What is the treatment plan for a patient with iron deficiency and vitamin D deficiency?

Treatment Plan for Iron Deficiency and Vitamin D Deficiency

The patient should be treated with oral iron supplementation of 60-120 mg elemental iron daily for 3 months, along with vitamin D2 50,000 units orally every month for 6 months. 1, 2

Laboratory Assessment

The patient's laboratory results show:

• Iron deficiency: Low transferrin saturation (0.12, normal 0.15-0.50) with borderline ferritin (22 ug/L, normal 15-170)
• Vitamin D deficiency: Low vitamin D level (33 nmol/L, normal 50-150)
• Normal hemoglobin (137 g/L) and normal red cell indices (MCV 85 fL)

This represents iron deficiency without anemia and vitamin D deficiency requiring treatment.

Iron Deficiency Treatment

Oral Iron Therapy

• First-line treatment: Oral iron supplementation with ferrous sulfate containing 60-120 mg of elemental iron daily 2, 3
• Duration: Continue for 3 months after normalization of iron parameters to replenish iron stores 2, 4
• Administration: Take on an empty stomach with vitamin C (orange juice) to enhance absorption 2
• Dosing schedule: Consider alternate-day dosing (e.g., 120 mg every other day) which may improve absorption and reduce side effects 5, 6

Monitoring

• Check iron studies (ferritin, transferrin saturation) after 3 months of therapy 1
• Target ferritin >30 μg/L and transferrin saturation >20% 1, 2

Common Side Effects and Management

• Gastrointestinal side effects: nausea, constipation, diarrhea 3
• If GI side effects occur, consider:
  • Taking with meals (though this reduces absorption by 40%)
  • Reducing dose temporarily
  • Switching to alternate-day dosing 5, 6

Vitamin D Deficiency Treatment

Supplementation

• Recommended regimen: Vitamin D2 50,000 units orally every month for 6 months 1
• Alternative regimen: Daily vitamin D3 1000-2000 IU for 3 months 2

Monitoring

• Recheck vitamin D level after 3-6 months of supplementation 2
• Target level: >50 nmol/L (preferably >75 nmol/L) 2

Dietary Recommendations

Iron-Rich Foods

• Heme iron sources (better absorbed): Red meat, poultry, fish
• Non-heme iron sources: Legumes, dark green leafy vegetables, fortified cereals
• Pair non-heme iron with vitamin C-rich foods to enhance absorption 2

Vitamin D Sources

• Fatty fish (salmon, mackerel)
• Egg yolks
• Fortified foods (milk, orange juice, cereals)
• Sun exposure (15-30 minutes of midday sun several times weekly) 2

Important Considerations

• Avoid concurrent intake of iron with:

  • Tea, coffee, calcium supplements (reduce absorption)
  • Certain antibiotics (mutual interference with absorption) 2, 3

• Potential relationship between deficiencies: Iron deficiency may affect vitamin D metabolism, so correcting iron status may help improve vitamin D status 7

• Common pitfalls to avoid:

  • Stopping treatment too early (before iron stores are replenished)
  • Failing to add vitamin C to enhance absorption
  • Administering iron with absorption inhibitors 2

If oral iron is not tolerated or ineffective after 4 weeks (no improvement in iron parameters), consider evaluation for malabsorption or switching to intravenous iron therapy 1.