COMMENTARY
Pumping Iron: Which
IV Iron Formulation Is
Right for Your Patient?
Matthew F. Watto, MD; Paul N.
Williams, MD
July 17, 2025
This transcript has been edited for clarity.
Matthew F. Watto, MD: Welcome back to
The Curbsiders. I'm Dr Matthew Frank Watto
here with my great friend and America's
primary care physician, Dr Paul Nelson
Williams. Paul, are you a fan of iron?
Paul N. Williams, MD: You know it! That's
why we've done about 12 episodes on iron
at this point.
Watto: As in, pumping iron?
Williams: Sure, look at me — I'm jacked!
Watto: Paul, we had a great guest on this
episode, Dr Tom DeLoughery (Bloodman).
He was a great guest and a hilarious guy.
Let's talk about it, Paul: microcytic anemia. I
know iron deficiency can cause that, but
what else can cause microcytic anemia?
, Williams: I appreciated the breakdown of
this episode. Our guest says that there are
four big things that can cause microcytic
anemia that you need to know about. One is
iron deficiency; that is far and away
probably the most common one. Then there
is anemia of chronic disease, which I don't
think we think about as much. If the mean
corpuscular volume (MCV) is less than 70 fL,
it's probably not anemia of chronic disease,
but anemia of chronic disease can cause
microcytic anemia. The next is thalassemia,
which is probably more common than we
give it credit for. The last one is sideroblastic
anemia, which is something you're probably
not going to be diagnosing in adulthood
and is an uncommon cause.
So really, if you consider those first three
causes — especially with the framework that
he gives — it can be pretty easy to
distinguish between iron deficiency, anemia
of chronic disease, and thalassemia. That's
what you need to figure out before we start
just giving iron willy-nilly.
Watto: I don't think I've ever even seen
sideroblastic anemia in a chart outside of an
exam setting. I feel like you're more likely to
see consumption written in the chart than
sideroblastic anemia!
Williams: Yeah, I feel like it's the type of
disorder I would've been quizzed about
during floors a million years ago but not
something I've actually seen — ever, I don't
think.
Watto: Now, Paul, when I'm working up
anemia, I like to look at all the things: red
cell distribution width (RDW), total iron
Pumping Iron: Which
IV Iron Formulation Is
Right for Your Patient?
Matthew F. Watto, MD; Paul N.
Williams, MD
July 17, 2025
This transcript has been edited for clarity.
Matthew F. Watto, MD: Welcome back to
The Curbsiders. I'm Dr Matthew Frank Watto
here with my great friend and America's
primary care physician, Dr Paul Nelson
Williams. Paul, are you a fan of iron?
Paul N. Williams, MD: You know it! That's
why we've done about 12 episodes on iron
at this point.
Watto: As in, pumping iron?
Williams: Sure, look at me — I'm jacked!
Watto: Paul, we had a great guest on this
episode, Dr Tom DeLoughery (Bloodman).
He was a great guest and a hilarious guy.
Let's talk about it, Paul: microcytic anemia. I
know iron deficiency can cause that, but
what else can cause microcytic anemia?
, Williams: I appreciated the breakdown of
this episode. Our guest says that there are
four big things that can cause microcytic
anemia that you need to know about. One is
iron deficiency; that is far and away
probably the most common one. Then there
is anemia of chronic disease, which I don't
think we think about as much. If the mean
corpuscular volume (MCV) is less than 70 fL,
it's probably not anemia of chronic disease,
but anemia of chronic disease can cause
microcytic anemia. The next is thalassemia,
which is probably more common than we
give it credit for. The last one is sideroblastic
anemia, which is something you're probably
not going to be diagnosing in adulthood
and is an uncommon cause.
So really, if you consider those first three
causes — especially with the framework that
he gives — it can be pretty easy to
distinguish between iron deficiency, anemia
of chronic disease, and thalassemia. That's
what you need to figure out before we start
just giving iron willy-nilly.
Watto: I don't think I've ever even seen
sideroblastic anemia in a chart outside of an
exam setting. I feel like you're more likely to
see consumption written in the chart than
sideroblastic anemia!
Williams: Yeah, I feel like it's the type of
disorder I would've been quizzed about
during floors a million years ago but not
something I've actually seen — ever, I don't
think.
Watto: Now, Paul, when I'm working up
anemia, I like to look at all the things: red
cell distribution width (RDW), total iron
