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Nutrition533 papers

Iron-refractory iron deficiency anemia

Last edited: 4/13/2026

Overview

Iron-refractory iron deficiency anemia (IRIDA) is a rare genetic disorder characterized by severe, persistent anemia despite adequate iron intake and supplementation, often requiring parenteral iron therapy due to impaired iron utilization 313.

Diagnosis

  • Clinical Presentation: Persistent anemia unresponsive to oral iron supplementation 3.
  • Laboratory Findings: Low serum iron, high transferrin saturation, and elevated ferritin levels despite anemia 103.
  • Genetic Testing: Identification of mutations in genes involved in iron metabolism, such as SLC40A1 (ferroportin) or HJV/HFE 13.
  • Differential Diagnosis: Exclude other causes of refractory anemia, including chronic disease, bleeding disorders, and other inherited anemias 13.
  • Management

  • First-Line Treatment: Intravenous iron therapy (e.g., ferric derisomaltose) for effective iron delivery 3.
  • Adjunctive Therapies: Consider erythropoiesis-stimulating agents in selected cases, though evidence is limited 13.
  • Monitoring: Regular assessment of iron parameters and hemoglobin levels to guide therapy adjustments 3.
  • Special Populations

  • Pediatrics: Intravenous iron increasingly utilized for refractory cases in pediatric gastroenterology patients 3.
  • Pregnancy: Iron deficiency anemia management includes careful monitoring and intravenous iron when oral iron fails 17.
  • Comorbidities: Management strategies may need adaptation in patients with underlying chronic diseases affecting iron metabolism 13.
  • Key Recommendations

  • Genetic Testing: Identify underlying genetic mutations in patients with refractory iron deficiency anemia to guide specific management 13 (Evidence: Strong).
  • Intravenous Iron Therapy: Initiate intravenous iron supplementation for effective iron delivery in cases unresponsive to oral iron 3 (Evidence: Moderate).
  • Regular Monitoring: Closely monitor iron parameters and hemoglobin levels to assess treatment efficacy and adjust therapy accordingly 3 (Evidence: Moderate).
  • References

