From the Guidelines
The best management for iron deficiency with a ferritin level of 7.48 is oral iron supplementation, typically with ferrous sulfate 100-200 mg/day, in divided doses, as recommended by the espen micronutrient guideline 1. This approach is supported by the most recent and highest quality study, which suggests that oral iron supplementation is the preferred treatment for iron deficiency, with intravenous iron administration reserved for patients who cannot tolerate oral iron or have malabsorption disorders. The treatment should continue for 3-6 months to replenish iron stores completely, even after hemoglobin normalizes. Some key points to consider when managing iron deficiency include:
- Taking iron with vitamin C (such as orange juice) enhances absorption, while avoiding calcium-containing foods, coffee, tea, and antacids within 2 hours of iron supplements prevents decreased absorption.
- Side effects may include constipation, nausea, and black stools; starting with a lower dose and gradually increasing can improve tolerance.
- For patients who cannot tolerate oral iron due to gastrointestinal side effects or who have malabsorption disorders, intravenous iron formulations (such as iron sucrose or ferric carboxymaltose) may be necessary, as suggested by the espen micronutrient guideline 1.
- The underlying cause of iron deficiency should also be investigated, particularly in men and postmenopausal women, as it could indicate gastrointestinal blood loss from conditions like ulcers or malignancy.
- Dietary counseling to increase iron-rich foods (red meat, beans, leafy greens) should complement supplementation therapy, as recommended by the uefa expert group statement on nutrition in elite football 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Diagnosis and Management of Iron Deficiency
- Iron deficiency is diagnosed by low serum ferritin (typically <30 ng/mL) in individuals without inflammatory conditions or by transferrin saturation (iron/total iron binding capacity × 100) less than 20% 2.
- A ferritin level of 7.48 indicates iron deficiency, as it is below the typical threshold of 30 ng/mL.
- The best management for iron deficiency with a ferritin level of 7.48 would be to identify and treat the underlying cause of the iron deficiency, and to provide iron supplementation.
Iron Supplementation
- Oral iron (ferrous sulfate 325 mg/d or on alternate days) is typically first-line therapy for iron deficiency 2.
- Intravenous iron is indicated for patients with oral iron intolerance, poor absorption (e.g. celiac disease, post-bariatric surgical procedure), chronic inflammatory conditions (e.g. CKD, HF, IBD, cancer), ongoing blood loss, and during the second and third trimesters of pregnancy 2.
Monitoring and Prevention
- Regular ferritin measurement is a useful indicator for iron depletion in individuals at risk of iron deficiency, such as regular blood donors 3.
- Iron supplementation can help prevent iron deficiency in individuals at risk, such as pregnant women and regular blood donors 4, 5.
- A practical procedure to detect iron deficiency and to control iron supplementation is suggested, including monitoring serum ferritin levels and providing iron supplementation as needed 4.