Iron and Internal Medicine: new evidence for earlier and more accurate management

At IMCID 2025, Dr. Andras Rabi emphasizes the strategic role of iron supplementation in the management of complex patients and highlights the need for precise clinical assessment to avoid invasive treatments.

The 9th edition of the International Multidisciplinary Course on Iron Deficiency (IMCID) featured several sessions focused on the value of a multidisciplinary approach to diagnosing and treating iron deficiency. Representing the field of internal medicine, Dr. Andras Rabi, internist and hematologist at the Immuno-Hematology Unit of San Pietro Fatebenefratelli Hospital in Rome, took part in the scientific discussion within the session dedicated to complex and chronically ill patients.

The session featured the following key presentations:

• Nutritional status and impact of proper supplementation in obese patients after bariatric surgery (D. Dellepiane, Koelliker Hospital, Turin)
• Hemoglobin response after Sucrosomial® Iron vs orodispersible ferric pyrophosphate films daily treatment (G. Giordano, Regional Hospital “A. Cardarelli”, Campobasso)
• Sucrosomial® Iron in the treatment of anemia in pluri-pathological patients (M.B. Alonso, University of Las Palmas de Gran Canaria)
• The role of nutritional supplement on post-stroke fatigue: preliminary data of a randomized controlled trial (S. Giovannini, Università Cattolica del Sacro Cuore, Rome)
• Fatigue related to iron deficiency due to gastrointestinal disorders (M. Aloi, University of Milan – Policlinico)

Dr. Rabi, IMCID has become a reference point for professionals working in iron deficiency. What stood out to you in this year’s edition?
This edition was rich in both scientific content and practical clinical implications. I was particularly struck by a presentation from a colleague in New York on iron metabolism in cardiac cells and the differences between Sucrosomial® Iron and ferrous sulfate. The two forms affect cells differently, and Sucrosomial® Iron may also offer anti-inflammatory properties. Another highlight was a new sachet-based iron formulation for post-bariatric surgery patients, offering better nutrient absorption—including iron and vitamin B12. In our hematology clinic, we see many post-bariatric patients with severe iron deficiency, and early supplementation can help avoid invasive treatments.

From your experience, what role does nutritional supplementation play in managing post-stroke fatigue?
It’s a frequently overlooked issue. Post-stroke patients often have multiple comorbidities and may develop anemia that goes unnoticed, especially if hemoglobin levels appear borderline. But even values around 11 g/dL can significantly slow recovery, particularly in older patients. Data presented at IMCID 2025 confirm that maintaining adequate iron and hemoglobin levels improves oxygen delivery to tissues and supports faster rehabilitation.

Iron deficiency is often underdiagnosed in clinical practice. What strategies do you recommend for early recognition?
This remains a widespread issue. Too often, patients are referred to hematologists for microcytic hypochromic anemia without a proper iron workup. Internists should feel confident managing these cases independently by requesting complete iron studies—including ferritin, serum iron, transferrin saturation, and inflammation markers. It’s also important to remember that functional iron deficiency can occur without overt anemia, yet still cause symptoms like fatigue and headache. Recognizing these “subclinical” patterns can make a real difference in patient outcomes.

What are the key takeaways from IMCID for assessing iron status in patients with multiple conditions?
IMCID 2025 strongly emphasized the role of Sucrosomial® Iron, not only for its higher bioavailability but also for its anti-inflammatory properties—particularly relevant in conditions like autoimmune GI diseases and myelodysplastic syndromes. A complete and accurate iron profile is essential before initiating treatment, and therapies should always be adapted to the patient’s clinical picture. This approach ensures a more effective, personalized strategy while limiting unnecessary use of intravenous iron.

Dr. Rabi’s contribution at IMCID 2025 reinforced the importance of including iron deficiency management as an essential part of internal medicine, especially in complex patient cases. A more precise diagnostic approach combined with innovative oral formulations like Sucrosomial® Iron may represent a turning point in day-to-day clinical practice.

The Abstract Book of the 9^th IMCID – International Multidisciplinary Course on Iron Deficiency, held in Palermo (Sicily, Italy) from 3 to 4 April 2025, has been published as Supplement n°3 of the last issue of May 2025 of the international journal Blood Transfusion (IF=2.4).
Download the abstract book here!