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Iron Deficiency

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Diagnostic and Therapy

Interested doctors

Iron Clinic

Iron Clinics

Infothek

The first follow up (appraisal after the therapy) takes place two weeks after the last Venofer or three weeks after the last Ferinject injection, respectively. It comprises:

 

· measurement of the ferritin value

 

· 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 differen-

    tial diagnoses

 

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 Venofer twice a week

 

IDA-Patienten (4):

500 (to 1000) mg

Ferinject once a Woche

 

 

 

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)

 

· 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 (5)

 

Now, the amount of iron required per year in order to avoid relapses is calculated (6).

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 by Dr. Schaub

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

5) 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

6) 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

 

 

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AIM Advanced ID Management

 

Copyright (2005) Dr. med. Beat Stephan Schaub