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Iron Clinic

The first follow up (appraisal after the therapy) takes place two weeks after the last administration of 0.2 gram or three weeks after the last administration of 0.5 (1.0) gram. It comprises:

· measurement of the ferritin value (5)

· documentation of the change of former symptoms

If the treatment has been successful, the diagnosis of IDS (iron deficiency syndrome) is confirmed.

If the treatment has not been successful, another cause has to be looked for immediately, in order to be able to treat the symptoms effectively.

Self Check

Tentative Diagnosis

Diagnostic Evaluation

Saturation

Confirmation of Diagnosis

Maintenance Therapy

If the Clinical Score IDS indicates such a suspicion, the ferritin value needs to be measured.

If it lies below 50 ng/ml, the suspicion is confirmed.

The self check (Clinical Score IDS) provides a first indication of symptoms characteristic of iron deficiency.

If at least one point is achieved, a first vague suspicion of iron deficiency exists.

Before a saturation is carried out, five requirements must be met (1):

1. Confirmed tentative

diagnosis

2. Exclusion of contra-

indications

3. Consideration of

differential diagnosis

4. Passing of the „final

indication check“ (2)

5. Calculating of the indi-

vidually required iron

amount (3)

Therapeutic

Recommandations:

IDS-Patients (4):

200 mg Iron twice a week

IDA-Patients (4):

500 (to 1000) mg

Iron once a Week

A confirmed suspicion of iron deficiency (characteristic iron deficiency symptoms at a ferritin level below 50 ng/ml) in principle requires the insufficiently filled or empty iron accumulators of the patient to be refilled intravenously.

At the second follow up (three months later), the same procedure is repeated:

· measurement of the ferritin value (mostly decreased in the case of women at an age at which they menstruate) (6)

· documentation of the state of the patient

An observation of the correlation of the patient’s state and the diagnostic findings (steps 2, 5 and 6) allows for an individual determination of the rated range, within which the patient does not feature iron deficiency symptoms. (7)

Now, the amount of iron required per year in order to avoid relapses is calculated.(8)

Step 1:

Step 2:

Step 3:

Step 5:

Step 6:

Step 4:

1) Every doctor needs to decide before a treatment, whether there is a natural (as menstruation) or a pathological cause (as blood loss in the gastrointestinal tract), which is responsible for iron deficiency

2) Average of STR (mg/l) and TF (g/l) divided by log (Ferritin (ng/ml)) must amount to 1.5, at least

3) Iron Deficiency Anemia: Ganzoni formula / Iron Deficiency Syndrome: Iron formula of Basel for saturation therapy by Dr. Schaub

4) IDS: Iron Deficiency Syndrome (early stage) / IDA: Iron Deficiency Anemia (late stage)

5) Initial target value for ferritin: 200 ng/ml two weeks after the last partial dose of 0.2 gram / 250-300 ng/ml three weeks after the last partial dose of 0.5 (1.0) gram. With IDA-patients the hemoglobin needs to be determined as well

6) With IDA-patients the hemoglobin needs to be determined as well

7) Ferritin value, state of patient and their correlation can be documented chronologically in a „feel good-passport“, which the patient keeps at home and brings to the consultation

8) Iron formula of Basel for maintenance therapy by Dr. Schaub

The know-how can be acquired in a 3 hour workshop: Module 1: diagnostics, therapy and prevention of patients with iron deficiency / Module 2: Health-Banking

AIM Advanced ID Management