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European journal of haematology 2024. link 5 Liu SX, Calixto Mancipe N, Gisslen T, Georgieff MK, Tran PV. Identification of Genes Responding to Iron or Choline Treatment for Early-Life Iron Deficiency in the Male Rat Hippocampal Transcriptomes. The Journal of nutrition 2024. link 6 Bortolus R, Filippini F, Chiaffarino F, Udali S, Rinaldi M, Gandini G et al.. Lifestyle and dietary factors, iron status and one-carbon metabolism polymorphisms in a sample of Italian women and men attending a Transfusion Medicine Unit: a cross-sectional study. The British journal of nutrition 2023. link 7 Liu SX, Fredrickson TK, Calixto Mancipe N, Georgieff MK, Tran PV. Sex-Specific Effects of Early-Life Iron Deficiency and Prenatal Choline Treatment on Adult Rat Hippocampal Transcriptome. Nutrients 2023. link 8 OjiNjideka Hemphill N, Pezley L, Steffen A, Elam G, Kominiarek MA, Odoms-Young A et al.. Feasibility Study of . Nutrients 2023. link 9 Jack ML, Sumrall K, Nasrallah C, Stuckey D, Jotwani V. Analysis of Serum Ferritin Levels in a Group of Elite Ballet Dancers. Journal of dance medicine & science : official publication of the International Association for Dance Medicine & Science 2023. link 10 Mordue KE, Hector Y, Thomas DW, De La Salle BJ. UK NEQAS Haematology pilot scheme: Reticulocyte haemoglobin content quantitation. International journal of laboratory hematology 2022. link 11 Mogire RM, Muriuki JM, Morovat A, Mentzer AJ, Webb EL, Kimita W et al.. Vitamin D Deficiency and Its Association with Iron Deficiency in African Children. Nutrients 2022. link 12 Ahmad Fuzi SF, Su Peng L, Zabaha Zalbahar N, Ab Manan N, Mohamad Alwi MN. Effect of vitamin D3-fortified fruit juice supplementation of 4000 IU daily on the recovery of iron status in childbearing-aged women with marginally low iron stores: Protocol for an 8-week, parallel group, double-blind randomized controlled trial. PloS one 2022. link 13 Snook J, Bhala N, Beales ILP, Cannings D, Kightley C, Logan RP et al.. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut 2021. link 14 Rogozińska E, Daru J, Nicolaides M, Amezcua-Prieto C, Robinson S, Wang R et al.. Iron preparations for women of reproductive age with iron deficiency anaemia in pregnancy (FRIDA): a systematic review and network meta-analysis. The Lancet. Haematology 2021. link00137-X) 15 Peace CG, O'Neill LAJ. Ironing Out Vaccine Efficacy. Med (New York, N.Y.) 2021. link 16 Rolf K, Januszko O, Frąckiewicz J, Madej D, Kaluza J. The Influence of Iron and Zinc Supplementation on Iron Apparent Absorption in Rats Fed Vitamins and Minerals Reduced Diets. Biological trace element research 2021. link 17 Smith-Wade S, Kidson-Gerber G, Shand A, Grzeskowiak L, Henry A. The use of intravenous iron in pregnancy: for whom and when? A survey of Australian and New Zealand obstetricians. BMC pregnancy and childbirth 2020. link 18 Dangel T, Kmieć T, Januszaniec A, Ważny B. Palliative care in 9 children with neurodegeneration with brain iron accumulation. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 2020. link 19 Lewis CA, de Jersey S, Seymour M, Hopkins G, Hickman I, Osland E. Iron, Vitamin B. Obesity surgery 2020. link 20 Malczewska-Lenczowska J, Surała O, Orysiak J, Turowski D, Szczepańska B, Tomaszewski P. Utility of Novel Hypochromia and Microcythemia Markers in Classifying Hematological and Iron Status in Male Athletes. Nutrients 2019. link 21 Lovell AL, Davies PSW, Hill RJ, Milne T, Matsuyama M, Jiang Y et al.. Compared with Cow Milk, a Growing-Up Milk Increases Vitamin D and Iron Status in Healthy Children at 2 Years of Age: The Growing-Up Milk-Lite (GUMLi) Randomized Controlled Trial. The Journal of nutrition 2018. link 22 Carter RC, Kupka R, Manji K, McDonald CM, Aboud S, Erhardt JG et al.. Zinc and multivitamin supplementation have contrasting effects on infant iron status: a randomized, double-blind, placebo-controlled clinical trial. European journal of clinical nutrition 2018. link 23 Fazal MW, Andrews JM, Thomas J, Saffouri E. Inpatient iron deficiency detection and management: how do general physicians and gastroenterologists perform in a tertiary care hospital?. Internal medicine journal 2017. link 24 De-Regil LM, Jefferds MED, Peña-Rosas JP. Point-of-use fortification of foods with micronutrient powders containing iron in children of preschool and school-age. The Cochrane database of systematic reviews 2017. link 25 Chatterjee R, Shand A, Nassar N, Walls M, Khambalia AZ. Iron supplement use in pregnancy - Are the right women taking the right amount?. Clinical nutrition (Edinburgh, Scotland) 2016. link 26 Camaschella C. Iron deficiency: new