What is the treatment for iron deficiency anemia?

Treatment for Iron Deficiency Anemia

Ferrous sulfate 324 mg (65 mg elemental iron) once daily is the first-line treatment for iron deficiency anemia, which should be continued for 3 months after hemoglobin normalizes to replenish iron stores. 1

Oral Iron Therapy Protocol

First-Line Treatment

• Dosage: Ferrous sulfate 324 mg (65 mg elemental iron) once daily 1, 2
• Alternative oral preparations: Ferrous gluconate and ferrous fumarate (equally effective) 1
• Duration: Continue for 3 months after hemoglobin normalizes 1
• Expected response: Hemoglobin rise of approximately 2 g/dL after 3-4 weeks of treatment 1
• Optimal timing: Morning administration on alternate days may maximize absorption 3

Enhancing Absorption

• Take with vitamin C-rich foods or add ascorbic acid supplements when response is poor 1
• Avoid afternoon or evening doses as circadian increases in hepcidin can reduce absorption 3

Monitoring Protocol

1. Check hemoglobin after 2-4 weeks of therapy 1
2. Continue monitoring every 4 weeks until hemoglobin normalizes 1
3. Assess treatment response at day 14 - a hemoglobin increase <1.0 g/dL indicates potential need to switch to IV iron 4

When to Consider Intravenous Iron

Intravenous iron (such as ferric carboxymaltose) should be used when:

• Intolerance to at least two oral preparations 1
• Non-compliance with oral therapy 1
• Clinically active inflammatory bowel disease 1, 5
• Inadequate response to oral iron therapy (hemoglobin increase <1.0 g/dL at day 14) 4

IV Dosage: 750 mg in two doses separated by at least 7 days for patients weighing ≥50 kg 1

Diagnostic Criteria for Iron Deficiency

Ferritin Level	Interpretation
<30 μg/L	Definitive iron deficiency
30-100 μg/L with transferrin saturation <20%	Possible iron deficiency, especially with inflammation
>100 μg/L with normal transferrin saturation	Iron deficiency is unlikely

Patient Evaluation

• Patients >45 years with iron deficiency anemia should undergo both upper and lower GI investigations 1
• Patients <45 years with upper GI symptoms should have endoscopy and small bowel biopsy 1
• Patients <45 years without GI symptoms should have antiendomysial antibody testing to exclude celiac disease 1
• Women with heavy menstrual bleeding require anemia workup and consideration of gynecological causes 1

Dietary Recommendations

• Encourage consumption of iron-rich foods: red meat, fish, poultry, dark green leafy vegetables, iron-fortified cereals 1
• Recommend vitamin C-rich foods to enhance iron absorption: citrus fruits, strawberries 1

Common Pitfalls to Avoid

1. Premature discontinuation: Stopping iron supplementation before iron stores are replenished leads to recurrence 1
2. Inadequate monitoring: Failure to check hemoglobin response can miss non-responders 1
3. Accepting upper GI findings alone: Overlooking dual pathology (occurs in 10-15% of patients) 1
4. Overlooking occult GI blood loss: Particularly important in men and postmenopausal women 1
5. Inappropriate dosing: High daily doses may stimulate hepcidin and reduce absorption; alternate-day dosing may be more effective 3

Special Considerations

• For women with heavy menstrual bleeding and uterine leiomyomas, consider selective progesterone receptor modulators along with iron supplementation 1
• In patients with gastrointestinal disease, intravenous iron may be more effective due to compromised absorption 5