Q: My mother aged 68 years, is obese, has hiatus hernia since long. She has iron deficiency anaemia - her haemoglobin went down to as low as 3.5, then the doctor suggested us blood transfusion, her iron is very low and she has also had a bone marrow biopsy. Everything is normal except low iron. She is not responding to oral iron medicines; Vit. B12 is also normal, Creatinine is also normal. The doctor has suggested for injectable iron. I want to know the complications involved in giving i.v. iron as she is vulnerable to allergies so please help me and give your advice. The cause of anaemia is still a mystery for us as we have also tested stools (3 consecutive days), endoscopy, barium test, etc

A:Large hiatus hernias may be associated with iron deficiency anaemia that is presumably caused by recurrent superficial ulcerations at the site where the diaphragm exerts pressure on the herniated stomach. If no other source of GI blood loss is discovered after thorough investigation, and patients continue to be iron-deficient despite supplementation and antiulcer treatment, surgical correction of the hernia should be performed. For parenteral iron, a test dose of 25 mg diluted in 50 ml normal saline and infused over 5 minutes should be given. Infusion should then be stopped for 1 hour. If there is no reaction after 1 hour, it is continued. Fatal anaphylactic reactions are possible. Epinephrine should be immediately available. The overall consensus regarding IV administration of iron dextran is that total dose infusion is the preferred method. If severe reactions develop, multiple bolus injections over several days may be required. Parenterally administered iron does not give a faster response compared to oral administration, therefore, the rate of recovery from anaemia should be the same.