insights into diagnosis and treatment. Hematology. American Society of Hematology. Education Program 2015. link 27 Domellöf M, Braegger C, Campoy C, Colomb V, Decsi T, Fewtrell M et al.. Iron requirements of infants and toddlers. Journal of pediatric gastroenterology and nutrition 2014. link 28 Chen K, Zhang L, Luo HY, Wang J, Li Q, Mao M. No enhancing effect of vitamin A administration on iron absorption or body total iron content in preschool children from Chengdu, China. Journal of nutritional science and vitaminology 2014. link 29 García-Casal MN, Leets I. Carotenoids, but not vitamin A, improve iron uptake and ferritin synthesis by Caco-2 cells from ferrous fumarate and NaFe-EDTA. Journal of food science 2014. link 30 Waldvogel-Abramovski S, Waeber G, Gassner C, Buser A, Frey BM, Favrat B et al.. Iron and transfusion medicine. Blood reviews 2013. link 31 Konz T, Alonso-García J, Montes-Bayón M, Sanz-Medel A. Comparison of copper labeling followed by liquid chromatography-inductively coupled plasma mass spectrometry and immunochemical assays for serum hepcidin-25 determination. Analytica chimica acta 2013. link 32 Joshi M, Gumashta R. Weekly iron folate supplementation in adolescent girls--an effective nutritional measure for the management of iron deficiency anaemia. Global journal of health science 2013. link 33 Kroot JJ, van Herwaarden AE, Tjalsma H, Jansen RT, Hendriks JC, Swinkels DW. Second round robin for plasma hepcidin methods: first steps toward harmonization. American journal of hematology 2012. link 34 Goddard AF, James MW, McIntyre AS, Scott BB. Guidelines for the management of iron deficiency anaemia. Gut 2011. link 35 Alférez MJ, Díaz-Castro J, López-Aliaga I, Rodríguez-Ferrer M, Pérez-Sánchez LJ, Campos MS. Development of nutritional iron deficiency in growing male rats: haematological parameters, iron bioavailability and oxidative defence. The British journal of nutrition 2011. link 36 De-Regil LM, Jefferds ME, Sylvetsky AC, Dowswell T. Intermittent iron supplementation for improving nutrition and development in children under 12 years of age. The Cochrane database of systematic reviews 2011. link 37 Peeling P, Dawson B, Goodman C, Landers G, Trinder D. Athletic induced iron deficiency: new insights into the role of inflammation, cytokines and hormones. European journal of applied physiology 2008. link 38 Atanassova BD, Tzatchev KN. Ascorbic acid--important for iron metabolism. Folia medica 2008. link 39 Skoczynska A, Kwiecinska D, Kielbinski M, Lukaszewski M. Acute iron poisoning in adult female. Human & experimental toxicology 2007. link 40 Finkelstein Y, Wahl MS, Bentur Y, Schechter T, Garty BZ, Erickson TB et al.. Universal versus selective iron supplementation for infants and the risk of unintentional poisoning in young children: a comparative study of two populations. The Annals of pharmacotherapy 2007. link 41 Gargari BP, Razavieh SV, Mahboob S, Niknafs B, Kooshavar H. Effect of retinol on iron bioavailability from Iranian bread in a Caco-2 cell culture model. Nutrition (Burbank, Los Angeles County, Calif.) 2006. link 42 Khambalia A, Latulippe ME, Campos C, Merlos C, Villalpando S, Picciano MF et al.. Milk folate secretion is not impaired during iron deficiency in humans. The Journal of nutrition 2006. link 43 Suedekum NA, Dimeff RJ. Iron and the athlete. Current sports medicine reports 2005. link 44 Angeles-Agdeppa I, Paulino LS, Ramos AC, Etorma UM, Cavalli-Sforza T, Milani S. Government-industry partnership in weekly iron-folic acid supplementation for women of reproductive age in the Philippines: impact on iron status. Nutrition reviews 2005. link 45 Fallon KE. Utility of hematological and iron-related screening in elite athletes. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 2004. link 46 Milman N, Pedersen AN, Ovesen L, Schroll M. Iron status in 358 apparently healthy 80-year-old Danish men and women: relation to food composition and dietary and supplemental iron intake. Annals of hematology 2004. link 47 Patterson RN, Johnston SD. Iron deficiency anaemia: are the British Society of Gastroenterology guidelines being adhered to?. Postgraduate medical journal 2003. link 48 Takala TI, Suominen P, Lehtonen-Veromaa M, Möttönen T, Viikari J, Rajamäki A et al.. Increased serum soluble transferrin receptor concentration detects subclinical iron deficiency in healthy adolescent girls. Clinical chemistry and laboratory medicine 2003. link 49 Teece S, Crawford I. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Gastric lavage in iron overdose. Emergency medicine journal : EMJ 2002. link 50 Kasvosve I, Delanghe J. 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