JOURNAL CLUB – IRON SUPPLEMENTATION FOR THE IRON DEFICIENT ATHLETE
Journal Club Episode 3
Presenter: Dr. Riam Shamma – UofT Primary Care Sports Medicine Fellow
Date: November 11, 2014
Special Guest: Dr. Jeannie Callum (Hematologist – Sunnybrook Research Institute)
Podcast:
PrePodcast Quiz:
- What is the most common source of blood loss in endurance athletes?
- What is the prevalence of iron depletion in female athletes and in male athletes?
- What is the cutoff of serum ferritin to diagnose non-anemic iron depletion?
Part 1:
IronSupplementationPart1web.mp3
Part 2:
IronSupplementationPart2web.mp3
Part 3 Case Summary:
IronSupplementationPart1web.mp3
Articles Reviewed:
1. Friedmann B, Weller E, Mairbaurl H, Bärtsch P. Effects of iron repletion on blood volume and performance capacity in young athletes. Med Sci Sports Exerc. 2001 May;33(5):741-6.
2. DellaValle DM1, Haas JD. Impact of iron depletion without anemia on performance in trained endurance athletes at the beginning of a training season: a study of female collegiate rowers. Int J Sport Nutr Exerc Metab. 2011 Dec;21(6):501-6.
Supplementary Materials
IronDepletionSupplementationSummary
Table 1 – Iron Deficiency v. Iron Depletion
| Iron Deficient | Iron Depletion | |
| Non-Anemic Diagnosis: | Ferritin < 30ng/mL | Ferritin < 12ng/mL |
| Investigations: | ||
| Initial | CBC, Ferritin | CBC, Ferritin |
| Follow-up | CBC, Ferritin | CBC, Ferritin |
| Follow-up, Ferritin still low | Consider Celiac, anti-pyloric antibodies, H.Pylori, blood loss, hemolysis | Consider Celiac, anti-pyloric antibodies, H.Pylori, blood loss, hemolysis |
Table 2 – Management of both: Goal of therapy – Ferritin > 30ng/mL in endurance athletes (> 50ng/mL if cognitive/depressive symptoms)
| Management: | Brand Names | Dose | Elemental Iron | Duration |
| Oral supplementation*@ | ||||
| Ferrous sulfate | Fer-in-Sol/Slow Fe | iX300mg tab | 60mg | > 12 weeks |
| Ferrous gluconate | Fergon | iX300mg cap | 35mg | > 12 weeks |
| Ferrous fumarate | Palafer | iX300mg cap | 100mg | > 12 weeks |
| Polysaccharide-iron complex | FeraMax | iX150mg cap | 150mg | > 12 weeks |
| Heme iron polypeptide # | Proferrin | iiiX398mg tabs | 33mg heme Fe (11mg per tab) | > 12 weeks |
| Intraveonous Replacement **/^ | ||||
| Iron Sucrose | Venofer | 300mg IV | 300mg IV over 2 hours | May repeat ferritin at 6 months |
| Ferumoxytol | Feraheme | 510mg IV dilute in 50-200mL NS or D5W*** | 510mg IV over 15 minutes | May repeat ferritin at 6 months |
* Reference: Rx Files: Drug Comparison Charts 9th Edition
@ Special instructions for taking oral supplementation include: taking at night OR opposite end of day as training. Taking on an empty stomach in the absence of calcium (will decrease absorption), and/or antacids.
# Heme iron polypeptide – increased absorption through different receptors than iron salts
** Indications for Intravenous Replacement include:
- Emergency situation
- Anemic
- Oral Iron supplementation not effective
- Ferritin < 30 and symptomatic
^ – IV infusion clinics Bayshore locations:
Bayshore Clinics:
http://www.bayshore.ca/services/specialty-rx/
Provis Clinic:
http://provisinfusion.com
*** Reference: Lexicomp 2014/11/12