What is the treatment for a patient with anemia and low ferritin (iron) levels?

From the Guidelines

Treatment for anemia with low ferritin levels should involve oral iron supplementation, typically with ferrous sulfate 100-200 mg/day, in divided doses, as recommended by the most recent guidelines 1. The goal of treatment is to replenish iron stores and correct anemia, with the aim of improving morbidity, mortality, and quality of life.

• Key considerations in treatment include:
  • Oral iron supplementation as the first line of treatment
  • Use of alternative formulations, such as ferrous gluconate or ferrous fumarate, if side effects occur
  • Treatment duration of 3-6 months to replenish iron stores, even after hemoglobin normalizes
  • Dietary changes to increase iron intake, including consuming red meat, beans, leafy greens, and iron-fortified foods
  • Investigation of the underlying cause of iron deficiency, which may result from blood loss, poor dietary intake, or malabsorption conditions
• Intravenous iron may be necessary in cases of severe anemia or malabsorption issues, with the choice of formulation depending on the individual patient's needs and risk factors 1.
• Regular monitoring of hemoglobin and ferritin levels is crucial to assess treatment response, with follow-up testing recommended after 4-8 weeks of therapy 1.
• It is essential to note that iron supplementation should only be given when iron deficiency is associated with anemia and/or low ferritin levels, as supplementation in the presence of normal or high ferritin values is not recommended and may be potentially harmful 1.

From the FDA Drug Label

The safety and efficacy of Injectafer for treatment of IDA were evaluated in two randomized, open-label, controlled clinical trials (Trial 1 and Trial 2). In these two trials, Injectafer was administered at a dose of 15 mg/kg body weight up to a maximum single dose of 750 mg of iron on two occasions separated by at least 7 days up to a cumulative dose of 1,500 mg of iron Inclusion criteria prior to randomization included hemoglobin (Hb) <12 g/dL, ferritin ≤100 ng/mL or ferritin ≤300 ng/mL when transferrin saturation (TSAT) ≤30%. Increases from baseline in mean ferritin (264.2 ± 224.2 ng/mL in Cohort 1 and 218.2 ± 211. 4 ng/mL in Cohort 2), and transferrin saturation (13 ± 16% in Cohort 1 and 20 ± 15% in Cohort 2) were observed at Day 35 in Injectafer-treated patients

The treatment for a patient with anemia and low ferritin (iron) levels is intravenous iron supplementation, such as ferric carboxymaltose (Injectafer) or iron sucrose (Venofer).

• The dose of Injectafer is 15 mg/kg body weight up to a maximum single dose of 750 mg of iron on two occasions separated by at least 7 days up to a cumulative dose of 1,500 mg of iron.
• Injectafer has been shown to increase hemoglobin, ferritin, and transferrin saturation levels in patients with iron deficiency anemia.
• The treatment should be individualized based on the patient's specific needs and medical history, and should only be administered under the guidance of a healthcare professional 2.

From the Research

Treatment Options for Anemia with Low Ferritin Levels

• Intravenous ferric carboxymaltose is an effective treatment for iron-deficiency anemia, allowing for controlled delivery of iron to target tissues 3, 4.
• Ferric carboxymaltose can replenish depleted iron stores and improve health-related quality-of-life (HR-QOL) in patients with iron-deficiency anemia 3.
• Oral iron supplementation is usually the first choice for treatment, but intravenous iron compounds like ferric carboxymaltose may be preferred in cases where oral iron is less than ideal due to gastrointestinal adverse events or a long treatment course 4.

Administration and Efficacy

• Ferric carboxymaltose can be administered in a single and rapid session (15-minute infusion) without the requirement of a test dose, with a maximum dose of 1000mg/infusion 4.
• Treatment with ferric carboxymaltose is associated with rapid and sustained increases from baseline in haemoglobin levels, and is at least as effective as ferrous sulfate in improving haemoglobin levels and replenishing depleted iron stores 3.
• An eleven-step desensitization protocol for ferric carboxymaltose has been developed for high-risk patients, demonstrating the safety of ferric carboxymaltose desensitization in patients with a history of anaphylaxis to IV iron and iron deficiency anemia 5.

Response to Iron Supplementation

• Hemoglobin response at day 14 of oral iron may be useful in assessing whether and when to transition patients from oral to intravenous (IV) iron 6.
• A ≥1.0-g/dL increase in hemoglobin on day 14 of oral iron most accurately predicts satisfactory overall hemoglobin response to oral iron on day 42/56 6.
• Iron-replacement therapy, including carbonyl iron, can improve quality of life and reduce fatigue in patients with iron-deficiency anemia 6, 7.