What is the recommended treatment for a 22-year-old male with iron deficiency anemia, as indicated by low iron levels, low iron saturation, and elevated Total Iron-Binding Capacity (TIBC)?

Treatment for Iron Deficiency in a 22-Year-Old Male

The recommended treatment for this 22-year-old male with iron deficiency is oral iron supplementation with ferrous sulfate 200 mg three times daily, which should be continued for three months after correction of anemia to replenish iron stores. 1

Diagnosis Confirmation

The patient's laboratory results clearly indicate iron deficiency:

• Low serum iron: 49 mcg/dL (reference range: 59-158 mcg/dL)
• Normal TIBC: 389 mcg/dL (reference range: 228-428 mcg/dL)
• Low iron saturation: 13% (reference range: 20-55%)

These findings are consistent with iron deficiency, with the low transferrin saturation (<16%) being particularly diagnostic 1. While a serum ferritin level would have been helpful to confirm the diagnosis, the combination of low iron and low transferrin saturation is sufficient to establish iron deficiency 1.

Treatment Protocol

First-Line Therapy

• Medication: Ferrous sulfate 200 mg three times daily
• Duration: Continue until anemia is corrected, then for an additional three months to replenish iron stores
• Expected response: Hemoglobin should rise by approximately 2 g/dL after 3-4 weeks of therapy 1

Alternative Oral Preparations

If ferrous sulfate is not tolerated:

• Ferrous gluconate or ferrous fumarate are equally effective alternatives 1
• Liquid preparations may be better tolerated in patients who cannot take tablets 1

Adjunctive Therapy

• Consider adding ascorbic acid (vitamin C) to enhance iron absorption if response is poor 1
• Take iron supplements on an empty stomach if possible, to maximize absorption

Monitoring and Follow-up

• Check hemoglobin and iron studies after 3-4 weeks of therapy to assess response

• If hemoglobin does not increase appropriately, consider:

  • Poor compliance
  • Misdiagnosis
  • Continued blood loss
  • Malabsorption 1

• Once normalized, monitor hemoglobin concentration and red cell indices at three-month intervals for one year, then after another year 1

Etiological Investigation

Since this is a young male with iron deficiency, further investigation is warranted to identify the underlying cause:

• Gastrointestinal evaluation: Consider upper GI endoscopy with small bowel biopsy and either colonoscopy or barium enema 1
• Celiac disease screening: Recommended as celiac disease is found in 3-5% of cases of iron deficiency anemia 1
• Urinalysis: To exclude hematuria which might indicate urinary tract pathology 1

Important Considerations

• Iron deficiency in young men is uncommon and warrants thorough investigation, as it often indicates underlying pathology
• Parenteral iron should be reserved for cases with intolerance to at least two oral preparations or documented non-compliance 1
• Alternate-day dosing (60-120 mg iron in the morning) may improve absorption and reduce side effects compared to daily divided doses 2
• Common side effects of oral iron include constipation, nausea, and abdominal discomfort

Pitfalls to Avoid

• Do not assume that iron deficiency in a young male is nutritional without appropriate investigation
• Do not discontinue iron therapy once hemoglobin normalizes; continue for three additional months to replenish iron stores 1
• Do not overlook potential gastrointestinal causes of iron deficiency, which are common in males with iron deficiency anemia
• Avoid administering iron in the afternoon or evening after a morning dose, as this may reduce absorption due to circadian increases in hepcidin 2