Pharmacological agents may also be required in cases where deficiency is more severe, in cases where iron loss exceeds dietary intake, and in individuals who follow a plant-based diet as non-heme sources often have lower bioavailability. When oral iron supplements are used, they should be taken on an empty stomach to increase absorption This might increase the risk of side effects however, such as nausea and epigastric pain. Anemia of Chronic Disease
Anemia of chronic disease (ACD) is the second most common cause of anemia after IDA. It usually occurs in individuals that have chronic inflammation due to a medical condition. Both diagnosis and treatment can be difficult as there may be an overlap with iron deficiency and thus it is a diagnosis of exclusion. Since ACD is caused by an underlying disorder, complete resolution of the condition is unlikely and we focus on controlling the inflammatory disorder rather than treating the ACD itself. Potential inflammatory conditions that can cause ACD are pulmonary tuberculosis, rheumatoid arthritis, and malignancies among many others. Thalassemia
Thalassemia is an inherited condition that has variants in alpha or beta globin genes that result in lower levels of globin chains required to make hemoglobin, resulting in alpha thalassemia or beta thalassemia, respectively. Diagnosis is made by DNA analysis for alpha thalassemia and hemoglobin analysis for beta thalassemia. Management of thalassemia involves chronic transfusions that maintain a hemoglobin level that reduces symptoms of anemia as well as suppresses extramedullary hematopoiesis which can lead to multiple morbidities.
Microcytic anaemia is any of several types of anaemia characterized by small red blood cells (called microcytes). The normal mean corpuscular volume (abbreviated to MCV on full blood count results, and also known as mean cell volume) is approximately 80–100 fL. When the MCV is <80 fL, the red cells are described as microcytic and when >100 fL, macrocytic (the latter occurs in macrocytic anemia). The MCV is the average red blood cell size. In microcytic anaemia, the red blood cells (erythrocytes) contain less hemoglobin and are usually also hypochromic, meaning that the red blood cells appear paler than usual. This can be reflected by a low mean corpuscular hemoglobin concentration (MCHC), a measure representing the amount of hemoglobin per unit volume of fluid inside the cell; normally about 320–360 g/L or 32–36 g/dL. Typically, therefore, anemia of this category is described as "microcytic, hypochromic anaemia".