What is the diagnosis for a 38-year-old female with microcytic hypochromic anemia, low iron, and low ferritin levels?

From the Guidelines

This patient's lab results indicate iron deficiency anemia, and the recommended treatment is oral iron supplementation, typically with ferrous sulfate 325 mg taken orally three times daily between meals, as supported by the most recent guidelines 1. The diagnosis of iron deficiency anemia is based on the patient's microcytic hypochromic anemia, low iron, and low ferritin levels, which are consistent with iron deficiency anemia as defined by a serum ferritin level <35 μg/L and normal or low blood hemoglobin values 1.

Key Considerations

• The patient's age and sex suggest a high risk of iron deficiency due to menstrual bleeding, and regular blood loss during menstrual bleeding may be a contributing factor 1.
• A thorough history and physical examination should be conducted to investigate the underlying cause of iron deficiency, which may include gastrointestinal bleeding, malabsorption, or increased iron requirements.
• Further tests such as a complete blood count, peripheral blood smear, and stool occult blood test may be necessary to rule out other causes of anemia.
• Dietary counseling to increase iron-rich foods in the diet is also recommended, with a focus on highly bioavailable sources of iron such as meat and seafood, and vitamin C should be co-ingested with non-haem iron sources to enhance absorption 1.

Treatment

• Oral iron supplementation is the standard first-line treatment for iron deficiency anemia, and parenteral iron is a convenient and relatively safe alternative if oral iron is not tolerated 1.
• The treatment regimen should continue for 3-6 months to replenish iron stores, and follow-up testing of hemoglobin, iron, and ferritin levels should be performed after 4-8 weeks of treatment to assess response and adjust therapy if needed.
• If oral iron is not effective, intravenous iron therapy may be considered, particularly in cases where there is impaired iron digestion from the gut, such as in coeliac disease 1.

From the FDA Drug Label

Purpose Iron Supplement Therapy Ferrous Sulphate is an iron supplement for iron deficiency and iron deficiency anemia when the need for such therapy has been determined by a physician. The diagnosis for a 38-year-old female with microcytic hypochromic anemia, low iron, and low ferritin levels is iron deficiency anemia 2.

• Key findings: microcytic hypochromic anemia, low iron, and low ferritin levels
• Diagnosis: iron deficiency anemia The patient's symptoms are consistent with iron deficiency anemia, which is a condition where the body does not have enough iron to produce adequate amounts of hemoglobin, a substance in red blood cells that enables them to carry oxygen around the body.

From the Research

Diagnosis and Treatment

The diagnosis for a 38-year-old female with microcytic hypochromic anemia, low iron, and low ferritin levels is likely iron deficiency anemia. The treatment for this condition typically involves iron supplementation.

Treatment Options

• Oral iron supplementation is usually the first line of treatment for iron deficiency anemia, as stated in 3 and 4.
• However, in some cases, oral iron supplementation may not be effective, and intravenous iron therapy may be necessary, as mentioned in 5 and 6.
• The choice of treatment depends on several factors, including the presence of inflammation, the time available for iron replenishment, and the anticipated risk of side-effects or intolerance, as discussed in 5.

Considerations for Treatment

• Patient education and understanding, social support, simple dosing, perceived efficacy, and tolerability are factors that promote medication adherence and persistence, as noted in 4.
• The use of ferrous sulfate, particularly extended-release forms, can facilitate adherence to iron therapies due to its optimal absorption and improved tolerability, as mentioned in 4.
• Proton pump inhibitors, such as omeprazole, may decrease the absorption of oral iron supplementation, and iron-deficient patients taking these medications may require high-dose iron therapy for a longer duration or intravenous iron therapy, as reported in 7.

Management in Specific Contexts

• In the emergency department, intravenous iron may be underutilized, and red blood cell transfusions may be administered too liberally, as highlighted in 6.
• For selected patients with moderate-to-severe iron deficiency anemia, intravenous iron is safe and more effective than oral iron, as stated in 6.