What is the next step if Total Iron Binding Capacity (TIBC) is low in a patient with anemia (iron deficiency)?

From the Guidelines

The next step if Total Iron Binding Capacity (TIBC) is low in a patient with anemia (iron deficiency) is to initiate iron supplementation with ferrous sulphate 200 mg twice daily to correct anemia and replenish body stores. This approach is based on the guidelines for the management of iron deficiency anemia, which recommend iron therapy to correct anemia and replenish body stores 1.

Key Considerations

• The treatment of an underlying cause should prevent further iron loss, but all patients should have iron supplementation both to correct anemia and replenish body stores 1.
• Lower doses of ferrous sulphate may be as effective and better tolerated and should be considered in patients not tolerating traditional doses 1.
• Other iron compounds, such as ferrous fumarate or ferrous gluconate, or formulations like iron suspensions, may also be tolerated better than ferrous sulphate 1.
• Oral iron should be continued for 3 months after the iron deficiency has been corrected so that stores are replenished 1.

Additional Recommendations

• Ascorbic acid (250-500 mg twice daily with the iron preparation) may enhance iron absorption, but there are no data for its effectiveness in the treatment of IDA 1.
• For those intolerant or not responding to oral iron, parenteral preparations like iron sucrose, ferric carboxymaltose, or iron (III) hydroxide dextran can be considered 1.

From the Research

Diagnosis and Treatment of Iron Deficiency Anemia

• If Total Iron Binding Capacity (TIBC) is low in a patient with anemia (iron deficiency), the next step would be to investigate the underlying cause of the iron deficiency, as low TIBC can indicate iron overload or hemochromatosis 2.
• The diagnosis of iron deficiency anemia should be clearly established through appropriate testing, including determination of serum ferritin and iron levels, and iron-binding capacity 3.
• Transferrin saturation (calculated as serum iron/total iron binding capacity × 100) can be used to screen for hemochromatosis, and further testing for the hemochromatosis gene is recommended if transferrin saturation is >45% with or without hyperferritinemia 2.
• Unbound iron binding capacity (UIBC) may be a more accurate marker of empty iron stores than serum transferrin saturation, and can be used to diagnose iron deficiency anemia 4.
• Treatment of iron deficiency anemia typically involves oral iron therapy, but intravenous iron administration may be necessary for patients who are intolerant of or unresponsive to oral iron 5.

Investigation of Underlying Cause

• A search for a source of bleeding is indicated if there is no clear cause of iron deficiency anemia 5.
• Medical records should be reviewed to ensure that parameters of body iron status are being used to adjust the frequency of phlebotomies, if applicable 6.
• Bone marrow aspiration and iron staining may be necessary in some cases to confirm the diagnosis of iron deficiency anemia 3.

Treatment Options

• Oral iron therapy should be continued for 6 months after the hemoglobin level returns to normal to replace total iron stores 3.
• Intravenous iron administration is a safe and effective treatment option for patients who are intolerant of or unresponsive to oral iron, and can be used in all clinical circumstances, including pregnancy 5.