From the Guidelines
Iron supplementation should be initiated in a patient with low iron saturation, low-normal serum iron, and elevated Total Iron-Binding Capacity (TIBC) to address iron deficiency and improve morbidity, mortality, and quality of life. The patient's laboratory values indicate iron deficiency, which can lead to various health complications if left untreated. According to the most recent and highest quality study 1, oral iron supplements are the preferred initial treatment for iron deficiency anemia.
Key Considerations for Iron Supplementation
- Oral iron supplements, such as ferrous sulfate 325 mg once or twice daily, ferrous gluconate 300 mg daily, or ferrous fumarate 200 mg daily, are appropriate initial treatments 2.
- Taking iron supplements on an empty stomach with vitamin C (such as orange juice) can enhance absorption, while separating them from calcium, dairy, coffee, tea, and antacids can reduce absorption 2.
- Side effects may include constipation, nausea, and black stools, and treatment should continue for 3-6 months to replenish iron stores, even after symptoms improve 2.
- Further investigation into the cause of iron deficiency is also warranted, as it may result from blood loss, poor dietary intake, or malabsorption issues 3.
Intravenous Iron Supplementation
Intravenous iron supplementation may be necessary in patients who cannot tolerate oral iron or have impaired absorption due to certain medical conditions, such as inflammatory bowel disease or chronic kidney disease 1. However, intravenous iron is substantially more expensive than oral formulations and should be reserved for patients who do not respond to oral iron therapy or have specific indications for its use 1.
Monitoring and Follow-up
Patients on iron supplementation should be monitored for improvements in hemoglobin concentration and iron stores, and adjustments to treatment should be made as needed 1. Adherent patients on oral iron should have a reasonable expectation that ferritin should increase in a month, and if these parameters are not met, intravenous iron should be considered 1.
From the FDA Drug Label
Purpose Iron Supplement The FDA drug label does not answer the question.
From the Research
Patient Evaluation
To determine if iron supplementation should be initiated in a patient with low iron saturation, low-normal serum iron, and elevated Total Iron-Binding Capacity (TIBC), the following factors should be considered:
- Low iron saturation and low-normal serum iron indicate depleted iron stores 4, 5, 6
- Elevated TIBC suggests iron deficiency, as it is often increased in this condition 7, 6
Diagnostic Approach
The diagnostic approach for iron deficiency anemia includes:
- Measuring serum ferritin as an index of iron stores 6
- Measuring serum transferrin receptor as an index of tissue iron deficiency 6
- Evaluating hemoglobin levels and other parameters such as mean corpuscular haemoglobin concentration, erythrocyte zinc protoporphyrin, percentage of hypochromic erythrocytes, or reticulocyte haemoglobin concentration 6
Treatment
Treatment of iron deficiency anemia should always be initiated with oral iron 6, with the goal of normalizing hemoglobin levels and replenishing iron stores 4, 5
- Oral iron therapy can be effective in maintaining adequate iron levels, but may require supplementation with ascorbic acid to enhance absorption 8
- Parenteral iron therapy may be necessary in patients who cannot tolerate or absorb oral preparations, or in cases of large blood losses or iron malabsorption 4, 5, 6
Key Considerations
Key considerations in the treatment of iron deficiency anemia include: