Current misconceptions in diagnosis and management of iron deficiency

Abstract

The prevention and treatment of iron deficiency is a major public health goal. Challenges in the treatment of iron deficiency include finding and addressing the underlying cause and the selection of an iron replacement product which meets the needs of the patient. However, there are a number of non-evidence-based misconceptions regarding the diagnosis and management of iron deficiency, with or without anaemia, as well as inconsistency of terminology and lack of clear guidance on clinical pathways. In particular, the pathogenesis of iron deficiency is still frequently not addressed and iron not replaced, with indiscriminate red cell transfusion used as a default therapy. In our experience, this imprudent practice continues to be endorsed by non-evidence-based misconceptions. The intent of the authors is to provide a consensus that effectively challenges these misconceptions, and to highlight evidence-based alternatives for appropriate management (referred to as key points). We believe that this approach to the management of iron deficiency may be beneficial for both patients and healthcare systems. We stress that this paper solely presents the Authors' independent opinions. No pharmaceutical company funded or influenced the conception, development or writing of the manuscript.

Conflict of interest statement

Disclosure of conflict of interests

MM has received industry-supplied funding for consultancies, lectures and/or travel from Pharmacosmos, Vifor Pharma, Zambon and NutraPharma, and is member of the Editorial Boards of Revista Española de Anestesiología y Reanimación and Blood Transfusion; MB has received has received a fee from Alexion and support, for staff and drugs as part of a trial, from Pharmacosmos; FG has received funding for consultancies, lectures and/or travel from Pharmacosmos, Vifor Pharma, Abbvie, Janssen, Takeda and MSD previously, and is member of the Editorial Boards of Journal of Crohn’s and Colitis and Gastroenterología y Hepatología; GML is the Editorin-Chief of Blood Transfusion and this manuscript has undergone additional external review as a result; SB has received honoraria for lecturing and research funding for an investigator-led study from Pharmacosmos, and funding from Vifor Pharma to attend the EDTA 2017; MC has received industry-supplied funding for consultancies, lectures and/or travel from Vifor Pharma, and Zambon; AS received research grants from CSL Behring, Gauss Surgical, Masimo and HbO2 Therapeutics; he has also received honoraria from CSL Behring, Masimo and Merck, and acted as a consultant for CSL Behring, Gauss Surgical, Masimo Corporation and Vifor Pharma; MA has received funding for research and/or honoraria from Pharmacosmos, AMAG Pharmaceuticals and Luitpold Pharmaceuticals Inc; SG-Rand JP have nothing to declare.