What is the treatment for iron deficiency anemia?

Treatment for Iron Deficiency Anemia with Ferritin 17.4

Oral iron supplementation with 50-100 mg of elemental iron once daily, taken in the fasting state, should be administered and continued for three months after hemoglobin normalization to replenish iron stores. 1

Diagnosis Confirmation

The patient's laboratory values clearly indicate iron deficiency anemia:

• Iron level of 40 (low)
• Ferritin of 17.4 μg/L (well below the 30 μg/L threshold that definitively indicates iron deficiency) 1

Treatment Protocol

First-Line Therapy: Oral Iron Supplementation

1. Medication Options:

   • Ferrous sulfate 325 mg (containing 65 mg elemental iron) once daily 2
   • Alternative: Ferrous gluconate 324 mg (containing 38 mg elemental iron) once daily 3

2. Administration Guidelines:

   • Take on an empty stomach to maximize absorption 1
   • If GI side effects occur, consider:
     • Taking with a small amount of food
     • Reducing to alternate-day dosing (60-120 mg elemental iron every other day) 1
     • Taking with vitamin C to improve absorption 1

3. Expected Response:

   • Hemoglobin should increase by ≥1 g/dL within 4 weeks 1
   • Check hemoglobin response after 2-4 weeks of therapy 1
   • An increase in hemoglobin of at least 10 g/L after 2 weeks strongly predicts successful treatment (sensitivity 90.1%, specificity 79.3%) 1

4. Duration of Treatment:

   • Continue iron supplementation for 3 months after hemoglobin normalizes to replenish iron stores 4, 1

Monitoring Protocol

1. Initial Response:

   • Check hemoglobin after 2-4 weeks of therapy 1

2. Ongoing Monitoring:

   • Continue monitoring every 4 weeks until hemoglobin normalizes 1
   • Once normal, monitor hemoglobin concentration and red cell indices at 3-month intervals for one year, then after another year 4
   • Additional oral iron should be given if hemoglobin or MCV falls below normal 4

When to Consider Alternative Approaches

Consider intravenous iron therapy if any of the following occur:

• Intolerance to oral iron
• No hemoglobin increase of at least 10 g/L after 2 weeks of oral therapy
• Malabsorption conditions
• Chronic inflammatory conditions
• Ongoing blood loss exceeding oral replacement capacity 1

Evaluation of Underlying Cause

Identifying and treating the underlying cause of iron deficiency is essential:

• For men and postmenopausal women: Evaluate for gastrointestinal blood loss with upper GI endoscopy and colonoscopy 1
• For premenopausal women: Assess for heavy menstrual bleeding 1
• Screen for malabsorption conditions (e.g., celiac disease) 1
• Evaluate dietary intake patterns 1

Common Pitfalls to Avoid

1. Inadequate monitoring: Failure to check hemoglobin response after 2-4 weeks may delay recognition of treatment failure 1

2. Premature discontinuation: Stopping iron supplementation once hemoglobin normalizes without continuing for 3 months to replenish iron stores 1

3. Ignoring non-response: Failure to respond to oral iron may indicate:

   • Non-compliance
   • Malabsorption
   • Systemic disease
   • Continued bleeding
   • Concurrent deficiency of vitamin B12 or folic acid 1

4. Failing to identify the underlying cause: Particularly important in men and postmenopausal women, where gastrointestinal malignancy must be excluded 1

Iron deficiency anemia is a common condition that can significantly impact quality of life, but with proper treatment and follow-up, most patients can achieve complete resolution of symptoms and replenishment of iron stores.