Keywords
Refractory anemia
Review
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Abstract
Objective: To describe the approach to the main etiologies of iron-deficiency anemia refractory to iron supplementation. Literature review: In the case of a patient with iron-deficiency anemia refractory to treatment, gastrointestinal, infectious, poor adherence to treatment, and genetic syndromes should be considered and investigated. H. pylori infection, autoimmune gastritis, and celiac disease are gastrointestinal conditions that, through different mechanisms, impair iron absorption. Another hypothesis to be considered is menstrual blood loss in women or occult bleeding in both sexes. Finally, there are rarer genetic causes, such as the transmembrane serine protease-6 mutation, a diagnosis usually made after the exclusion of more common etiologies. Final considerations: It is of utmost importance to investigate, diagnose, and properly manage anemia refractory to iron supplementation. These conditions are challenging for the general practitioner but are prevalent in clinical practice and deserve special attention, as anemia causes various detriments to the individual's quality of life.
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