What is the primary treatment for severe iron deficiency anemia with low hemoglobin?

From the Guidelines

The primary treatment for severe iron deficiency anemia with low hemoglobin is oral iron supplementation, typically ferrous sulfate 200 mg taken once daily, as it provides a good balance between efficacy and tolerability 1. For patients with severe iron deficiency anemia, such as those with a hemoglobin level of 7.5 g/dL, oral iron supplementation is the first line of treatment.

• The optimal dosage of elemental iron is 50-100 mg per day, which can be achieved with ferrous sulfate 200 mg taken once daily 1.
• The choice of oral iron preparation depends on the patient's tolerance and the presence of any underlying conditions, such as gastrointestinal disease or previous intolerance to traditional iron salts.
• Ferric maltol is a suitable alternative for patients with significant intolerance to oral iron therapy, as it has been shown to normalize hemoglobin levels in 63-66% of cases with moderate iron deficiency anemia 1.
• Parenteral iron administration is reserved for patients with severe symptomatic anemia, significant symptoms, or those who cannot tolerate oral therapy, and should be considered as an alternative to blood transfusion 1.
• Blood transfusion is generally reserved for patients with hemodynamic instability or severe symptoms that require immediate intervention, and should be used with caution due to the risks associated with transfusion 1.
• Regular monitoring of hemoglobin levels is essential to ensure an adequate response to treatment, and to adjust the treatment regimen as needed 1.

From the Research

Diagnosis and Treatment of Iron Deficiency Anemia

• Iron deficiency anemia is a common nutritional disorder worldwide, accounting for approximately one-half of anemia cases 2.
• The diagnosis of iron deficiency anemia is confirmed by the findings of low iron stores and a hemoglobin level two standard deviations below normal 2.
• In the given scenario, the patient has a hemoglobin level of 7.5 and a ferritin level of 51, indicating iron deficiency anemia.

Primary Treatment for Severe Iron Deficiency Anemia

• The primary treatment for severe iron deficiency anemia involves replenishing iron stores and returning the hemoglobin to a normal level 3, 4.
• Oral iron therapy can be initiated to replenish iron stores, but parenteral therapy may be used in patients who cannot tolerate or absorb oral preparations 2.
• High-dose intravenous iron therapy has been shown to be effective and safe for quick correction and avoidance of red blood cell transfusion in patients with severe iron deficiency anemia 5.

Considerations for Treatment

• The underlying cause of iron deficiency anemia should be treated, and gastrointestinal endoscopy may be necessary to evaluate the cause of bleeding in men and postmenopausal women 2.
• Iron replacement can be done orally or intravenously, depending on the patient's condition and response to therapy 3, 5.
• The treatment of iron deficiency anemia should aim to improve quality of life, morbidity, prognosis in chronic disease, and outcomes in pregnancy 4.