What to do with someone who has hypoferritinemia (iron level of 10)

From the Guidelines

For a person with an iron level of 10, iron supplementation is necessary to treat iron deficiency and prevent associated morbidity and mortality, with oral iron supplements being the first line of treatment, at a dose of 100-200 mg/day, in divided doses, as recommended by the espen micronutrient guideline 1. When treating iron deficiency, it is essential to consider the patient's overall health and potential underlying causes of the deficiency. According to the espen micronutrient guideline 1, iron supplementation should be taken in divided doses to minimize gastrointestinal side effects, which are common with iron therapy.

• Typical doses of oral iron supplements are 100-200 mg/day, in divided doses, to reduce the risk of adverse effects such as constipation, diarrhea, and nausea.
• Recent data suggest that alternate day dosing may result in better iron resorption and fewer adverse effects 1.
• In cases where oral supplementation is not effective or feasible, intravenous iron administration may be necessary, with ferric carboxymaltose being a suitable option, which can be infused over 15 minutes 1.
• It is crucial to identify and address the underlying cause of iron deficiency, which could include blood loss, poor dietary intake, malabsorption, or increased iron requirements, to prevent recurrence and ensure adequate treatment.
• A diet rich in iron-containing foods, such as red meat, spinach, beans, and fortified cereals, should complement supplementation to support the replenishment of iron stores.
• Regular monitoring of iron levels is essential to track progress and adjust treatment as needed, as iron deficiency can cause significant morbidity, including fatigue, weakness, pale skin, shortness of breath, and cognitive issues.

From the FDA Drug Label

The mean age of the patients enrolled in this study was 41 years, with ages ranging from 16 to 70 years. Of 130 patients evaluated for efficacy in this study, 68 (52%) were male and 62 (48%) were female. Forty-eight percent of the patients had previously been treated with oral iron. Exclusion criteria were similar to those in studies A and B Venofer was administered in doses of 100 mg during sequential dialysis sessions until a pre-determined (calculated) total dose of iron was administered. A 50 mg dose (2. 5 mL) was given to patients within two weeks of study entry as a test dose. This study enrolled patients with a hemoglobin ≤ 10 g/dL, a serum transferrin saturation ≤ 20%, and a serum ferritin ≤ 200 ng/mL, who were undergoing maintenance hemodialysis 2 to 3 times weekly

Treatment for someone with an iron level of 10

• The patient should be evaluated for iron deficiency and anemia.
• Venofer (iron sucrose) can be administered in doses of 100 mg during sequential dialysis sessions until a pre-determined total dose of iron is administered.
• A test dose of 50 mg (2.5 mL) should be given to patients within two weeks of study entry.
• The patient's hemoglobin, serum transferrin saturation, and serum ferritin levels should be monitored during treatment 2

From the Research

Treatment Options for Iron Deficiency

• Oral iron supplementation is the first line of treatment for iron deficiency anemia and pre-anemic iron deficiency 3
• Ferrous sulfate is the simplest, least expensive, and most commonly prescribed oral iron supplement, but it can cause gastrointestinal side effects 3
• Other oral iron formulations, such as ferric maltol and sucrosomial iron, have been developed to improve efficacy and tolerability 3, 4

Dosage and Frequency of Oral Iron Supplementation

• The optimal dosage and frequency of oral iron supplementation are still debated, but recent studies suggest that doses of 60-120 mg iron as a ferrous salt given with ascorbic acid on alternate days may be an effective regimen 5
• Daily low-dose and every other day dosing protocols have been proposed to improve iron absorption and reduce side effects 6

Alternative Treatment Options

• Intravenous iron therapy can be used when oral iron supplementation is contraindicated or ineffective, and can rapidly achieve therapeutic targets without gastrointestinal complications 3, 7
• Sucrosomial iron is an oral formulation that has been shown to have higher iron intestinal absorption and excellent gastrointestinal tolerance compared to oral iron salts, and may be a valid first option for the treatment of iron deficiency and iron deficiency anemia 4

Considerations for Treatment

• The choice of treatment should be based on the individual's specific needs and circumstances, and should take into account factors such as the severity of iron deficiency, the presence of gastrointestinal side effects, and the availability of different treatment options 3, 5, 6, 7, 4