Swiss Delphi Study on Iron Deficiency

Objectives

Iron deficiency (ID) and iron deficiency anaemia (IDA) are important conditions affecting a large proportion of the general population, causing the patients` physical and psychosomatic symptoms, particularly fatigue, significantly affecting their quality of life. In pregnancy, ID and IDA may affect the foetus and the new-born child, and may lead to pregnancy complications. Unspecific symptoms due to ID are frequently encountered in General practice, however, little evidence is available to guide iron substitution. As a consequence, misuse of iron replacement therapy has been reported.


Design

We conducted a Swiss Delphi Study on Iron Deficiency in order to generate a broad consensual Swiss expert opinion in various therapeutic areas on diagnosis and treatment of ID/IDA and their practical implications.


Setting

Specific statements regarding clinical relevance, practical diagnostic and therapeutic approaches, and treatment have been evaluated by Swiss experts in various therapeutic areas.


Participants

Expert panel.


Intervention

Online anonymous surveys containing overall 440 statements.


Outcome measures

Percentage of Consensus, Critical Consensus and Disagreement for each statement. Results

Consensus (>80% agreement) was achieved for 50% (N=218), Critical Consensus (agreement of 50-79%) for further 39% (N=173) and Disagreement for 11% (N=49) (agreement<50%) of the statements.

In patients without systemic inflammation, the threshold of 30 μg/L for serum ferritin provides a good accuracy for the diagnosis of ID without anaemia. Additionally, ferritin levels within the range of 30-50 μg/L with transferrin saturation (TSAT)<20% can indicate ID without anaemia. Iron replacement therapy is accepted for treatment, not only of IDA, but also of symptomatic ID without anaemia. Finally, GPs play a central role in diagnosis and management of ID.


Conclusion

This consensus study, based on opinions of a high number of contributing specialists, provides potential therapeutic strategies for management of iron deficiency in a wide range of clinical perspectives.