Should iron supplements be discontinued with a serum iron level of 158?

Iron Supplements Should Be Discontinued with Serum Iron Level of 158

Iron supplements should be discontinued when serum iron levels reach 158, as this indicates adequate iron stores and continuing supplementation may lead to iron overload with potential adverse effects on organ function.

Understanding Iron Parameters and Supplementation

Iron status evaluation requires consideration of multiple parameters, not just serum iron alone:

• Serum iron level of 158 suggests adequate or potentially excessive iron availability
• Transferrin saturation (TSAT) and serum ferritin provide more complete assessment of iron stores
• According to guidelines, iron supplementation should be maintained only when:
  • TSAT is below 20% 1
  • Serum ferritin is below 100 ng/mL 1

Decision Algorithm for Iron Supplementation Discontinuation

1. Assess iron parameters:

   • Serum iron of 158 indicates adequate circulating iron
   • Check TSAT - if >20%, discontinue supplementation
   • Check ferritin - if >100 ng/mL, discontinue supplementation

2. Consider risk of iron overload:

   • High serum iron levels may lead to oxidative damage
   • Excess iron can accumulate in organs (liver, heart, pancreas)
   • Ferritin levels >1000 ng/mL indicate significant iron overload 1

3. Evaluate need for continued supplementation:

   • If anemia has resolved, discontinue iron
   • If hemoglobin has normalized, discontinue iron
   • If patient is no longer receiving treatments that deplete iron (e.g., erythropoietin therapy), discontinue iron

Potential Risks of Continued Supplementation

Continuing iron supplementation with already elevated serum iron (158) may lead to:

• Gastrointestinal side effects (constipation, nausea, abdominal pain)
• Altered gut microbiome and inflammation 2
• Reduced absorption of other minerals
• Increased risk of oxidative stress
• Potential organ damage with long-term excess

Monitoring After Discontinuation

After discontinuing iron supplements:

• Recheck iron parameters in 3 months
• Monitor for symptoms of anemia
• If iron deficiency recurs (TSAT <20%, ferritin <100 ng/mL), consider restarting at lower dose or alternate-day dosing 2

Special Considerations

• In chronic kidney disease patients, iron supplementation should be guided by TSAT and ferritin levels rather than serum iron alone 1
• In cancer patients receiving chemotherapy, iron supplementation should be discontinued when adequate iron stores are achieved 1
• For patients with history of blood donation, iron supplementation beyond recovery of baseline parameters is not recommended 3

Remember that serum iron alone is not the most reliable indicator of iron status, as it fluctuates throughout the day. The decision to discontinue should ideally incorporate TSAT and ferritin values along with the serum iron level of 158.