What is the treatment for iron deficiency anemia?

Treatment of Iron Deficiency Anemia

The first-line treatment for iron deficiency anemia is oral iron supplementation with ferrous sulfate 65mg of elemental iron daily, administered in the morning on an empty stomach to maximize absorption. 1

Diagnosis Confirmation

Before initiating treatment, confirm iron deficiency with:

• Serum ferritin <45 ng/mL (definitive diagnosis)
• For patients with inflammation, chronic disease, or malignancy: ferritin cutoff <100 μg/L with transferrin saturation <16% 1
• Red cell distribution width (RDW) is typically elevated 1

Treatment Algorithm

1. Oral Iron Therapy (First-Line)

• Formulation: Ferrous sulfate 324mg tablet (provides 65mg elemental iron) 2
• Dosing schedule:
  • Single morning dose daily OR
  • Alternate-day dosing (may improve absorption and reduce side effects) 3
• Administration: Take on empty stomach, between meals 1
• Expected response: Hemoglobin increase ≥1 g/dL within 4 weeks 1
• Duration: Continue for 3 months after hemoglobin normalizes to replenish iron stores 1

2. Intravenous Iron Therapy (For specific indications)

Consider IV iron as first-line in patients with:

• Heart failure with iron deficiency 1
• Active inflammatory bowel disease 1
• Previous intolerance to oral iron 1
• Severe anemia 1, 4
• Malabsorption conditions (celiac disease, post-bariatric surgery) 4
• Ongoing blood loss 4
• Second and third trimesters of pregnancy (when indicated) 4

Monitoring and Follow-up

• Check hemoglobin within 4 weeks of starting therapy 1
• If no response despite compliance, further evaluation is needed 1
• Target transferrin saturation >20% to ensure adequate iron stores 1

Addressing Underlying Causes

Identifying and treating the underlying cause is crucial:

• Menstruating women: Assess menstrual blood loss
• Men and postmenopausal women: Mandatory gastrointestinal evaluation (upper and lower endoscopy) unless there's a clear non-GI cause 1, 4
• All patients: Consider testing for:
  • Celiac disease (present in 2-3% of iron deficiency anemia patients) 1
  • H. pylori infection 1
  • Malabsorption conditions

Common Pitfalls to Avoid

1. Diagnostic pitfalls:

   • Using inappropriate ferritin cutoffs in patients with inflammation 1
   • Relying solely on hemoglobin for diagnosis 1
   • Failing to identify the underlying cause, particularly in men and postmenopausal women 1

2. Treatment pitfalls:

   • Discontinuing iron too early (before stores are replenished)
   • Administering iron with meals (reduces absorption)
   • Mistaking infusion reactions for true anaphylaxis with IV iron 1
   • Using diphenhydramine for reactions (can mask worsening symptoms) 1

Special Considerations

• Gastrointestinal side effects: Common with oral iron; alternate-day dosing may improve tolerability 3
• Absorption enhancers: Consider administering with vitamin C to enhance absorption
• Dietary recommendations: Encourage iron-rich foods, but note that oral supplements provide much higher doses than diet alone 1

Iron deficiency anemia is a common condition affecting approximately 1.2 billion people worldwide 4. Proper diagnosis and treatment are essential to prevent complications including fatigue, reduced exercise tolerance, and impaired cognitive function. The treatment approach should be guided by the severity of anemia, patient tolerance, and underlying causes.