is a good plan
however, not the clams
per this link about bioavailability of iron in clams
https://www.researchgate.net/public...n_bioavailability_in_live_and_processed_clams
patient is going to eat at least a 16 oz steak when they sit down to do it (assuming they can afford red meat) so based on 10 mg iron/8 oz that would be 20 mg, and patient absorbs 47%, that would be 9.4 mg
4 times per week big steak as I suggest, that's 37.6 mg weekly
that's 20% of the Blood paper's goal for treatment of IDA, so no, you don't have to eat a whole cow for it to be worthwhile to add some high quality heme sources of iron to your diet for deficiency
I can take
2 Flintstones vitamins daily with no ill effects, n=1 says up to 36 mg PO this way is tolerable, assuming 15% not 10% absorption becuz deficient for sake of argument, 5.4 mg daily, or
37.8 mg weekly
the NIH link above says 16.3–18.2 mg/day in men and 12.6–13.5 mg/day in women older than 19 is average daily intake that I can bank on just cuz they eating food, and I know I'm not adding as much iron as I would like because the patient was likely already eating some red meat
but for simplifying that math let's say it's 13 mg daily baseline, in this population that amount is enough to stay iron replete, which according to the links above we need to absorb about 2 mg daily to make up for normal losses, so that's
91 mg weekly from regular eating
I'mma scrap the spinach what I was just reading suggests it's crap absorption
So my plan of likely tolerable vitamins and red meat supplemention plus whatever else they eat gets us close to 166 mg weekly
my menstruating patient per numbers above I would save 14 mg weekly with extended cycling, getting me to 180 mg weekly goal
and remember in this case it's 36 mg PO Flintstone I was giving, not the 70 mg TID as the Blood paper mentions, which they don't seem to recommend, I could get us to goal 180 mg weekly with the steak and PO vitamin plan if we just increase the supplement a little, now I need to find the paper that shows that 36 mg PO iron (the amount in my 2 Flinstones, I'm still a kid at heart) BID is more tolerable in term of GI side effects/patient perspective
So the math checks out that a common sensical approach to compliance, ie steak (most of my patients are glad for a blessing to scarf down red meat) and a reduced but still increased sized supplement of iron, could meet the Blood paper's goal for treatment
So the whole point I'm making is in line with the med student's scenario, I'm just arguing we skip the "convenience" of IV Fe and go PO. And I was making a point of how we can go PO that isn't a ****ty giant horsepill TID tons of SEs and low compliance but will work.
