What is the treatment protocol for iron deficiency anemia?

Iron Deficiency Anemia Treatment Protocol

The standard treatment for iron deficiency anemia is oral iron supplementation with ferrous sulfate 200 mg daily (providing approximately 65 mg of elemental iron), taken with vitamin C to enhance absorption, and continued for three months after hemoglobin normalization to replenish iron stores. 1

Diagnosis Confirmation

• Low serum ferritin (<30 ng/mL) in individuals without inflammatory conditions
• Transferrin saturation <20%
• Low hemoglobin (typically <12 g/dL in women, <13 g/dL in men)

Oral Iron Therapy Protocol

First-Line Treatment

• Dosage: Ferrous sulfate 200 mg once daily (provides ~65 mg elemental iron) 1
  • Alternative formulations: Ferrous gluconate or ferrous fumarate (equally effective) 2
  • For severe anemia or symptomatic patients: Consider 200 mg/day 3
• Administration:
  • Take on an empty stomach in the morning 1
  • Add vitamin C (500 mg) with each dose to enhance absorption 1
  • Avoid concurrent intake of tea, coffee, calcium supplements, and high-fiber foods 1
• Duration: Continue for 3 months after hemoglobin normalizes to replenish iron stores 1

Monitoring Response

• Expect hemoglobin to increase by approximately 2 g/dL after 3-4 weeks 2
• Check hemoglobin within 4 weeks of starting therapy 1
• Monitor hemoglobin and red cell indices at 3-month intervals for one year, then after another year 1
• Check iron studies (ferritin, transferrin saturation) after 3 months of therapy 1
  • Target values: Ferritin >30 μg/L and transferrin saturation >20% 1

Managing Side Effects

• If side effects occur (constipation, nausea, abdominal discomfort):
  • Consider alternate-day dosing 4
  • Try liquid preparation if tablets are not tolerated 2
  • Consider switching to a different iron salt formulation 2

Intravenous Iron Therapy Protocol

Indications for IV Iron

1. Intolerance to at least two oral preparations or non-compliance 2
2. Poor absorption (celiac disease, post-bariatric surgery) 1
3. Active inflammation with compromised absorption 2
4. Ongoing significant blood loss 1
5. Need for rapid correction of severe anemia 3

IV Iron Administration

• Formulations that require only 1-2 infusions are preferred 2
• Options include iron sucrose (Venofer) 5 or ferric gluconate (Ferrlecit) 6
• Dosing based on calculated iron deficit (weight-based formulas)
• Monitor for infusion reactions, though true anaphylaxis is rare 2

Special Populations

Inflammatory Bowel Disease

• Determine if IDA is due to inadequate intake/absorption or GI bleeding 2
• Treat active inflammation to enhance iron absorption 2
• Use IV iron in patients with active inflammation and compromised absorption 2

Portal Hypertensive Gastropathy

• Start with oral iron supplements 2
• Consider nonselective β-blockers to treat portal hypertension 2
• Switch to IV iron if ongoing bleeding and poor response to oral therapy 2

Celiac Disease

• Ensure adherence to gluten-free diet to improve iron absorption 2
• Consider oral iron supplementation based on severity of deficiency 2
• Use IV iron if iron stores do not improve despite dietary compliance 2

Dietary Recommendations

• Increase intake of iron-rich foods:
  • Heme iron: Red meat, poultry, fish
  • Non-heme iron: Leafy greens, legumes, fortified cereals
• Consume vitamin C-rich foods with meals to enhance absorption 1
• Plant-based diets require approximately 1.8 times more dietary iron 1

Common Pitfalls to Avoid

1. Stopping treatment too early before iron stores are replenished 1
2. Failing to investigate underlying causes, especially in men and postmenopausal women 1
3. Inadequate monitoring of response to therapy 1
4. Administering oral iron with absorption inhibitors 1
5. Using parenteral iron when oral therapy would be effective 2
6. Overlooking the need for vitamin C to enhance absorption 1

By following this protocol, most patients with iron deficiency anemia should achieve resolution of anemia within 6 months, with approximately 80% responding adequately to treatment 2.