What is the initial treatment for microcytic hypochromic anemia?

From the Guidelines

The initial treatment for microcytic hypochromic anemia is oral iron supplementation, typically with ferrous sulfate 325 mg taken 1-3 times daily between meals, as recommended by the practice guidelines for the diagnosis and management of microcytic anemias due to genetic disorders of iron metabolism or heme synthesis 1. This provides approximately 65 mg of elemental iron per tablet. Alternative formulations include ferrous gluconate or ferrous fumarate if ferrous sulfate is not tolerated.

Key Considerations

• Treatment should continue for 3-6 months to replenish iron stores completely, even after hemoglobin levels normalize.
• Patients should take iron supplements with vitamin C (such as orange juice) to enhance absorption and avoid taking them with calcium, dairy products, tea, coffee, or antacids which can decrease absorption.
• Side effects may include constipation, nausea, and black stools.
• If oral therapy fails due to intolerance or poor absorption, intravenous iron formulations may be necessary, with the choice of chemical form based on its registration for the specific age group or a proven good safety profile in adults during several years of postmarketing surveillance 1.
• The underlying cause of iron deficiency should also be identified and addressed, whether it's blood loss, poor dietary intake, or malabsorption.
• In severe cases with significant symptoms or very low hemoglobin levels, blood transfusion may be required before starting iron therapy.

Monitoring and Adjustments

• Serum ferritin levels should be monitored and preferably should not exceed 500 mg/L to avoid toxicity of iron overload, especially in children and adolescents 1.
• The total intravenous iron cumulative doses should be calculated on the basis of formulas of the deficit of body iron, allowing for the correction of the Hb deficit and rebuilding the iron stores 1.

From the Research

Definition and Causes of Microcytic Hypochromic Anemia

• Microcytic hypochromic anemia is defined as anemia with a mean corpuscular volume (MCV) of less than 80 mcm3 in adults, characterized by small and pale red blood cells [(2,3)].
• The most common cause of microcytic hypochromic anemia is iron deficiency anemia, which can be managed with oral or intravenous iron [(2,3,4)].

Initial Treatment for Microcytic Hypochromic Anemia

• The initial treatment for microcytic hypochromic anemia due to iron deficiency is oral iron supplementation, with a recommended dosage of 2 to 6 mg/kg per day of ferrous sulfate for children 5.
• For adults, oral iron preparations are usually effective and well-tolerated 2.
• In cases of malabsorption, significant blood loss, or intolerance to oral iron, parenteral iron dextran may be used 2.
• The goal of treatment is to replete iron stores and correct the anemia [(2,4)].

Special Considerations

• Pregnant patients and patients with heart failure require special considerations to prevent significant morbidity and mortality 3.
• Patients with thalassemia, sickle cell anemia, and sideroblastic anemia may require alternative treatments, such as iron chelation 3.
• Referral to a pediatric hematologist may be beneficial for children who do not respond to treatment or have underlying bone marrow suppression 5.