What is the recommended treatment for low ferritin and iron saturation levels without anemia?

From the Guidelines

The recommended treatment for low ferritin and iron saturation without anemia is oral iron supplementation, typically ferrous sulfate 325mg taken once or twice daily between meals with vitamin C to enhance absorption. According to the most recent and highest quality study 1, the goal ferritin level is 50 ng/mL, regardless of sex at birth. In this case, with a ferritin level of 25 and iron saturation of 29, oral iron supplementation is necessary to replenish iron stores.

The patient's current ferritin level is below the normal range, indicating iron deficiency without anemia, as defined by low serum ferritin (<35 μg/L) and normal blood haemoglobin values 1. To address this, dietary changes to include iron-rich foods like lean red meat, beans, spinach, and fortified cereals can complement supplementation. It is also essential to identify and address the underlying cause of iron deficiency, whether it's blood loss, poor dietary intake, or malabsorption issues.

Some key points to consider when taking oral iron supplements include:

• Taking iron supplements on an empty stomach improves absorption, though they can be taken with food if stomach upset occurs
• Avoid taking iron with calcium, dairy, coffee, tea, or antacids as these reduce absorption
• Potential side effects include constipation, nausea, and black stools
• Treatment should continue for 3-6 months to fully replenish iron stores, with follow-up testing to monitor ferritin levels 1

If oral supplements aren't tolerated or effective, intravenous iron infusions may be considered, especially in cases of ongoing blood loss or malabsorption issues 1. However, this should be done under the guidance of a qualified medical practitioner, and laboratory monitoring should be performed regularly to assess the response to treatment and adjust as needed.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Diagnosis and Treatment

• The patient's ferritin level is 25 and iron saturation is 29, indicating low iron stores without anemia 2, 3.
• According to the study by 2, iron deficiency without anemia is common and may cause symptoms such as fatigue, exercise intolerance, and difficulty concentrating.
• The cause of the iron deficiency should be identified and managed, and oral iron supplements are typically the first-line therapy 2, 3.

Oral Iron Supplements

• Oral iron supplements, such as ferrous sulfate 325 mg/d or on alternate days, are usually effective in treating iron deficiency without anemia 2.
• Iron studies should be repeated after 60-90 days of oral iron supplements to assess the response to treatment 3.
• If the iron deficiency has not been corrected, further investigations are needed to identify the underlying cause 3.

Intravenous Iron

• Intravenous iron may be considered for patients who do not tolerate or have impaired absorption of oral iron, those with ongoing blood loss, or certain chronic inflammatory conditions 2.
• However, there is limited evidence on the benefits of giving iron to people who do not have anemia, and more research is needed to determine the effectiveness of intravenous iron in this population 3.

Dietary Intervention

• Dietary intervention with iron and vitamin C administered separately may be effective in improving iron status in young women to prevent iron deficiency anemia 4.
• Consuming foods high in vitamin C, such as fruits and vegetables, can enhance iron absorption and improve iron status 5.
• A diet rich in iron and vitamin C may be beneficial in treating iron deficiency without anemia, but more research is needed to confirm this 4, 5.