From the Guidelines
Iron supplementation is indicated for individuals with iron deficiency anemia or those at high risk of developing it, including pregnant women, as it improves maternal hematologic indexes and reduces the risk of adverse birth outcomes. The decision to initiate iron supplementation should be based on a thorough assessment of the individual's risk factors and iron status. According to the U.S. Preventive Services Task Force recommendation statement published in 2015 1, iron supplementation is recommended for pregnant women to improve maternal health and birth outcomes. Key groups that may benefit from iron supplementation include:
- Pregnant women
- Infants and young children
- Women with heavy menstrual bleeding
- People with certain gastrointestinal disorders that affect absorption, such as celiac disease or inflammatory bowel disease
- Those who have had gastric bypass surgery
- Individuals with chronic kidney disease Common iron supplements include ferrous sulfate, ferrous gluconate, and ferrous fumarate, with the typical adult dose being one tablet 1-3 times daily, usually taken between meals with vitamin C to enhance absorption 1. Treatment should continue for 3-6 months after hemoglobin normalizes to replenish iron stores. It is essential to note that iron supplementation can have side effects, including constipation, nausea, and black stools. The Centers for Disease Control and Prevention also recommends universal iron supplementation for pregnant women due to the high risk of iron-deficiency anemia during pregnancy and its association with adverse outcomes 1. Overall, iron supplementation is a crucial intervention for preventing and treating iron deficiency anemia, and its benefits in improving maternal and infant health outcomes make it a recommended practice in high-risk populations.
From the FDA Drug Label
Venofer is an iron replacement product indicated for the treatment of iron deficiency anemia (IDA) in patients with chronic kidney disease (CKD). Iron supplementation, in the form of Venofer (iron sucrose) injection, is indicated for the treatment of iron deficiency anemia (IDA) in patients with chronic kidney disease (CKD) 2.
- Key points:
- Indicated for IDA, not explicitly for iron deficiency (ID) without anemia
- Specifically for patients with CKD No information is provided on the use of iron supplementation for iron deficiency without anemia, or in patients without CKD.
From the Research
Indications for Iron Supplementation
Iron supplementation is indicated for individuals with iron deficiency (ID) or iron deficiency anemia (IDA) [(3,4,5,6,7)]. The following are some scenarios where iron supplementation is recommended:
- Pregnancy [(4,5,7)]
- Blood loss [(4,5)]
- Renal disease [(4,5)]
- Heavy menstrual bleeding [(4,5,7)]
- Inflammatory bowel disease [(4,5)]
- Bariatric surgery [(4,5)]
- Genetic disorders 4
- Heart failure 4
- Restless leg syndrome 4
- Fatigue [(4,7)]
- Prevention of acute mountain sickness 4
Optimal Dosing Regimen
The optimal dosing regimen for iron supplementation varies depending on the individual's condition and response to treatment. Some studies suggest the following:
- For women with iron-deficiency and mild IDA, a morning dose of 60-120 mg iron as a ferrous salt given with ascorbic acid on alternate days may be an optimal oral dosing regimen 3
- For children and adolescents with IDA, low-dose iron supplementation (<5 mg/kg/day) combined with treatment durations of either less than 3 months or more than 6 months may be optimal 6
- For individuals with IDA who do not respond to oral iron supplementation, intravenous iron may be considered [(4,5,7)]
Monitoring and Adjustment
It is essential to monitor the individual's response to iron supplementation and adjust the dosing regimen as needed. Some studies suggest the following: