From the Guidelines
The patient with microcytic anemia and normal hemoglobin level of 12.6 g/dL should be treated with oral iron supplementation, typically ferrous sulfate 325 mg taken once or twice daily between meals with vitamin C to enhance absorption, as iron deficiency is the most likely cause of microcytosis 1. The diagnosis of iron deficiency is supported by the patient's microcytic anemia, indicated by a mean corpuscular volume (MCV) of 78.1 fL, which is a common finding in iron deficiency anemia 1. Although the patient's hemoglobin level is normal, iron deficiency can still be present, and the microcytosis suggests that iron supplementation is necessary to replenish iron stores and prevent further complications. Key considerations for treatment include:
- Taking iron supplements between meals with vitamin C to enhance absorption
- Avoiding taking iron with calcium, dairy, coffee, tea, or antacids as these reduce absorption
- Continuing treatment for 3-6 months, even after blood counts normalize, to replenish iron stores
- Monitoring for common side effects such as constipation, nausea, and black stools, and adjusting the treatment plan as needed
- Identifying and addressing the underlying cause of iron deficiency, which may include blood loss, poor dietary intake, or malabsorption 1. It is also important to note that serum ferritin (SF) is the most specific test for iron deficiency in the absence of inflammation, and an SF level of <15 μg/L is indicative of absent iron stores 1. However, in this case, the patient's microcytic anemia and normal hemoglobin level suggest that iron deficiency is the most likely cause, and treatment with oral iron supplementation is warranted.
From the Research
Treatment for Microcytic Anemia
The patient's microcytic anemia, indicated by a mean corpuscular volume (MCV) of 78.1 fL, suggests an iron deficiency anemia. The treatment for iron deficiency anemia typically involves iron supplementation.
- Iron supplementation can be administered orally, with ferrous sulfate being a common choice 2, 3, 4, 5.
- The dosage and frequency of iron supplementation may vary, with some studies suggesting that a single daily dose can be as effective as multiple daily doses 6.
- In cases where oral iron supplements are not tolerated or effective, intravenous iron dextran may be considered 2.
Monitoring and Adjustment
It is essential to monitor the patient's iron stores and adjust the treatment as needed.
- Plasma ferritin levels and transferrin saturation can be used to confirm the diagnosis of iron deficiency and monitor the response to treatment 2, 3.
- The treatment should be adjusted based on the patient's response, with ongoing monitoring of hemoglobin, hematocrit, and iron stores.
Comparison of Iron Supplements
Different iron supplements have been compared in various studies.
- Ferric citrate has been shown to be more effective than ferrous sulfate in increasing transferrin saturation and ferritin levels in patients with chronic kidney disease and iron deficiency 3.
- Ferrous bisglycinate chelate has been compared to ferrous sulfate and found to have similar efficacy and potentially lower gastrointestinal toxicity 5.
- A prolonged release ferrous sulfate formulation has been shown to be non-inferior to a standard ferrous sulfate formulation in treating iron deficiency anemia, with a better gastrointestinal tolerance profile 4.