What is the best course of treatment for a 47-year-old female with iron deficiency anemia?

From the Guidelines

The best course of treatment for a 47-year-old female with iron deficiency anemia is oral iron supplementation, typically ferrous sulfate 200 mg taken once daily, providing 65 mg of elemental iron, as it is the most cost-effective option with a comparable efficacy to other formulations 1.

Treatment Approach

The treatment should aim to correct the anemia and replenish iron stores.

• The supplement should be taken on an empty stomach to enhance absorption, though it can be taken with food if gastrointestinal side effects occur.
• Common side effects include constipation, nausea, and black stools.
• If oral therapy fails or is not tolerated, alternative options such as ferric maltol or parenteral iron formulations like iron sucrose or ferric carboxymaltose may be considered 1.

Monitoring and Duration

• Regular monitoring of hemoglobin, ferritin, and iron saturation is necessary to assess treatment response.
• Treatment should continue for at least 3-6 months, even after hemoglobin normalizes, to replenish iron stores 1.

Underlying Cause

• The underlying cause of iron deficiency must be identified and addressed, particularly in this age group where menstrual bleeding, gastrointestinal blood loss, or malabsorption are common causes.
• For menorrhagia, hormonal treatments might be needed, while gastrointestinal causes may require endoscopic evaluation.
• Dietary counseling to increase iron-rich foods (red meat, spinach, beans) should complement supplementation.

Key Considerations

• The absence of an Hb rise of at least 10 g/L after 2 weeks of daily oral iron replacement therapy is strongly predictive of subsequent failure to achieve a sustained haematological response 1.
• Intermittent oral iron has been reported to be at least as effective as daily dosing in raising Hb levels in young women and during pregnancy, although less effective in boosting iron stores in the short-term 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 best course of treatment for a 47-year-old female with iron deficiency anemia is to take ferrous sulfate orally. The dosage is not specified in the provided drug labels, but the labels indicate that each tablet contains 65mg of elemental iron 2, 2.

• Key points:
  • The patient has iron deficiency anemia.
  • Ferrous sulfate is a common treatment for iron deficiency anemia.
  • The drug labels do not provide a specific dosage for this patient's condition.

From the Research

Diagnosis and Treatment of Iron Deficiency Anemia

The patient's lab results show iron deficiency anemia, with low iron levels (111 mcg/dL) and high TIBC (395 mcg/dL) 3. The diagnosis of iron deficiency anemia is based on laboratory tests, including serum iron, TIBC, and ferritin levels.

Diagnostic Strategy

The recommended diagnostic strategy for unexplained anemia with iron deficiency includes serological celiac disease screening and bidirectional endoscopy (gastroscopy and colonoscopy) 3. However, bidirectional endoscopy is not required in premenopausal women < 40 years of age.

Treatment Options

The treatment of iron deficiency anemia typically involves oral iron supplementation, with a goal of normalizing hemoglobin levels and replenishing iron stores 3, 4. The recommended oral iron dose is 100-200 mg daily of elemental iron, with a lower dose if side effects occur.

• Oral iron supplementation is usually efficacious in correcting iron-deficiency anemia and replenishing iron stores, but may cause gastrointestinal side effects 4.
• Intravenous iron therapy can be used if oral treatment lacks efficacy or causes side effects, or in the presence of intestinal malabsorption or prolonged inflammation 3, 5.
• Novel iron formulations, such as ferric maltol or nanoparticle encapsulated sucrosomial iron, have been developed to improve efficacy and tolerability 4.

Potential Complications

Intravenous iron administration can cause severe and symptomatic hypophosphatemia, especially in patients with pre-existing disorders in phosphate homeostasis 6, 5.

• Proton pump inhibitors, such as omeprazole, may decrease the absorption of oral iron supplementation, leading to suboptimal response to ferrous sulfate therapy 7.
• Intravenous iron therapy is associated with a risk of severe infusion reactions, although modern iron formulations have improved safety profiles 5.