From the Guidelines
The patient's lab results indicate iron deficiency, and treatment should begin with oral iron supplementation, typically ferrous sulfate 325 mg taken once or twice daily, as the elevated TIBC and low iron saturation are key indicators of iron deficiency. The patient's iron level is within the normal range, but the elevated TIBC at 532 mcg/dL and low iron saturation of 11% suggest that the body is not utilizing the available iron effectively, which is consistent with iron deficiency 1.
According to the British Society of Gastroenterology guidelines, serum ferritin is the most specific test for iron deficiency in the absence of inflammation, and a level of <15 μg/L is indicative of absent iron stores 1. Although the patient's ferritin level is not provided, the low iron saturation and elevated TIBC suggest iron deficiency.
The patient's treatment plan should include:
- Oral iron supplementation with ferrous sulfate 325 mg taken once or twice daily, providing 65 mg elemental iron per tablet
- Taking the supplement on an empty stomach with vitamin C (such as orange juice) to enhance absorption
- Separating the supplement from calcium-containing foods, tea, coffee, and antacids which can decrease absorption
- Monitoring for side effects such as constipation, nausea, and black stools
- Further investigation into the cause of iron deficiency, including evaluation for gastrointestinal blood loss, heavy menstrual bleeding, or malabsorption
- Dietary counseling to increase iron-rich foods (red meat, spinach, beans)
Follow-up labs should be obtained in 2-3 months to assess response to therapy, and intravenous iron may be considered if oral therapy is not tolerated or ineffective after 3 months 1. Iron deficiency in achondroplasia is not directly related to the condition but should be addressed to prevent progression to anemia and associated symptoms like fatigue and decreased exercise tolerance.
From the Research
Iron Deficiency Anemia Diagnosis and Treatment
- The patient's lab results show low iron levels (56 mcg/dL) and low iron saturation (11%), indicating iron deficiency anemia 2, 3.
- The total iron-binding capacity (TIBC) is high (532 mcg/dL), which is consistent with iron deficiency anemia 2, 3.
- The diagnosis of iron deficiency anemia is typically confirmed by low iron stores and a hemoglobin level two standard deviations below normal 2.
- The underlying cause of iron deficiency anemia should be determined, and treatment should be initiated to replenish iron stores 2, 3.
Treatment Options
- Oral iron supplementation is commonly used to treat iron deficiency anemia, but some patients may require intravenous iron therapy 4.
- Intravenous iron therapy may be necessary for patients who cannot tolerate or absorb oral preparations, such as those with gastric bypass or inflammatory bowel disease 4.
- Oral ferrous sulfate has been shown to improve functional capacity in heart failure patients with iron deficiency anemia 5.
Evaluation of Microcytosis
- Microcytosis is typically an incidental finding in asymptomatic patients, and the most common causes are iron deficiency anemia and thalassemia trait 6.
- Serum ferritin measurement is the first laboratory test recommended in the evaluation of microcytosis, and low ferritin levels suggest iron deficiency 6.
- Further evaluation should include total iron-binding capacity, transferrin saturation level, serum iron level, and possibly hemoglobin electrophoresis if the serum ferritin level is not initially low 6.