Oncology Brothers: Practice-Changing Cancer Discussions Challenging Cases of Iron Abnormalities, Anemia or Iron Overload - Dr. Marina Beltrami
Dec 4, 2025
Dr. Marina Beltrami, a Hematologist from The Ohio State University specializing in non-malignant hematology, shares her insights on complex iron disorders. She discusses the crucial differences between IV and oral iron treatments for anemia in pregnancy. The conversation dives into managing elderly patients with mixed anemia causes, emphasizing comprehensive diagnostics including marrow biopsies and molecular tests. Dr. Beltrami also cautions against the risks of erythropoietin-stimulating agents and the careful approach needed for iron overload treatment.
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Personalize Oral Iron Dosing
- Offer oral iron formulations with lower elemental doses (18–65 mg) if patients prefer or cannot get IV iron, and tailor daily versus every-other-day dosing to tolerability.
- Prioritize adherence and tolerability over strict alternate-day regimens when patients find daily dosing easier to remember.
Timely Lab Rechecks And Calculated Replacement
- Recheck hemoglobin about four weeks after starting iron therapy in pregnancy to confirm improvement.
- Estimate the iron deficit before infusion and be aggressive in replacing the calculated total when possible.
Multiple Causes Common In Older Adults
- Anemia in older adults often has multiple contributors, so maintain a broad differential including iron deficiency despite high ferritin.
- Ferritin under ~200 with low transferrin saturation should still prompt consideration of iron deficiency or occult blood loss.