Iron deficiency anemia in patients receiving home total parenteral nutrition.
BACKGROUND
Certain patients receiving home total parenteral nutrition (HPN) are likely to develop iron-deficiency anemia because of inadequate absorption or chronic iron loss from gastrointestinal lesions. The objective of this study was to examine the incidence and prevalence of iron deficiency anemia in patients on long-term HPN (>6 months) and to investigate both the efficacy of and rate of adverse reactions to parenteral iron dextran therapy.


METHODS
The records of 55 patients treated with HPN for >6 months between January 1, 1994 and December 31, 1999 were examined.


RESULTS
Thirty patients (55%) had evidence of iron-deficiency anemia. Ten patients were diagnosed at the initiation of HPN, and in 20 patients, iron deficiency developed after receiving HPN. The time between initiation of HPN and development of anemia ranged from 2 to 97 months (mean 28.8+/-26.2 months). Mild iron loss from the gastrointestinal tract seemed to be the predominant reason for iron deficiency. Regular treatment with small amounts of iron in HPN appeared to be safe and efficacious, with no reported side effects. Total dose infusion of iron was associated with adverse reactions in as many as 25% of these patients, although all reactions were mild and self-limited.


CONCLUSIONS
Iron-deficiency anemia is common in patients receiving chronic HPN. Regular small doses of iron in HPN formula, rather than total dose infusion, is the preferred treatment.
Khaodhiar
Lalita
L
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
Keane-Ellison
Mary
M
Tawa
Nicholas E
NE
Thibault
Ann
A
Burke
Peter A
PA
Bistrian
Bruce R
BR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications; D006471:Gastrointestinal Hemorrhage / Q000150:complications; D006801:Humans; D007262:Infusions, Intravenous; D007501:Iron / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016562:Parenteral Nutrition, Home Total; D012778:Short Bowel Syndrome / Q000150:complications / Q000628:therapy; D013997:Time Factors
D007501:Iron