Treatment of Iron Deficiency Anemia
Oral iron supplementation is the first-line treatment for iron deficiency anemia with ferritin of 10 ng/mL, iron of 36 ng/mL, TIBC of 515 ng/mL, and transferrin saturation of 7%. 1
Diagnostic Confirmation
The laboratory values clearly indicate iron deficiency anemia:
- Ferritin: 10 ng/mL (deficient < 30 ng/mL)
- Transferrin saturation: 7% (deficient < 16%)
- TIBC: 515 ng/mL (elevated)
- Serum iron: 36 ng/mL (low)
These values meet the diagnostic criteria for iron deficiency anemia according to clinical guidelines 1.
Treatment Approach
Oral Iron Therapy
- Dosing: Ferrous sulfate 325 mg (containing approximately 65 mg elemental iron) once daily in the morning 2, 3
- Schedule: Consider alternate-day dosing rather than daily dosing for better absorption and fewer side effects 3, 4
- Timing: Administer in the morning on an empty stomach for optimal absorption 1
- Duration: Continue treatment for three months after correction of anemia to replenish iron stores 1
Optimizing Absorption
- Add vitamin C (250-500 mg) with iron to enhance absorption 2, 1
- Avoid taking with tea, coffee, dairy products, calcium supplements, or antacids 1
- If GI side effects occur, iron can be taken with food, though absorption will be reduced 1
Monitoring Response
- Check hemoglobin and reticulocyte count at 2-4 weeks 1
- Assess ferritin and transferrin saturation at 4-8 weeks after treatment initiation 1
- Expect a hemoglobin increase of 1-2 g/dL within 4-8 weeks of starting therapy 2
When to Consider Intravenous Iron
Switch to intravenous iron if any of the following occur:
- No response to oral iron after 4-8 weeks of therapy 2, 1
- Intolerance to oral iron due to significant gastrointestinal side effects 2, 5
- Conditions that impair oral iron absorption (celiac disease, inflammatory bowel disease, post-bariatric surgery) 2, 6
- Need for rapid repletion of iron stores 7, 5
IV Iron Options
- Ferric carboxymaltose: Indicated for iron deficiency anemia in patients with intolerance or unsatisfactory response to oral iron 5
- Iron sucrose: Alternative option with established safety profile 7
Managing Side Effects of Oral Iron
- Increase fluid intake to 2-2.5 liters per day 1
- Ensure adequate dietary fiber intake to prevent constipation 1
- Consider stool softeners if constipation occurs
- If GI side effects are significant, options include:
Pitfalls and Caveats
- Avoid divided daily doses: Research shows that split dosing increases hepcidin levels and reduces iron absorption compared to single morning doses 3, 4
- Don't continue ineffective therapy: If no response after 8 weeks, reassess the diagnosis and consider IV iron 2
- Investigate underlying cause: Iron deficiency anemia warrants evaluation for sources of blood loss or malabsorption 1, 6
- Monitor long-term: Regular ferritin monitoring is essential if supplementation continues beyond one year to avoid potential iron overload 1
By following these evidence-based recommendations, iron stores should be effectively replenished, anemia corrected, and symptoms improved.