Should a 15-year-old be prescribed iron supplements for iron deficiency anemia?

Iron Supplementation for a 15-Year-Old with Iron Deficiency Anemia

Iron supplements should be prescribed for a 15-year-old with iron deficiency anemia at a dose of 60-120 mg of elemental iron daily for adolescents. 1

Diagnosis Confirmation

Before starting treatment, confirm the diagnosis of iron deficiency anemia:

• The CDC defines anemia in children under 15 years as hemoglobin less than 11.0 g/dL 1
• A single hemoglobin value is insufficient for diagnosis; additional tests should include:
  • Complete blood count with red cell indices
  • Serum ferritin (a value ≤15 μg/L confirms iron deficiency) 2
  • Consider MCV and RDW if diagnosis is unclear

Treatment Protocol

Dosing Recommendations

• For adolescent girls: 60-120 mg/day of elemental iron 2
• For adolescent boys: Two 60-mg iron tablets daily 2
• Common formulations include ferrous sulfate, ferrous gluconate, or ferrous fumarate 1

Administration Tips

• Administer iron between meals to maximize absorption 2
• Add vitamin C (ascorbic acid) with iron doses to enhance absorption 1
• Avoid calcium-containing foods or antacids at the time of iron administration 1
• Consider morning dosing rather than afternoon/evening dosing for better absorption 3
• For patients with side effects, alternate-day dosing may improve tolerance while maintaining efficacy 3

Monitoring and Follow-up

1. Recheck hemoglobin after 4 weeks of therapy 2, 1

   • An increase in hemoglobin ≥1 g/dL confirms iron deficiency anemia

2. If response is confirmed:

   • Continue iron treatment for 2-3 months total (even after hemoglobin normalizes) 2, 1
   • Provide dietary counseling about iron-rich foods

3. If no response after 4 weeks despite compliance:

   • Further evaluate with additional laboratory tests (MCV, RDW, serum ferritin) 2
   • Consider other causes of anemia

4. Schedule follow-up 6 months after successful treatment 2

Dietary Counseling

Alongside supplementation, provide guidance on:

• Iron-rich foods (lean meats, iron-fortified cereals, beans, lentils) 1
• Vitamin C-rich foods with meals to enhance iron absorption 1
• Limiting cow's milk intake to no more than 24 oz daily 1

Important Considerations

• Untreated iron deficiency in adolescence can lead to developmental delays and behavioral alterations 1
• For adolescent girls, consider menstrual blood loss as a common cause of iron deficiency 4
• Screen for potential sources of blood loss, especially in cases that don't respond to treatment 4
• Be aware that excessive iron supplementation can cause iron overload and should be avoided 4

Pitfalls to Avoid

• Don't rely solely on hemoglobin for diagnosis; confirm with ferritin levels
• Don't stop treatment once hemoglobin normalizes; continue for 2-3 months to replenish iron stores
• Don't overlook dietary factors that may contribute to iron deficiency
• Don't miss follow-up monitoring to ensure adequate response to treatment