What is the treatment for iron deficiency with a transferrin saturation of 12%?

From the Guidelines

The treatment for iron deficiency with a transferrin saturation of 12% involves intravenous iron supplementation as first-line therapy, as it has been shown to be more effective and better tolerated than oral iron in patients with iron deficiency anaemia, particularly in those with active disease or previous intolerance to oral iron 1.

Key Considerations

• The European Crohn's and Colitis Organization (ECCO) guidelines recommend intravenous iron as the first-line treatment for patients with clinically active IBD, previous intolerance to oral iron, haemoglobin below 100 g/L, and those who need erythropoiesis-stimulating agents 1.
• Intravenous iron has been shown to have a higher efficacy in achieving a haemoglobin rise of 2.0 g/dL compared to oral iron, with lower treatment discontinuation rates due to adverse events or intolerance 1.
• The estimation of iron need is usually based on baseline haemoglobin and body weight, and treatment should continue until iron stores are replenished, even after hemoglobin normalizes 1.

Monitoring and Follow-up

• Patients should be monitored with repeat complete blood counts and iron studies after 1-2 months to assess response to treatment 1.
• The underlying cause of iron deficiency should be investigated and addressed to prevent recurrence of anaemia 1.
• Re-treatment with intravenous iron should be initiated as soon as serum ferritin drops below 100 mg/L or haemoglobin below 12 or 13 g/dL according to gender, to prevent recurrence of iron deficiency anaemia 1.

From the FDA Drug Label

CONTAINS: Each tablet contains 324 mg of ferrous sulfate, equivalent to 65 mg of elemental iron, providing 362% of the U.S. recommended daily intake (RDI) of iron for adults and children 4 and older. The treatment for iron deficiency with a transferrin saturation of 12% is oral iron supplementation with ferrous sulfate, which contains 65mg of elemental iron per tablet 2.

• The recommended daily intake is not specified in the provided drug labels, but ferrous sulfate tablets are available for treatment.
• It is essential to follow the prescribed dosage and consult a healthcare professional for proper guidance.

From the Research

Treatment for Iron Deficiency with Transferrin Saturation of 12%

The treatment for iron deficiency with a transferrin saturation of 12% typically involves oral iron supplementation.

• The optimal formulation and dosing strategy for oral iron supplementation are still debated, but some studies suggest that daily low-dose or every-other-day dosing protocols may be effective in improving iron absorption and reducing side effects 3.
• A study published in 2020 found that providing morning doses of 60-120 mg iron as a ferrous salt given with ascorbic acid on alternate days may be an optimal oral dosing regimen for women with iron-deficiency and mild IDA 4.
• Another study published in 2023 highlighted the importance of considering the hepcidin-ferroportin iron regulatory pathway in the management of iron deficiency, and suggested that oral iron supplementation should be tailored to individual patient needs 3.
• Expert consensus recommendations published in 2025 suggest that oral iron is often recommended as first-line treatment for iron deficiency, but that there is no consensus on the optimal formulation, dosing strategy, or which patients should be treated preferentially with intravenous iron 5.
• In cases where oral iron supplementation is not effective, intravenous iron may be considered, particularly if the patient has a serum ferritin level less than 100 microg/liter, a transferrin saturation less than 20%, or a percentage of hypochromic red cells more than 10% 6, 7.

Key Considerations

• The choice of oral iron preparation and dosing strategy should be individualized based on patient factors, such as the severity of iron deficiency and the presence of side effects.
• Monitoring of iron status, including transferrin saturation and serum ferritin levels, is essential to ensure that the treatment is effective and to adjust the dosing strategy as needed.
• Intravenous iron may be considered in cases where oral iron supplementation is not effective or tolerated, but it requires greater clinical supervision and carries a risk of adverse reactions.